Assessment of Pulmonary Artery Pressure and Right Ventricular Function in Children With Adenotonsillar Hypertrophy Using Different Parameters

Abstract

Objective: Our aim was comparison of preoperative and postoperative right ventricular functions of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction, using new echocardiographic parameters. Methods: Forty-one children who have admitted to our hospital with symptoms suggestive of upper airway obstruction, whose history and physical examination findings suggest upper airway obstruction and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2 and 12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue Doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation. Results: Of 41 children in study group, 26 (63.4%) had adenotonsillectomy and 15 (36.6%) had adenoidectomy. Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in preoperative group compared to control group (18.46 +/- 1.67, 19.77 +/- 1.62; p = 0.000, respectively). Myocardial performance index (MPI) was significantly higher in preoperative group than postoperative and control group (0.40 +/- 0.07, 0.36 +/- 0.06, 0.35 +/- 0.07; p = 0.032, respectively). Tricuspid isovolumic acceleration (TIVA) was significantly lower in preoperative group than preoperative and control group (2.97 +/- 0.8, 3.43 +/- 0.7, 3.43 +/- 0.9; p = 0.020, respectively). Disappearance of this difference was found between postoperative and control groups (p = 0.984). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control group (109.68 +/- 18.03, 118.93 +/- 17.46, 120.0 +/- 14.07; p = 0.010, respectively). Mean pulmonary artery pressure (mPAP) was significantly higher in preoperative group than control group (29.64 +/- 8.11, 24.95 +/- 6.33; p = 0.010, respectively). In postoperative group mPAP was found to be similar to control group (25.48 +/- 7.85, 24.95 +/- 633; p = 0.740, respectively). Conclusions: TAPSE, PAcT, MPI and TIVA are useful markers for evaluation of preoperative and postoperative ventricular function in children with ATH who have findings of upper airway obstruction. We think that using these practical and easy-to perform parameters may be relevant for evaluation and postoperative follow-up of patients with ATH who have findings of upper airway obstruction. Besides adenotonsillectomy is a beneficial treatment option for these patients. (C) 2014 Elsevier Ireland Ltd. All rights reserved.