Evaluation of cardiac functions before and after operation inchildren with adenotonsillar hypertrophy

Introduction: Chronic tonsillar hypertrophy is a pathological condition often seen in childhood. It is one of the most common causes of upper airway obstruction. If left untreated, adenotonsillar hypertrophy can lead to cardiovascular complications secondary to chronic hypoxia. Objective: We aimed to evaluate children with adenotonsillar hypertrophy using electrocardiography, 24-hour Holter ECG monitoring, conventional Doppler and tissue Doppler echocardiography in order to understand the status of cardiac involvement before the operation and the time the cardiac functions begin to improve after the operation. Materials and methods: 33 children with adenotonsillar hypertrophy and 17 healthy children as a control group were included in the study. Children included in the study group were evaluated prospectively, preoperative, at the first month and at the third month of operation. Electrocardiography, conventional and tissue Doppler echocardiography and 24-hour Holter ECG monitoring was performed on all children included in the study group and control group. Results: There was no difference between the groups in terms of age, height, gender, body mass index, and arterial blood pressure (p>0.05). BNP levels were higher in the study group than in the control group (p<0.05). While QT and QTc dispersion were higher in the study group than in the control group in the preoperative period (p<0.05); it was determined that the results reached similar values to the control group in the third postoperative month (p>0.05). M-mode echocardiography parameters were similar in the study group and control group (p>0.05). While mitral valve E and A wave velocity and E/A ratio were similar in conventional Doppler echocardiography in the study and control groups; tricuspid valve E wave velocity and E/A ratio were lower, but A wave velocity was higher in the study group, (p<0.05). Mean PAP values in the study group were found 25.33±6.01 mmHg in the preoperative period; 21.69±5.37 mmHg in the first month of operation; 16.83±4.84 mmHg in the 3rd month of operation and 15.09±4.2 mmHg in the control group. While Edm, Adm, and Edm/Adm ratio and Edivs, Adivs and Edivs/Adivs ratio were similar in tissue Doppler echocardiography in the study and control groups; Edt and Edt/Adt ratio were lower, but Adt was higher in the study group (p<0.05). In the study group, SD, RMSSD and pNN50 values of heart rate variability parameters were lower than the control group, although there was no statistical difference (p>0.05). Conclusion: Cardiac effects appear to occur in children with adenotonsillar hypertrophy. Since the duration of exposure to hypoxia is not clearly known, the recovery process of cardiac functions after the operation is different in each child. Children with adenotonsillar hypertrophy should be evaluated cardiacally and adenotonsillectomy surgery should be planned before irreversible damage occurs in the cardiovascular system. Keywords: Adenotonsillar hypertrophy, adenotonsillectomy, conventional Doppler echocardiography, tissue Doppler echocardiography, electrocardiography, heart rate variability