Korean J Pediatr.  2018 Dec;61(12):392-396. 10.3345/kjp.2018.06436.

The improvement of right ventricular function after adenotonsillectomy in children with obstructive sleep apnea

• Kim DY
• Ko KO
• Lim JW
• Yoon JM
• Song YH
• Cheon EJ

• KMID: 2433728
• DOI: http://doi.org/10.3345/kjp.2018.06436

Abstract

PURPOSE
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.
METHODS
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.
RESULTS
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).
CONCLUSION
RVMPI using TDE could be an early parameter of RV function in children with OSA due to ATH.

Keyword

Obstructive sleep apnea; Adenotonsillectomy; Myocardial performance index of the right ventricle

MeSH Terms

Airway Obstruction
Apnea
Child*
Dichlorodiphenyldichloroethane
Echocardiography
Echocardiography, Doppler
Follow-Up Studies
Humans
Hypertrophy
Pulmonary Artery
Reference Values
Sleep Apnea, Obstructive*
Tricuspid Valve Insufficiency
Vasoconstriction
Ventricular Function, Right*
Dichlorodiphenyldichloroethane