The effect of adenoidectomy on right ventricular performance in children

Abstract

Objective: Several studies have shown a reduction in pulmonary artery pressure (PAP) after adenoidectomy in children suffering form upper airway obstruction caused by adenoid hypertrophy (AH). However, it is not clear whether this would be significantly reflected on right ventricle output (RVO). Methods: Our aim was to determine if there were any detectable changes in RV performance parameters after adenoidectomy in children with AH. Thirty children with AH (female/male: 11/19) aged between 2.5 and 12 years (median: five years) were included in this study. Adenoidectomy was performed under sinuscopic guide using adenoid curette and microdebrider. All children were examined by echocardiography one day before and one month after adenoidectomy. Velocity time integral of tricuspid valve flow (VTItv) and pulmonary valve flow (VTIpa); E/A ratio of tricuspid valve flow; RV end-diastolic diameter (RVEDd) and left ventricle fraction shortening (FS) were measured. Heart rate (HR) was also recorded. Results: Preoperatively VTItv, VTIpa, E/A ratio, RVEDd, FS, and HR were 18.6 ± 3.0 cm, 20.8 ± 3.1 cm, 1.21 ± 0.31, 11.5 ± 2.1 mm, 35.1 ± 4.3%, and 112 ± 19, respectively. Postoperatively VTItv, VTIpa, E/A ratio, RVEDd, FS, and HR were 21.5 ± 2.5 cm, 24.4 ± 4.3 cm, 1.44 ± 0.32, 9.3 ± 2.6 mm, 33.9 ± 3.5%, and 104 ± 28, respectively. There were significant differences between preoperative and postoperative VTItv (p = 0.03), VTIpa (p = 0.01), E/A ratios (p = 0.04), and RVEDd (p = 0.01). FS and HR were not significantly different. Conclusions: This study illustrated that in children suffering from AH, relieving upper airway obstruction by adenoidectomy may result in improvement of RV filling and RVO, associated with the reduction in PAP. © 2009 Elsevier Ireland Ltd. All rights reserved.