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http://dx.doi.org/10.3345/kjp.2014.57.11.484

Effect of adenotonsillar hypertrophy on right ventricle function in children  

Lee, Jin Hwan (Department of Pediatrics, Konyang University College of Medicine)
Yoon, Jung Min (Department of Pediatrics, Konyang University College of Medicine)
Lim, Jae Woo (Department of Pediatrics, Konyang University College of Medicine)
Ko, Kyung Og (Department of Pediatrics, Konyang University College of Medicine)
Choi, Seong Jun (Department of Otolaryngology, Konyang University College of Medicine)
Kim, Jong-Yeup (Department of Otolaryngology, Konyang University College of Medicine)
Cheon, Eun Jung (Department of Pediatrics, Konyang University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.57, no.11, 2014 , pp. 484-488 More about this Journal
Abstract
Purpose: Chronic 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. Methods: Twenty-one children (male/female, 15/6; mean age, $92.3{\pm}39.0$ 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. Results: The 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 ($66.44{\pm}37.63pg/mL$ vs. $27.85{\pm}8.89pg/mL$, P=0.001). The echocardiographic parameters were not significantly different between the groups. Conclusion: We 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.
Keywords
Hypertrophy; Obstructive sleep apnea; Airway obstruction; Echocardiography; Probrain natriuretic peptide;
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1 Blum RH, McGowan FX Jr. Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Paediatr Anaesth 2004;14:75-83.
2 Brown OE, Manning SC, Ridenour B. Cor pulmonale secondary to tonsillar and adenoidal hypertrophy: management considerations. Int J Pediatr Otorhinolaryngol 1988;16:131-9.
3 Duman D, Naiboglu B, Esen HS, Toros SZ, Demirtunc R. Impaired right ventricular function in adenotonsillar hypertrophy. Int J Cardiovasc Imaging 2008;24:261-7.
4 Guilleminault C, Huang YS, Glamann C, Li K, Chan A. Adenoton sillectomy and obstructive sleep apnea in children: a prospective survey. Otolaryngol Head Neck Surg 2007;136:169-75.
5 Krittayaphong R, Boonyasirinant T, Saiviroonporn P, Udompunturak S. NT-proBNP levels in the evaluation of right ventricular dysfunction in patients with coronary artery disease and abnormal left ventricular wall motion: a magnetic resonance imaging study. Coron Artery Dis 2008;19:481-7.
6 Blyth KG, Groenning BA, Mark PB, Martin TN, Foster JE, Steedman T, et al. NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension. Eur Respir J 2007;29:737-44.
7 Oran B, Ozturk K, Cimen D, Vatansev H, Bulut S, Arslan D. Release of NT-pro brain natriuretic peptide in children before and after adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2013;77:666-9.
8 Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci 1985;10:73-8.
9 Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551-69.
10 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-21.
11 Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995;26:135-6.
12 Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. 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, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
13 Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, et al. 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;22:715-9.
14 Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996;9:838-47.
15 Nir A, Lindinger A, Rauh M, Bar-Oz B, Laer S, Schwachtgen L, et al. NT-pro-B-type natriuretic peptide in infants and children: reference values based on combined data from four studies. Pediatr Cardiol 2009;30:3-8.
16 Tatlipinar A, Biteker M, Meric K, Bayraktar GI, Tekkesin AI, Gokceer T. Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications. Laryngoscope 2012;122:676-80.
17 Kang KT, Chou CH, Weng WC, Lee PL, Hsu WC. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 2013;8:e78666.
18 Tasali E, Leproult R, Spiegel K. Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis 2009;51:381-91.
19 Kang KT, Lee PL, Weng WC, Hsu WC. Body weight status and obstructive sleep apnea in children. Int J Obes (Lond) 2012;36:920-4.
20 Wing YK, Hui SH, Pak WM, Ho CK, Cheung A, Li AM, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child 2003;88:1043-7.
21 Kocabas A, Salman N, Ekici F, Cetin I, Akcan FA. Evaluation of cardiac functions and atrial electromechanical delay in children with adenotonsillar hypertrophy. Pediatr Cardiol 2014;35:785-92.
22 Goldbart AD, Levitas A, Greenberg-Dotan S, Ben Shimol S, Broides A, Puterman M, et al. B-type natriuretic peptide and cardiovascular function in young children with obstructive sleep apnea. Chest 2010;138:528-35.
23 Weber SA, Montovani JC, Matsubara B, Fioretto JR. Echocardiographic abnormalities in children with obstructive breathing disorders during sleep. J Pediatr (Rio J) 2007;83:518-22.
24 Cayler GG, Johnson EE, Lewis BE, Kortzeborn JD, Jordan J, Fricker GA. Heart failure due to enlarged tonsils and adenoids. The cardiorespiratory syndrome of increased airway resistance. Am J Dis Child 1969;118:708-17.
25 Sie KC, Perkins JA, Clarke WR. Acute right heart failure due to adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1997;41:53-8.
26 Phillips B. Sleep-disordered breathing and cardiovascular disease. Sleep Med Rev 2005;9:131-40.
27 Steiner S, Strauer BE. Functional dynamics of the right ventricle and pulmonary circulation in obstructive sleep apnea. Therapeutic consequences. Internist (Berl) 2004;45:1101-7.
28 Verrier RL, Harper RM, Hobson JA. Cardiovascular physiology: central and autonomic regulation. In: Kryger MH, Roth T, Dement WC, eds. Principles and practice of sleep medicine. 3rd ed. Philadelphia: WB Saunders, 2000;179-91.
29 Yilmaz MD, Onrat E, Altuntas A, Kaya D, Kahveci OK, Ozel O, et al. The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children. Am J Otolaryngol 2005;26:18-21.
30 Gerur 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; 59:41-6.
31 Schoen SP, Zimmermann T, Kittner T, Braun MU, Fuhrmann J, Schmeisser A, et al. NT-proBNP correlates with right heart haemodynamic parameters and volumes in patients with atrial septal defects. Eur J Heart Fail 2007;9:660-6.
32 Jabbari Moghaddam Y, Bavil SG, Abavisani K. Do pre-adenotonsillectomy echocardiographic findings change postoperatively in children with severe adenotonsillar hypertrophy. J Saudi Heart Assoc 2011;23:31-5.
33 Miman MC, Kirazli T, Ozyurek R. Doppler echocardiography in adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2000;54:21-6.
34 Sahin M, Portakal O, Karagoz T, Hascelik G, Ozkutlu S. Diagnostic performance of BNP and NT-ProBNP measurements in children with heart failure based on congenital heart defects and cardiomyopathies. Clin Biochem 2010;43:1278-81.
35 Pietrzak R, Werner B. Usefulness of NT-proBNP in assessment of right ventricular function in children after tetralogy of Fallot correction: a preliminary study. Kardiol Pol 2009;67:378-83.