Koc Sema, Aytekin Metin, Kalay Nihat, Ozcetin Mustafa, Burucu Turgay, Ozbek Kerem, Celik Atac, Kadi Hasan, Gulturk Sefa, Koc Fatih
Gaziosmanpasa University, Medical Faculty, Otolaryngology Department, Tokat, Turkey.
Int J Pediatr Otorhinolaryngol. 2012 Jan;76(1):45-8. doi: 10.1016/j.ijporl.2011.09.028. Epub 2011 Oct 13.
Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Severe upper airway obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction. The investigators aimed to study RV function and mean pulmonary artery pressure (mPAP) in patients with ATH who were undergoing adenotonsillectomy by using tissue Doppler echocardiography (TDE).
The study examined 27 children with ATH who had a mean age of 8 ± 2 years. The subjects were comprised 17 (63%) males and 10 (37%) females. Hypertrophy of the tonsils was graded according to the Brodsky scale. Children having either grade 3 or 4 hypertrophied adenotonsils were recruited for the study. Adenotonsillectomy was performed on all subjects in the study group and echocardiographic examination was repeated 3 months postoperatively.
Tricuspid Em significantly increased after adenotonsillectomy (17.7 ± 3.6 vs. 19.1 ± 5.5, p=0.04). The RV myocardial performance index (MPI) and mPAP significantly decreased after adenotonsillectomy (RV MPI: 0.57 ± 0.13 vs. 0.40 ± 0.12, p<0.001 and mPAP (mmHg): 31 ± 9 vs. 25 ± 7, p=0.001).
The results of this study, evaluated with the results of previous studies, demonstrated that adenotonsillectomy improved RV performance and reduced mPAP in children with ATH.
腺样体扁桃体肥大（ATH）是儿童上呼吸道梗阻最常见的原因。严重的上呼吸道梗阻可能会影响慢性肺泡通气不足，进而可能导致低氧性肺血管收缩引起的右心室（RV）功能障碍。研究人员旨在通过组织多普勒超声心动图（TDE）研究接受腺样体扁桃体切除术的ATH患者的RV功能和平均肺动脉压（mPAP）。
该研究对27名平均年龄为8±2岁的ATH儿童进行了检查。受试者包括17名（63%）男性和10名（37%）女性。扁桃体肥大根据布罗德斯基量表进行分级。招募患有3级或4级腺样体扁桃体肥大的儿童进行研究。对研究组的所有受试者进行腺样体扁桃体切除术，并在术后3个月重复进行超声心动图检查。
腺样体扁桃体切除术后三尖瓣E峰速度显著增加（17.7±3.6 vs. 19.1±5.5，p=0.04）。腺样体扁桃体切除术后RV心肌性能指数（MPI）和mPAP显著降低（RV MPI：0.57±0.13 vs. 0.40±0.12，p<0.001；mPAP（mmHg）：31±9 vs. 25±7，p=0.001）。
本研究结果与以往研究结果评估表明，腺样体扁桃体切除术改善了ATH儿童的RV性能并降低了mPAP。
