Effect of adenotonsillar hypertrophy on right ventricle function in children

Abstract

PurposeChronic upper airway obstruction causes hypoxemic pulmonary vasoconstriction, which may lead to right ventricle (RV) dysfunction. Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Therefore, we aimed to evaluate RV function in children with ATH.MethodsTwenty-one children (male/female, 15/6; mean age, 92.3¡¾39.0 months; age range, 4-15 years) with ATH and 21 healthy age- and gender-matched controls were included in this study. Tricuspid annular plane systolic excursion and RV myocardial performance index were measured by transthoracic echocardiography. Further, the plasma level of N-terminal of probrain natriuretic peptide (NT-proBNP), an indicator of RV function, was determined.ResultsThe snoring-tiredness during daytime-observed apnea-high blood pressure (STOP) questionnaire was completed by the patients' parents, and loud snoring was noted in the ATH group. The plasma NT-proBNP level was significantly higher in the ATH group than that in the controls (66.44±37.63 pg/mL vs. 27.85±8.89 pg/mL, P=0.001). The echocardiographic parameters were not significantly different between the groups.ConclusionWe were unable to confirm the significance of echocardiographic evidence of RV dysfunction in the management of children with ATH. However, the plasma NT-proBNP level was significantly higher in the ATH group than that in the control, suggesting that chronic airway obstruction in children may carry a risk for cardiac dysfunction. Therefore, more patients should be examined using transthoracic echocardiography. In addition, pediatricians and otolaryngologists should consider cardiologic aspects during the management of children with severe ATH.

Current trends of adenotonsillar hypertrophy presentation in a developing country, Nigeria

“…10 Severe forms of obstructive sleep apnoea due to adenotonsillar hypertrophy may be complicated by pneumonia, cor pulmonale, pulmonary hypertension, chronic hypercapnia or hypoxia and right heart failure. [11][12][13] However, adenotonsillar hypertrophy has been reported to more commonly cause acute and chronic otitis media, rhinosinusitis, maldevelopment of upper jaw and poor physical and mental development due to chronic hypoxia. 14 For proper assessment, good history of presenting symptoms such as mouth, breathing, noisy breathing, snoring, frequent awake from sleep, enuresis, nightmares, hypersomnolence, feeding habit and academic performance must be taken.…”

Adenotonsiller Hipertrofi Olan Çocuklarda Adenotonsillektominin N-Terminal Pro-Beyin Natriüretik Peptid (NT-ProBNP) Düzeylerine Etkileri

“…In our study, exclusion of the patients having diseases such as heart and renal failure, severe lung disease, or upper airway obstruction caused by other reasons like nasal polyps, which are likely to influence NT-proBNP levels, allowed elimination of confounding factors. In their study, Lee et al (11) reported that, children with ATH (n=21) who had no echocardiographic right ventricular dysfunction and had similar echocardiographic parameters with the control group (n=21), had significantly higher NTproBNP levels than the controls (66.44±37.63 pg/mL vs. 27.85±8.89 pg/mL, p=0.001). In their study on 90 children with OSAS and age-and gender-matched controls (n=45), Goldbart et al (12) reported higher NT-proBNP levels in OSAS children than in the controls (189.1±112.7 pg/mL vs. 104.8±49.5 pg/mL, p=0.006).…”

Upper airway reconstruction using long‐range optical coherence tomography: Effects of airway curvature on airflow resistance

“…Upper airway obstruction in children is most commonly caused by adenotonsillar hypertrophy (AH) . The AH condition also contributes to the development of obstructive sleep apnea (OSA) , leading to significantly lower quality of life from neurocognitive , behavioral , and cardiovascular concerns.…”

“…The AH condition also contributes to the development of obstructive sleep apnea (OSA) , leading to significantly lower quality of life from neurocognitive , behavioral , and cardiovascular concerns. Adenotonsillectomy (AT; the surgical removal of the adenoids and tonsils) is commonly used to treat AH and AH‐related sleep disorders , but guidelines are lacking to aid surgical decision‐making . While patient‐reported improvement following surgery is between 70% and 80%, persistent symptoms of sleep‐related breathing disorders have been reported in as many as 25% of normal‐weight and 75% of obese children after surgical management .…”