Cincin Altug, Sakalli Erdal, Bakirci Eftal Murat, Dizman Rafet
Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey.
Safa Private Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
Int J Pediatr Otorhinolaryngol. 2014 Aug;78(8):1281-7. doi: 10.1016/j.ijporl.2014.05.011. Epub 2014 May 21.
The aim of our study was to investigate subclinical cardiac disturbances in patients with symptoms due to adenotonsillar hypertrophy (ATH) and the impact of adenotonsillectomy (AT) using conventional and novel echocardiographic measures.
Thirty patients with grade 3 or 4 ATH (mean age: 7.86 ± 3.83 years; 10 females) and 30 healthy, age- and sex-matched volunteers (mean age, 8 ± 2.77; 14 females) were enrolled in the study. In addition to conventional two-dimensional and Doppler echocardiographic parameters, tissue Doppler parameters, including myocardial performance indices (MPIs) of both the right (RV) and left ventricle (LV), were studied. The severity of obstructive sleep apnea (OSA) was determined using the OSA-18 health quality questionnaire. The OSA-18 questionnaire and echocardiographic examination were repeated after AT in patients with ATH.
The total OSA-18 scores for the control, preoperative, and postoperative groups were 39.56 ± 19.98, 80.63 ± 22.32, and 44.10 ± 20.31, respectively. Conventional parameters were not different among the groups. The mean pulmonary artery pressure estimated using the Mahan formula was increased in the ATH group compared with that in the control group (21.72 ± 4.25 vs. 12.43 ± 3.83, respectively; p<0.001) and significantly improved after AT (21.72 ± 4.25 vs. 16.09 ± 4.53; p<0.001). The RV MPI was significantly different between the control and ATH groups (0.322 ± 0.052 vs. 0.383 ± 0.079, respectively; p=0.001). Both the LV and RV MPI significantly improved (0.515 ± 0.066 vs. 0.434 ± 0.052, p<0.001; and 0.383 ± 0.079 vs. 0.316 ± 0.058, p=0.018, respectively) after surgery for ATH.
Our study revealed that the patients with OSA-specific symptoms due to ATH had higher pulmonary artery pressure and impaired RV function according to novel echocardiographic parameters. Surgery for ATH seems to have an important effect on both LV and RV function.
我们研究的目的是使用传统和新型超声心动图测量方法，调查因腺样体扁桃体肥大（ATH）出现症状的患者的亚临床心脏紊乱情况以及腺样体扁桃体切除术（AT）的影响。
30例3级或4级ATH患者（平均年龄：7.86±3.83岁；10名女性）和30名年龄、性别匹配的健康志愿者（平均年龄，8±2.77岁；14名女性）纳入本研究。除了传统的二维和多普勒超声心动图参数外，还研究了组织多普勒参数，包括右心室（RV）和左心室（LV）的心肌性能指数（MPI）。使用OSA-18健康质量问卷确定阻塞性睡眠呼吸暂停（OSA）的严重程度。ATH患者在AT术后重复进行OSA-18问卷和超声心动图检查。
对照组、术前组和术后组的OSA-18总分分别为39.56±19.98、80.63±22.32和44.10±20.31。各组间传统参数无差异。与对照组相比，ATH组使用马汉公式估算的平均肺动脉压升高（分别为21.72±4.25和12.43±3.83；p<0.001），AT术后显著改善（21.72±4.25和16.09±4.53；p<0.001）。对照组和ATH组之间的RV MPI有显著差异（分别为0.322±0.052和0.383±0.079；p=0.001）。ATH手术后，LV和RV MPI均显著改善（分别为0.515±0.066和0.434±0.052，p<0.001；以及0.383±0.079和0.316±0.058，p=0.018）。
我们的研究表明，因ATH出现OSA特异性症状的患者，根据新型超声心动图参数，肺动脉压较高且RV功能受损。ATH手术似乎对LV和RV功能均有重要影响。
