Assessment of right cardiac functions before and after surgery in children who underwent adenoidectomy due to upper airway obstruction caused by adenoid hypertrophy

The most common cause of upper airway obstruction is chronic adenotonsillar hypertrophy in children. The children with adenoid hypertrophy are at risk for life-threatening pulmonary edema, pulmonary hypertension as well as development of cardiovascular complications such as right cardiac failure. The aim of this study was to assess right cardiac functions by pre-operative and post-operative electrocardiography and echocardiography in children with upper airway obstruction due to adenoid hypertrophy and to compare these patients with control group. The study included 40 patients who underwent adenoidectomy due to upper airway obstruction resulted from adenoid hypertrophy at ETN Department of Akdeniz University, Medicine School. The control group consisted of 20 age- and sex-matched healthy children. In patients who underwent adenoidectomy, electrocardiographic and echocardiographic evaluations (by same cardiologist) were performed before and 3 months after operation. All parents gave written informed consent before participation. There were 20 boys (54.1%) and 17 girls (45.9%) with mean age of 5.7±2.8 years in patients who underwent surgery due to adenoid hypertrophy, while there were 11 boys (55.0%) and 9 girls (45.0%) with mean age of 5.5±2.2 in control group. In electrocardiographic evaluations, significant difference was found in pdisp values between patient and control groups (pre-op: 34.2±9.92; post-op: 34.02±11.76; control: 28.75±7.15; p=0.046). Clinically, no significant difference was detected between patient and control groups on conventional echocardiography. However, significant differences were detected in most parameters of tissue Doppler echocardiography (IVS-ET; pre-op: 238.62±42.26, post-op: 258.53±23.99, p< 0.05, TL-E'; pre-op: 0.16±0.025, control: 0.18±0.022, p=0.009; TL-A'; pre-op: 0.12±0.039, control: 0.13±0.026, p< 0.05, TL-E/E'; post-op: 5.06±0.78*, control: 4.41±0.89, p=O.O38, TL-IVCT; pre-op: 57.96±8.49, control: 50.55±5.98, p< 0.05; TL-ET; pre-op: 237.19±19.11, post-op: 239.4±20.2 control:251.38±20.75 p< 0.05. TL-MPI; pre-op: 0.44±0.078, control: 0.39±0.065, p< 0.05, SV-E'; pre-op: 0.15±0.025, control: 0.17±0.023, p< 0.05, SV E/E'; post- op: 5.54±0.96, control: 4.75±1.08 p< 0.01, SV-ET; pre-op: 234.86±18.52,post-op: 235.4±25.6, control: 250.44±26.48, p< 0.05). No significant difference was detected in pre-op and post-op strain and strain rate parameters (p<0.05). When post-op values were compared with controls, it was found that post-op SR-E and SR-S values were significantly higher than those of controls (SR-E: post-op: 1.52±0.59, control: 1.13±0.53, p< 0,05 and SR-S; post-op: 0.99±0.68, control: 1.61±0.33, p< 0.05). Although children with upper airway obstruction due to adenoid hypertrophy doesn't present any clinical sign, there may be alterations in cardiac functions compared to healthy children and these changes can be detected by electrocardiography and echocardiography. In our study, it was found that p wave dispersion was significantly increased in patients with adenoid hypertrophy on electrocardiography. On tissue Doppler echocardiography, presence of significant differences, particularly in tricuspid valve lateral wall parameters, suggested impairment of right ventricular diastolic functions. Addition to literature, significant differences were detected between post-op values of patients and those of controls who were assessed by speckle tracking echocardiography. However, no significant differences were detected between pre-op values of patients and those of controls and between pre-op and post-op values of patients. This could be due to small sample size and the fact that control examination at post-operative month 3 may be early to detect alterations in cardiac functions. Further studies are needed for assessment of this condition.