Hypertrophied Adenoids Causing Pulmonary Hypertension and Severe Congestive Heart Failure

Levy, Arthur M.; Tabakin, Burton S.; Hanson, John S.; Narkewicz, Richard M.

doi:10.1056/nejm196709072771003

Cited by 166 publications

(39 citation statements)

References 7 publications

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“…Similar findings in rats experimentally subjected to hypoxia have been reported [12]. The same hypoxic hypertensive pulmo nary vascular disease appears to explain the cor pulmonale of the Pick wickian syndrome [1] and the hypoxic congestive cardiac failure occurring in children with enlarged adenoids [11],…”

supporting

confidence: 83%

Cor Pulmonale in Emphysema

Heath¹

1970

Pathobiology

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supporting

confidence: 83%

Cor Pulmonale in Emphysema

Heath¹

1970

Pathobiology

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“…The compliant chest wall impedes the neonate9s ability to generate adequate tidal volumes (VT) [4], increases the work of breathing (WOB) [5], by wasting force on chest wall distortion instead of generating effective alveolar ventilation [6], contributes to muscle fatigue [7] and accentuates growth retardation [8]. The mechanics of the respiratory system are further hampered by high-flow resistance of the nasal airway and small airways [9], increased propensity to hypertrophy of the adenoids and tonsils [10], a small zone of apposition of the diaphragm [6], horizontal ribs, and in the very young, immature muscles [11], all curtailing the endurance of the respiratory system. The metabolic rate is approximately double that of the adult, resulting in a ratio of alveolar ventilation:FRC of 5:1 in the infant compared with 1.5:1 in the adult [12], thus increasing the risk of hypoxaemia.…”

Section: Presentation/symptomsmentioning

confidence: 99%

Noninvasive ventilation in children

Nørregaard¹

2002

Eur Respir J

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The use of noninvasive ventilation (NIV)/ventilatory assistance has in its modern form experienced a resurgence during the last two decades, primarily in the adult population.During the last few years, NIV, predominantly in the form of positive-pressure ventilation/ventilatory assistance, has also become an option in the paediatric population. Although the technique is increasingly being applied, data in this often very heterogeneous group of patients are still very limited, and are usually derived from case series and not randomised controlled studies.Available experience indicates that the technique is useful for children with a wide spectrum of hypercapnic and/or hypoxaemic respiratory disorders, in the acute as well as in the chronic setting. Results have shown improvements in survival and arterial blood gases, and have indicated better quality of life. Adverse effects are generally minor, although the impact on facial bony structures should be monitored closely during long-term ventilation.Considering the paucity of data, the area badly needs research, which preferentially should include: 1) short-and long-term effects and adverse effects in various conditions and age groups; 2) techniques, in particular interfaces and triggering mechanisms; 3) comprehensive plans for training of attendants, discharge and follow-up; and 4) quality of life measurements. As many of the conditions suited for noninvasive ventilation are very rare, much of the research would probably benefit from multicentre studies, or even studies on a European level.

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“…Os sintomas referidos mais freqüentes são: roncos, pausas respiratórias, dificuldade para respirar, sono agitado e sudorese noturna 2,6 . A SAHOS pode ter conseqüên-cias clínicas graves, como cor pulmonale [7][8][9] , além de impacto negativo na qualidade de vida da criança, como atraso no crescimento pôndero-estatural, alterações do esqueleto facial e torácico 10 , enurese noturna e distúrbios do comportamento, do aprendizado e de outras funções cognitivas 11 .…”

Section: Introductionunclassified

Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

Weber¹,

Montovani²,

Matsubara³

et al. 2007

J Pediatr (Rio J)

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ResumoObjetivos: Avaliar a morfologia e função cardíaca através do ecocardiograma em crianças com obstrução respiratória no sono. Métodos:Foram estudadas 40 crianças de ambos os sexos, com idade entre 3 e 11 anos, sendo que 30 apresentavam obstrução respiratória no sono (grupo I) e 10 crianças eram controles saudáveis (grupo II). Os dois grupos eram semelhantes quanto a gênero, idade, peso e altura. As 40 crianças realizaram ecocardiograma, visando às quatro câmaras em sístole e diástole, com atenção especial ao ventrículo direito. Os dados obtidos foram comparados através do teste t de Student (p < 0,05).Resultados: Observou-se, no grupo I, aumento do diâmetro e da área do ventrículo direito em sístole e diástole. A variação entre sístole e diástole da área do ventrículo direito era menor. Em ventrículo esquerdo, foi observada diminuição do diâmetro diastólico, uma menor fração de ejeção e um encurtamento menor. Conclusões:As alterações morfológicas e funcionais cardíacas encontradas em ventrículo direito e ventrículo esquerdo sugerem que obstrução respiratória no sono em crianças pode levar a repercussões cardiovasculares. Estas alterações podem expor as crianças a um maior risco anestésico e cirúrgico.J Pediatr (Rio J). 2007;83(6):518-522: Apnéia do sono obstrutiva, criança, ecocardiografia. AbstractObjectives: To assess cardiac morphology and function by means of echocardiograms of children with obstructed breathing while asleep. Methods:The study enrolled 40 children of both sexes, aged from 3 to 11 years; 30 of them had obstructed breathing during sleep (group I) and 10 children were healthy controls (group II). The two groups were similar in terms of sex, age, weight and height. The 40 children underwent echocardiogram, viewing all four chambers during systole and diastole, paying special attention to the right ventricle (RV). These data were compared by means of Student's t test (p < 0.05). Results:In group I, increased diameter and area of the right ventricle were observed during both systole and diastole. There was less variation in RV area between systole and diastole. Reduced left ventricle (LV) diastolic diameter was also observed, together with reduced ejection fraction and reduced contraction. Conclusions:The morphological and functional cardiac abnormalities observed in the RV and LV suggest that, in children, obstructed breathing during sleep can lead to cardiovascular repercussions. These abnormalities may expose these children to increased anesthetic and surgical risks.J Pediatr (Rio J). 2007;83(6):518-522: Obstructive sleep apnea, child, echocardiography. IntroduçãoO quadro clínico de obstrução das vias aéreas superiores (VAS) no sono varia de intensidade, desde roncos noturnos à síndrome da apnéia hipopnéia obstrutiva do sono (SAHOS) 1 .A SAHOS é caracterizada por episódios repetidos de obstrução das VAS, associados à hipóxia e hipercapnia intermitente 1,2 . Sua prevalência nas crianças varia de 0,7 a 3% nos diferentes estudos epidemiológicos [3][4][5] . O seu pico de incidên-cia é observado...

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Hypertrophied Adenoids Causing Pulmonary Hypertension and Severe Congestive Heart Failure

Cited by 166 publications

References 7 publications

Cor Pulmonale in Emphysema

Cor Pulmonale in Emphysema

Noninvasive ventilation in children

Echocardiographic abnormalities in children with obstructive breathing disorders during sleep

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