Kim Dong Yeop, Ko Kyung Ok, Lim Jae Woo, Yoon Jung Min, Song Young Hwa, Cheon Eun Jeong
Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea.
Korean J Pediatr. 2018 Dec;61(12):392-396. doi: 10.3345/kjp.2018.06436. Epub 2018 Oct 26.
Adenotonsillar hypertrophy (ATH) that causes upper airway obstruction might lead to chronic hypoxemic pulmonary vasoconstriction and right ventricular (RV) dysfunction. We aimed to evaluate whether adenotonsillectomy (T&A) in children suffering from obstructive sleep apnea (OSA) due to severe ATH could improve RV function.
Thirty-seven children (boy:girl=21:16; mean age, 9.52±2.20 years), who underwent T&A forsleep apnea due to ATH, were included. We analyzedthe mean pulmonary artery pressure (mPAP), the presence and the maximal velocity of tricuspid regurgitation (TR), the tricuspid annular plane systolic excursion (TAPSE), and the right ventricular myocardial performance index (RVMPI) with tissue Doppler echocardiography (TDE) by transthoracic echocardiography pre- and post-T&A. The follow-up period was 1.78±0.27 years.
Only the RVMPI using TDE improved after T&A (42.18±2.03 vs. 40±1.86, P=0.001). The absolute value of TAPSE increased (21.45±0.90 mm vs. 22.30±1.10 mm, P=0.001) but there was no change in the z score of TAPSE pre- and post-T&A (1.19±0.34 vs. 1.24±0.30, P=0.194). The mPAP was within normal range in children with ATH, and there was no significant difference between pre- and post-T&A (19.6±3.40 vs. 18.7±2.68, P=0.052). There was no difference in the presence and the maximal velocity of TR (P=0.058).
RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.
引起上气道阻塞的腺样体扁桃体肥大（ATH）可能导致慢性低氧性肺血管收缩和右心室（RV）功能障碍。我们旨在评估因严重ATH导致阻塞性睡眠呼吸暂停（OSA）的儿童行腺样体扁桃体切除术（T&A）是否能改善RV功能。
纳入37例行T&A治疗因ATH导致的睡眠呼吸暂停的儿童（男∶女 = 21∶16；平均年龄9.52±2.20岁）。我们通过经胸超声心动图，采用组织多普勒超声心动图（TDE）在T&A前后分析平均肺动脉压（mPAP）、三尖瓣反流（TR）的存在情况及最大流速、三尖瓣环平面收缩期位移（TAPSE）和右心室心肌做功指数（RVMPI）。随访期为1.78±0.27年。
仅采用TDE的RVMPI在T&A后有所改善（42.18±2.03对40±1.86，P = 0.001）。TAPSE的绝对值增加（21.45±0.90 mm对22.30±1.10 mm，P = 0.001），但T&A前后TAPSE的z值无变化（1.19±0.34对1.24±0.30，P = 0.194）。ATH儿童的mPAP在正常范围内，T&A前后无显著差异（19.6±3.40对18.7±2.68，P = 0.052）。TR的存在情况及最大流速无差异（P = 0.058）。
采用TDE的RVMPI可能是因ATH导致OSA儿童RV功能的早期参数。
