Skip to main content
SpringerLink
Log in

Assessment of preoperative and postoperative cardiac function in children with adenotonsillar hypertrophy: a prospective cohort study

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Chronic upper airway obstruction caused by adenotonsillar hypertrophy is one of the major cause of morbidity in children. It can lead to Obstructive Sleep Apnoea Syndrome, Pulmonary Hypertension, Cor Pulmonale and right heart failure. The study aimed to evaluate and compare various parameters of cardiac function with the help of echocardiography preoperatively and postoperatively in children undergoing adenotonsillectomy.

Methodology

A prospective cohort study was conducted on 23 patients at an apex care institute, under the age group of 4–12 years, who were diagnosed with adenotonsillar hypertrophy. Preoperative symptom analysis and Echocardiographic examination were done. After the assessment, all patients underwent surgery in the form of adenotonsillectomy. Follow-up symptom analysis and echocardiographic examination was done after 3 months postoperatively.

Results

Significant improvement in the obstructive symptoms were noted in postoperative group as expected (p =  < 0.001) and also in parameters such as mPAP (p =  < 0.001), TAPSE (p =  < 0.001), TAV (p = 0.001), Ejection fraction (p = 0.027) and RVMPI (p = 0.044) were improved in postoperative group. 4 patients had Grade 1 Right ventricular diastolic dysfunction, which disappeared in three patients postoperatively.

Conclusion

We have concluded that there can be subclinical cardiac dysfunctions which occurs as a result of chronic upper airway obstruction due to untreated adenotonsillar hypertrophy. Routine cardiac screening in children presenting with sleep disordered breathing associated with adenotonsillar hypertrophy may be helpful in identifying and preventing the development of cardiopulmonary complication. These changes can be reversed by performing adenotonsillectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Li H-Y, Lee L-A (2009) Sleep-disordered breathing in children. Chang Gung Med J 32:247–257

    PubMed  Google Scholar 

  2. Kaditis AG, Alonso Alvarez ML, Boudewyns A et al (2016) Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 47:69–94

    Article  Google Scholar 

  3. Attia G, Ahmad MA, Saleh AB et al (2010) Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 31:1025–1036

    Article  Google Scholar 

  4. Rosenzweig EB, Widlitz AC, Barst RJ (2004) Pulmonary arterial hypertension in children. Pediatr Pulmonol 38:2–22

    Article  Google Scholar 

  5. Barst RJ, Ertel SI, Beghetti M et al (2011) Pulmonary arterial hypertension: a comparison between children and adults. Eur Respir J 37:665–677

    Article  CAS  Google Scholar 

  6. Dandel M, Lehmkuhl H, Knosalla C et al (2009) Strain and strain rate imaging by echocardiography—basic concepts and clinical applicability. Curr Cardiol Rev 5:133–148

    Article  Google Scholar 

  7. Chan J, Edman JC, Koltai PJ (2004) Obstructive sleep apnea in children. Am Fam Physician 69:1147–1154

    PubMed  Google Scholar 

  8. Ng SK, Lee DLY, Li AM et al (2010) Reproducibility of Clinical grading of tonsillar size. Arch Otolaryngol Neck Surg 136:159

    Article  Google Scholar 

  9. Sharifkashani S, Dabirmoghaddam P, Kheirkhah M et al (2015) A new clinical scoring system for adenoid hypertrophy in children. Iran J Otorhinolaryngol 27:55–61

    PubMed  PubMed Central  Google Scholar 

  10. Chan JYS, Li AM, Au C-T et al (2009) Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 64:233–239

    Article  CAS  Google Scholar 

  11. Sevimli S, Gundogdu F, Aksakal E et al (2007) Right ventricular strain and strain rate properties in patients with right ventricular myocardial infarction. Echocardiography 24:732–738

    Article  Google Scholar 

  12. Miman MC, Kirazli T, Ozyurek R (2000) Doppler echocardiography in adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 54:21–26

    Article  CAS  Google Scholar 

  13. Çetin M, Yılmaz M, Özen S et al (2014) Assessment of pulmonary artery pressure and right ventricular function in children with adenotonsillar hypertrophy using different parameters. Int J Pediatr Otorhinolaryngol 78:1837–1842

    Article  Google Scholar 

  14. Kjaergaard J, Akkan D, Iversen KK et al (2007) Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 9:610–616

    Article  Google Scholar 

  15. Lee JH, Yoon JM, Lim JW et al (2014) Effect of adenotonsillar hypertrophy on right ventricle function in children. Korean J Pediatr 57:484

    Article  Google Scholar 

  16. Tatlipinar A, Duman D, Uslu C et al (2011) The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children. Turk J Pediatr 53:359–363

    PubMed  Google Scholar 

  17. Kang SJ, Kwon YW (2018) Right atrial deformation mechanics in children with adenotonsillar hypertrophy. J Cardiovasc Imaging 26:201

    Article  Google Scholar 

  18. Koc S, Aytekin M, Kalay N et al (2012) The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 76:45–48

    Article  Google Scholar 

  19. Tezer MS, Karanfil A, Aktaş D (2005) Association between adenoidal–nasopharyngeal ratio and right ventricular diastolic functions in children with adenoid hypertrophy causing upper airway obstruction. Int J Pediatr Otorhinolaryngol 69:1169–1173

    Article  Google Scholar 

  20. Tal A, Leiberman A, Margulis G et al (1988) Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol 4:139–143

    Article  CAS  Google Scholar 

  21. Mirecka J, Mazurek-Kula A, Ostrowska K et al (2019) Left heart ventricle function in children snoring due to adeno-tonsillar hypertrophy. Pediatr Pol 94:13–17

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr. Prem Prakash Sharma (Associate Professor, Department of Community Medicine and Family Medicine) for his tremendous help in statistical analysis of the data.

Funding

No funding was received to conduct this study or with the preparation of manuscript.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342 005, India

    V. V. Sameema, Kapil Soni, Bikram Choudhury, Darwin Kaushal & Amit Goyal

  2. Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342 005, India

    Surender Deora & Jai Bharat Sharma

  3. Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342 005, India

    Swati Chhabra

Authors
  1. V. V. Sameema
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kapil Soni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Surender Deora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jai Bharat Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bikram Choudhury
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Darwin Kaushal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Swati Chhabra
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amit Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors certify that they have no affiliations or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.

Corresponding author

Correspondence to Kapil Soni.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

Ethical approval for this study was obtained from Institutional Ethical Committee, AIIMS Jodhpur vide their letter number No. AIIMS/IEC/2018/1440. There was no extra financial burden for the patients in relation to study.

Consent to participate

All parents of the patients were informed about the purpose of the study before enrolling. Informed written consent was taken from parents or caretakers of all the children included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sameema, V.V., Soni, K., Deora, S. et al. Assessment of preoperative and postoperative cardiac function in children with adenotonsillar hypertrophy: a prospective cohort study. Eur Arch Otorhinolaryngol 279, 3013–3019 (2022). https://doi.org/10.1007/s00405-022-07255-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07255-4

Keywords

Search

Navigation