Browse > Article
http://dx.doi.org/10.3345/kjp.2018.06436

The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea  

Kim, Dong Yeop (Department of Pediatrics, Konyang University College of Medicine)
Ko, Kyung Ok (Department of Pediatrics, Konyang University College of Medicine)
Lim, Jae Woo (Department of Pediatrics, Konyang University College of Medicine)
Yoon, Jung Min (Department of Pediatrics, Konyang University College of Medicine)
Song, Young Hwa (Department of Pediatrics, Konyang University College of Medicine)
Cheon, Eun Jung (Department of Pediatrics, Konyang University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.61, no.12, 2018 , pp. 392-396 More about this Journal
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, $9.52{\pm}2.20years$), 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 $1.78{\pm}0.27years$. Results: Only the RVMPI using TDE improved after T&A ($42.18{\pm}2.03$ vs. $40{\pm}1.86$, P=0.001). The absolute value of TAPSE increased ($21.45{\pm}0.90mm$ vs. $22.30{\pm}1.10mm$, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A ($1.19{\pm}0.34$ vs. $1.24{\pm}0.30$, 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 ($19.6{\pm}3.40$ vs. $18.7{\pm}2.68$, 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.
Keywords
Obstructive sleep apnea; Adenotonsillectomy; Myocardial performance index of the right ventricle;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA, et al. Guidelines for optimal physician training in echocardiography. Recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. Am J Cardiol 1987;60:158-63.   DOI
2 Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, et al. Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 1987;59:662-8.   DOI
3 Chemla D, Castelain V, Humbert M, Hebert JL, Simonneau G, Lecarpentier Y, et al. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest 2004; 126:1313-7.   DOI
4 Obstructive Sleep Apnea Syndrome. In: American Academy of Sleep Medicine, editor. The International Classification of Sleep Disorders. Rochester (MN): American Sleep Disorders Association, 2001:52-8.
5 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.   DOI
6 Lee JH, Yoon JM, Lim JW, Ko KO, Choi SJ, Kim JY, et al. Effect of adenotonsillar hypertrophy on right ventricle function in children. Korean J Pediatr 2014;57:484-8.   DOI
7 Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci 1985;10:73-8.   DOI
8 Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am 1989;36:1551-69.   DOI
9 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.   DOI
10 Koc S, Aytekin M, Kalay N, Ozcetin M, Burucu T, Ozbek K, et al. The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2012;76:45-8.   DOI
11 Ramakrishna S, Ingle VS, Patel S, Bhat P, Dada JE, Shah FA, et al. Reversible cardio-pulmonary changes due to adeno-tonsilar hypertrophy. Int J Pediatr Otorhinolaryngol 2000;55:203-6.   DOI
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.   DOI
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.   DOI
14 Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995;26:135-6.
15 Sie KC, Perkins JA, Clarke WR. Acute right heart failure due to adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1997;41: 53-8.   DOI
16 Mahajan M, Thakur JS, Azad RK, Mohindroo NK, Negi PC. Cardiopulmonary functions and adenotonsillectomy: surgical indications need revision. J Laryngol Otol 2016;130:1120-4.   DOI
17 Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, et al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel 2015;7:151-8.
18 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;69:527-32.   DOI
19 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;59:41-6.   DOI
20 Naiboglu B, Deveci S, Duman D, Kaya KS, Toros S, Kinis V, et al. Effect of upper airway obstruction on pulmonary arterial pressure in children. Int J Pediatr Otorhinolaryngol 2008;72:1425-9.   DOI
21 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.   DOI
22 Attia G, Ahmad MA, Saleh AB, Elsharkawy A. Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 2010;31:1025-36.   DOI
23 Cacciapuoti F. Echocardiographic evaluation of right heart function and pulmonary vascular bed. Int J Cardiovasc Imaging 2009;25:689-97.   DOI
24 Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997;10:169-78.   DOI
25 Acar OC, Uner A, Garca MF, Ece I, Epcacan S, Turan M, et al. The effect of tonsillectomy and adenoidectomy on right ventricle function and pulmonary artery pressure by using Doppler echocardiography in children. Clin Exp Otorhinolaryngol 2016;9:163-7.   DOI
26 Abd El-Moneim ES, Badawy BS, Atya M. The effect of adenoidectomy on right ventricular performance in children. Int J Pediatr Otorhinolaryngol 2009;73:1584-8.   DOI
27 Koc F, Tokac M, Kaya C, Kayrak M, Yazici M, Karabag T, et al. Diastolic functions and myocardial performance index in obese patients with or without metabolic syndrome: a tissue Doppler study. Turk Kardiyol Dern Ars 2010;38:400-4.