Chest
Cor Pulmonale Due to Adenoidal or Tonsillar Hypertrophy or Both in Children: Noninvasive Diagnosis and Follow-Up
Section snippets
Patients
Four children, aged 1 to 3½ years, were first seen with acute respiratory distress. In all four, parents reported symptoms compatible with upper airway obstruction almost from birth, including mouth breathing, noisy breathing while sleeping, frequent upper respiratory infections, chronic rhinorrhea, poor appetites and episodes of sleep apnea with cyanosis. The main clinical and laboratory findings on admission are summarized in Table 1. Three boys and one girl were first seen with severe
Techniques
M-mode and two-dimensional echocardiography was performed on all four patients using an Aloka Echocardiograph SSD-110S and a Sony Betamax video cassette recorder. Radionuclide angiography was performed on patients 1 and 4 using the method reported by Parrish et al.6 These noninvasive procedures were performed shortly after admission and prior to intubation, during supplemental oxygen administration. Because of their severe distress, we were unable to transfer patients 2 and 3 to radionuclide
Results
Echocardiography showed severe dilatation of the right atrium and of the right ventricle (RV) in all four patients (Table 2).7 This severe dilatation of the RV produced marked displacement of the interventricular septum (IVS) posteriorly and to the left, causing a marked alteration in normal left ventricle (LV) geometry. Instead of the normal round configuration of the LV, we observed a markedly flattened appearance in systole which was best observed in the parasternal short axis view (Fig 1,
Discussion
Pulmonary hypertension, cor pulmonale and even pulmonary edema have been reported in children with chronic upper airway obstruction.1, 2, 3, 4, 5 Most patients were first seen with features now referred to as the “obstructive sleep apnea syndrome,” with signs of respiratory and heart failure. Cardiac catheterization was frequently performed in these children to exclude congenital heart disease or cardiomyopathy or both.1, 2, 3, 4 The clinical features of upper airway obstruction and their
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2017, Sleep Medicine ClinicsThe impact of adenotonsillectomy on pulmonary arterial pressure in West African children with adenotonsillar hypertrophy
2017, International Journal of Pediatric OtorhinolaryngologyA systematic review and meta-analysis of cohort studies of echocardiographic findings in OSA children after adenotonsilectomy
2014, International Journal of Pediatric OtorhinolaryngologyAgreement between cone-beam computed tomography and nasoendoscopy evaluations of adenoid hypertrophy
2014, American Journal of Orthodontics and Dentofacial Orthopedics
Manuscript received January 30; revision accepted May 4.
Reprint requests: Dr. Sofer, Soroka Medical Center, PO Box 151, Beer Sheva, Israel 84-101