Evaluation of right ventricule functions by tissue doppler echocardiographic procedure at children with adenotonsillectomy

Aim: Our aim was comparison of pre-operative and post-operative right ventricular functions of children with obstructive sleep apnea secondary to tonsillar and/or adenoidal hypertrophy and who have been decided to be operated, using new echocardiographic parameters. Additionally, we evaluated effects of adenoidal hypertrophy on right ventricular function and effectiveness of adenotonsillectomy as a treatment modality.Methods: 41 children who have admitted to our hospital with symptoms suggestive of obstructive sleep apnea, whose history and physical examination findings suggest obstructive sleep apnea and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2-12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation.Results: There were no differences between study group (6.06 + 2.50 years) and control group (6.04 + 2.46 yıl) regarding age, gender and weight for age (p>0.05). Of 41 children in study group, 26 had adenotonsillectomy and 15 had adenoidectomy. IVS diameter was significantly higher in postoperative group compared to control group (p:0.002), while TAPSE was significantly lower in preoperative group compared to control group (p:0.000). There was no significant difference between postoperative and control groups (p:0.552). All groups were similar regarding left ventricular changes (E, A, E/A, DT, IVRT, IVCT, IVA, ET, MPI) evaluated both by conventional echocardiography and tissue doppler echocardiography (p>0.05). MPI value calculated through tricuspid valve using conventional doppler echocardiography, was found to be significantly higher in preoperative group compared to control group (p:0.032). This difference was absent between postoperative and control groups (p:0.454). E wave DT calculated through tricuspit valve using conventional doppler echocardiography was significantly higher in preoperative group than control group (p:0.028). Again this difference was absent between postoperative and control groups (p:0.757). E/A ratio calculated through tricuspit valve using conventional doppler echocardiography was similar between all groups (p:0.129). E?, A?, E/A?, S?, ET?, DT? ve AcT values obtained through tricuspid lateral annulus using tissue doppler echocardiography were also similar between groups (p>0.05). IVRT? and IVCT? values were significantly higher in preoperative group compared to postoperative and control group but this difference was statistically insignificant (p>0.05). MPI value through tricuspid annulus using tissue doppler echocardiography was significantly higher in preoperative group than control group (p:0.004). TIVA value through tricuspid annulus using tissue doppler echocardiography was significantly lower in preoperative group than control group (p:0.020). Disappearence of this difference was found between postoperative and control groups (p:0.984). PAcT was found to be significantly lower in preoperative group compared to postoperative and control group (p:0.010). mPAP was significantly higher in preoperative group than control group (p:0.010). In postoperative group mPAP was found to be similar to control group (p:0.740). No meaningful correlation was detected between mPAP and MPI values both in preoperative and postoperative groups (p:0.682, r:-0.066 ve p:0.690, r:0.064, respectively). In both preoperative and postoperative groups there was significant negative correlation between RV MPI and pulmonary ET (pre-operative p:0.016, r:-0.376, post-operative p:0.012, r:-0.389). Significant negative correlation between tricuspid MPI and IVA was found in all three groups (pre-operative p:0.004 r:-0.444, post-operative p:0.000, r:-0.430, control p:0.000, r:-0.558).Conclusion: TAPSE, PAcT, MPI, MPI' ve TIVA are useful markers for evaluation of pre-operative and post-operative ventricular function in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy. We think that using these practical and easy-to-perform parameters may be relevant for evaluation and post-operative follow-up of patients with obstructive sleep apnea. Besides adenotonsillectomy is a beneficial treatment option for these patients.Key words: Tissue doppler echocardiography, obstructive sleep apnea syndrome, TAPSE, TIVA