Jabbari Moghaddam Yalda, Bavil Shamsi Ghaffari, Abavisani Khosrou
Department of Otolaryngology-Head and Neck Surgery, Tabriz University of Medical Sciences, Iran.
J Saudi Heart Assoc. 2011 Jan;23(1):31-5. doi: 10.1016/j.jsha.2010.10.003. Epub 2010 Oct 28.
Hypertrophy of adenotonsillar tissue is one of the most common problems in childhood age and causes upper airway obstruction and even obstructive sleep apnea symptoms in severe forms. The aim of this study is to evaluate the changes of pre-adentonsillectomy echocardiographic findings after operation.
From August 2007 to November 2008, 55 children with adenotonsillar hypertrophy and obstructive-sleep symptoms (aged 3-11 years old of which 35 were males and 20 females) were randomly selected. Preoperatively echocardiography was performed for all patients by the pediatric cardiologist. In control group 55 children who referred to otolaryngology clinic because of non adenotonsillar related disease evaluated. One month and six months after operation, patients with positive findings were followed up and again echocardiography was performed separately.
No complaints of apnea were reported. Tonsillar grades of all cases were type III or IV. The preoperative mean pulmonary arterial pressure levels of the 4 (7.3%) children were higher than normal range (25 mm Hg) and it decreased significantly after operation (P < 0.000) (Preoperative MPAP = 32 ± 3 mm Hg, and six months postoperative follow up, MPAP = 11 ± 5 mm Hg). All the patients' parents complained about severe open mouth snoring, agitated sleep and hyperpnoea of their children. The preoperative tricuspid regurgitation pressure level of 7 children was higher than normal range and it decreased significantly after operation (P < 0.000 preoperative TR = 34 ± 8 mm Hg postoperative TR = 19 ± 6 mm Hg). AC/ET in these seven patients were lower than 0.4. In control group echocardiography findings are normal.
Severe chronic hypertrophic adenotonsillar tissue caused higher tricuspid regurgitation pressure and mean pulmonary arterial pressure.
腺样体扁桃体组织肥大是儿童期最常见的问题之一，严重时可导致上呼吸道梗阻甚至阻塞性睡眠呼吸暂停症状。本研究旨在评估腺样体扁桃体切除术前超声心动图检查结果术后的变化。
2007年8月至2008年11月，随机选取55例腺样体扁桃体肥大且有阻塞性睡眠症状的儿童（年龄3至11岁，其中男性35例，女性20例）。所有患者术前均由儿科心脏病专家进行超声心动图检查。选取55例因非腺样体扁桃体相关疾病就诊于耳鼻喉科门诊的儿童作为对照组进行评估。术后1个月和6个月，对有阳性结果的患者进行随访，并再次分别进行超声心动图检查。
未报告有呼吸暂停的主诉。所有病例的扁桃体分级均为III级或IV级。4例（7.3%）儿童术前平均肺动脉压水平高于正常范围（25mmHg），术后显著下降（P<0.000）（术前平均肺动脉压=32±3mmHg，术后6个月随访，平均肺动脉压=11±5mmHg）。所有患者的家长均抱怨其子女有严重的张口打鼾、睡眠不安和呼吸急促。7例儿童术前三尖瓣反流压力水平高于正常范围，术后显著下降（P<0.000，术前三尖瓣反流=34±8mmHg，术后三尖瓣反流=19±6mmHg）。这7例患者的加速时间/射血时间低于0.4。对照组超声心动图检查结果正常。
严重的慢性腺样体扁桃体组织肥大导致较高的三尖瓣反流压力和平均肺动脉压。
