The Improvement of Right Ventricular Function After Adenotonsillectomy in Children with Obstructive Sleep Apnea

Overview

Journal Korean J Pediatr

Specialty Pediatrics

Date 2018 Oct 26

PMID 30360034

Citations 3

Authors

Dong Yeop Kim

Kyung Ok Ko

Jae Woo Lim

Jung Min Yoon

Young Hwa Song

Eun Jeong Cheon

Affiliations

Soon will be listed here.

Abstract

Purpose: Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function.

Methods: Thirty-seven children (boy:girl=21:16; mean age, 9.52±2.20 years), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was 1.78±0.27 years.

Results: Only the RVMPI using TDE improved after T&A (42.18±2.03 vs. 40±1.86, P=0.001). The absolute value of TAPSE increased (21.45±0.90 mm vs. 22.30±1.10 mm, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A (1.19±0.34 vs. 1.24±0.30, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A (19.6±3.40 vs. 18.7±2.68, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058).

Conclusion: RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.

Citing Articles

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review.

Zaffanello M, Ersu R, Nosetti L, Beretta G, Agosti M, Piacentini G Children (Basel). 2024; 11(2).

PMID: 38397319 PMC: 10887195. DOI: 10.3390/children11020208.

Mean platelet volume levels in children with sleep-disordered breathing: a meta-analysis.

Chang W, Tseng C, Tsou Y BMC Pediatr. 2020; 20(1):204.

PMID: 32393268 PMC: 7212570. DOI: 10.1186/s12887-020-02099-5.

Effects of low-temperature plasma treatment on pulmonary function in children with obstructive sleep apnea-hypopnea syndrome.

Wang X, Liu Y, Tang G, Wang H, Zhao Y Ir J Med Sci. 2019; 189(2):603-609.

PMID: 31735988 DOI: 10.1007/s11845-019-02132-2.

References

Ramakrishna S, Ingle V, Patel S, Bhat P, Dada J, Shah F . Reversible cardio-pulmonary changes due to adeno-tonsilar hypertrophy. Int J Pediatr Otorhinolaryngol. 2000; 55(3):203-6. DOI: 10.1016/s0165-5876(00)00389-x. View

Gorur K, Doven O, Unal M, Akkus N, Ozcan C . Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2001; 59(1):41-6. DOI: 10.1016/s0165-5876(01)00449-9. View

Chemla D, Castelain V, Humbert M, Hebert J, Simonneau G, Lecarpentier Y . New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004; 126(4):1313-7. DOI: 10.1378/chest.126.4.1313. View

Pac A, Karadag A, Kurtaran H, Aktas D . Comparison of cardiac function and valvular damage in children with and without adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2005; 69(4):527-32. DOI: 10.1016/j.ijporl.2004.11.023. View

Duman D, Naiboglu B, Esen H, Toros S, Demirtunc R . Impaired right ventricular function in adenotonsillar hypertrophy. Int J Cardiovasc Imaging. 2007; 24(3):261-7. DOI: 10.1007/s10554-007-9265-1. View

Chung F, Yegneswaran B, Liao P, Chung S, Vairavanathan S, Islam S . STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008; 108(5):812-21. DOI: 10.1097/ALN.0b013e31816d83e4. View

Naiboglu B, Deveci S, Duman D, Kaya K, Toros S, Kinis V . Effect of upper airway obstruction on pulmonary arterial pressure in children. Int J Pediatr Otorhinolaryngol. 2008; 72(9):1425-9. DOI: 10.1016/j.ijporl.2008.06.005. View

Koestenberger M, Ravekes W, Everett A, Stueger H, Heinzl B, Gamillscheg A . Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr. 2009; 22(6):715-9. DOI: 10.1016/j.echo.2009.03.026. View

Cacciapuoti F . Echocardiographic evaluation of right heart function and pulmonary vascular bed. Int J Cardiovasc Imaging. 2009; 25(7):689-97. DOI: 10.1007/s10554-009-9478-6. View

10.

Abd El-Moneim E, Badawy B, Atya M . The effect of adenoidectomy on right ventricular performance in children. Int J Pediatr Otorhinolaryngol. 2009; 73(11):1584-8. DOI: 10.1016/j.ijporl.2009.08.013. View

11.

Rudski L, Lai W, Afilalo J, Hua L, Handschumacher M, Chandrasekaran K . Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology,.... J Am Soc Echocardiogr. 2010; 23(7):685-713. DOI: 10.1016/j.echo.2010.05.010. View

12.

Attia G, Ahmad M, Saleh A, Elsharkawy A . Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol. 2010; 31(7):1025-36. DOI: 10.1007/s00246-010-9755-0. View

13.

Koc F, Tokac M, Kaya C, Kayrak M, Yazici M, Karabag T . Diastolic functions and myocardial performance index in obese patients with or without metabolic syndrome: a tissue Doppler study. Turk Kardiyol Dern Ars. 2011; 38(6):400-4. View

14.

Koc S, Aytekin M, Kalay N, Ozcetin M, Burucu T, Ozbek K . The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2011; 76(1):45-8. DOI: 10.1016/j.ijporl.2011.09.028. View

15.

Kocabas A, Salman N, Ekici F, Cetin I, Akcan F . Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol. 2013; 35(5):785-92. DOI: 10.1007/s00246-013-0853-7. View

16.

Lee J, Yoon J, Lim J, Ko K, Choi S, Kim J . Effect of adenotonsillar hypertrophy on right ventricle function in children. Korean J Pediatr. 2015; 57(11):484-8. PMC: 4279009. DOI: 10.3345/kjp.2014.57.11.484. View

17.

Schmid E, Hilberath J, Blumenstock G, Shekar P, Kling S, Shernan S . Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel. 2015; 7(2):151-158. PMC: 4476769. View

18.

Brodsky L . Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989; 36(6):1551-69. DOI: 10.1016/s0031-3955(16)36806-7. View

19.

Acar O, Uner A, Garca M, Ece I, Epcacan S, Turan M . The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children. Clin Exp Otorhinolaryngol. 2016; 9(2):163-7. PMC: 4881318. DOI: 10.21053/ceo.2015.00087. View

20.

Mahajan M, Thakur J, Azad R, Mohindroo N, Negi P . Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. J Laryngol Otol. 2016; 130(12):1120-1124. DOI: 10.1017/S0022215116009129. View