Pulmonary heart disease in children with obstructive apnea syndrome: postoperative follow-up

ABSTRACT

Sporadic reports of advanced cor pulmonale secondary to obstructive sleep apnea syndrome [OSAS] in children were found in literature. Therefore, the present study was designed to evaluate early cardiopulmonary changes in 35 children with OSAS secondary to adenotonsillar hypertrophy using M-mode, two-dimensional and Doppler echocardiography and arterial blood gas analysis. A group of 35 age and sex-matched healthy Children were used as a control group. Their mean age was 4.3 +/- 1.5 years. Clinical, electrocardiographic and chest rontgenographic evaluation revealed evidence of right ventricular hypertrophy in 6 and cardiomegaly in and children with OSAS. Twenty seven children showed no clinical evidence of cardiac involvement. Tricuspid regurgitation was detected in 65.7% of cases. The right ventricular end diastolic diameter [RVD] was greater than the upper confidence limit of normal in 17 children. Pulmonary systolic pressure [PSP] ranged from 17.2 to 55 mmHg [mean 37.2 +/- 10.6 mmHg] and was above the 95% condifence limit of normal in 18 [51.4%] children. Arterial blood gas analysis revealed alveolar hypoventilation. Children with hypoxaemia had increased both RVD [P < 0.004] and PSP [P < 0.002] but decreased left ventricular egection fraction [EF] [p < 0.05] compared with those without hypoxaemia. Children with hypercapnia [PaCO2 > 45 mmHg] has large RVD [P < 0.009] and increased PSP [P < 0.007] and lower EF [P < 0.04] than those without. Tonsillectomy performed in 10 children was followed by complete resolution of sleep disturbances and significant decrease in RVD and PSP. Increased awareness about OSAS and subclinical cardiopulmonary changes should result in early treatment and less morbidity for these children