Subclinical Pulmonary Hypertension in Children with Obstructive Adenotonsillar Hypertrophy

Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction and obstructive sleep symptoms in children. The aim of this study is to compare pre-adentonsillectomy echocardiographic findings with postoperative findings. Fifty-five children with adnotonsillar hypertrophy and obstructive-sleep apnea symptoms (aged 4 to14 years, 35 males, 20 females) were randomly selected from Aug 2007 to November 2008. Preoperatively echocardiography was performed for all patients by the same pediatric cardiologist. Patients with positive findings were followed and again echocardiography was performed separately one month and six months after operation. All the patients’ parents complained about severe open mouth snoring, agitated sleep and hyperpnoea. No complaints of apnea were reported. Tonsillar grades of all cases were of III or IV. The preoperative mean pulmonary arterial pressure levels of the 4(7.3%) children were higher than normal range (25mmhg) and it significantly decreased after operation (P<0.0001 Npar test) (Preoperative MPAP = 32 ±3 mmHg, and six months postoperative follow up, MPAP=11±5 mmHg). The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (p<0.0001 preoperative TR=34±8 mmHg postoperative TR=19±6mmhg) Acceleration time / Ejection time (AC/ET) in these 7 patient were lower than 0.4. This study showed that chronic symptomatic obstructive hypertrophy of adenotonsillar tissue results in higher tricuspid regurgitation pressure and mean pulmonary arterial pressure, which could be relieved by adenotonsillectomy.