The effects of adenotonsillar hypertrophy corrective surgery on left ventricular functions and pulmonary artery pressure in children

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

This review investigates the relationship between pediatric obstructive sleep apnea, often associated with adenotonsillar hypertrophy, and cardiovascular health, particularly pulmonary hypertension. We conducted a comprehensive literature search using electronic databases, including Medline Pub-Med, Scopus, and the Web of Science. The study analyzed a total of 230 articles and screened 48 articles, with 20 included in the final analysis, involving 2429 children. The PRISMA flowchart visually illustrates the selection process, and the ROBINS-E and -I tools help ensure the reliability and validity of the evidence produced by these studies. These studies explored various aspects, including the severity of obstructive sleep apnea, cardiac anomalies, cardiac stress markers, risk factors for pulmonary hypertension, and the impact of adenoidectomy and tonsillectomy on cardiac function. The research found that adenotonsillar hypertrophy and obstructive sleep apnea are significant risk factors for cardiovascular complications, especially pulmonary hypertension, in children. Adenoidectomy and tonsillectomy may provide effective treatments. Following adenoidectomy in relation to obstructive sleep apnea, there appears to be a reduction in mean pulmonary artery pressure during echocardiographic examination. However, the efficacy of these procedures can vary based on the severity of obstructive sleep apnea and individual cardiac conditions. The study also identified concerns regarding data bias. The authors emphasize the need for well-designed clinical studies, including both healthy patients with adenotonsillar hypertrophy and vulnerable children with genetic disorders, to ensure that clinical decisions are based on solid scientific evidence.

Associations of systemic inflammation markers with myocardial enzymes in pediatric adenotonsillar hypertrophy: A cross-sectional study

Objective

The present study aimed to investigate the relationship between systemic inflammation markers and myocardial enzymes in children with adenotonsillar hypertrophy (ATH).

Methods

The levels of myocardial enzymes were detected and the systemic inflammatory biomarkers including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) were calculated. Regression analyses were performed and a prediction model for screening myocardial injury was established by receiver operating characteristic (ROC) curve.

Results

Finally, a total of 804 children with ATH were included. After adjusting for age, BMI, fasting blood glucose and lipid profiles, both NLR and SII were significantly associated with CK-MB (p = 0.041 and 0.034, respectively) and LDH (p = 0.002 and 0.001, respectively), and PLR was associated with CK-MB (p = 0.008). In addition, NLR, SII were independently associated with hyper-LDH [OR = 1.447, 95%CI (1.063, 1.968); OR = 1.001, 95%CI (1.000, 1.002), respectively] and the associations were more significant in girls. A prediction model for hyper-LDH based on SII was developed with the area under the ROC curve of 0.715 (0.682, 0.746).

Conclusion

Systemic inflammation markers were only independently associated with serum hyper-LDH in children with ATH, especially in girls. Further investigation was needed to determine the relationship between systemic inflammation with myocardial enzymes in ATH children.

The impact of the Adenotonsillectomy on cardiac functions and oxidative stress

OBJECTIVE

Obstructive sleep apnea syndrome (OSAS) causes cardiovascular comorbidities and increased oxidative stress. Adenotonsillectomy is the first treatment option for OSAS secondary to adenotonsillar hypertrophy (ATH). This study evaluated the presence of cardiovascular changes, hypertension and oxidative stress before and after adenotonsillectomy in patients with OSAS secondary to ATH.

METHODS

Patients with ATH diagnosed with OSAS by polysomnography (PSG) were included. All participants received an Echocardiography (ECHO) and 24-h ambulatory blood pressure measurement (ABPM). Serum malonyldialdehyde (MDA) and total oxidant activity (TOS) levels of oxidant parameters; total antioxidant activity (TAS), catalase (CAT), superoxide dismutase (SOD) and glutathione (GSH) levels of antioxidant parameters were measured. All patients received an adenotonsillectomy. Postoperative evaluation was performed at the 6th month. In the postoperative period, PSG, ECHO, ABPM and the oxidant-antioxidant parameter levels in the serum was repeated.

RESULTS

Twenty-eight patients (13 males, 15 females; mean age 8.2 ± 2.06 years) were included in the study. In the preoperative period, concentric remodeling was observed in 14,8% of the patients, although they had no cardiovascular system complaints. The apnea-hypopnea index (AHI) scores were classified as mild in 39.3% (n = 11), moderate in 21.4% (n = 6) and severe in 39.3% (n = 11) preoperatively. In the postoperative period, 22 patients were evaluated. It was observed that the severity of OSAS decreased, ventricular functions improved, oxidant parameters decreased and antioxidant parameters increased postoperatively.

CONCLUSION

Adenotonsillectomy provides a positive change in cardiovascular system parameters and an antioxidant change in the oxidative balance in patients with OSAS.

Effects of adenoidectomy or adenotonsillectomy on the cardiovascular system in children: a meta-analysis

OBJECTIVE

Adenoid or adenotonsillar hypertrophy (AATH) causes upper airway obstruction, leading to cardiovascular complications. This meta-analysis was conducted to evaluate the efficacy of adenoidectomy or adenotonsillectomy (AATE) on the cardiovascular system.

METHODS

Using the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases, we identified studies involving a comparison of preoperative and postoperative cardiovascular function in children with AATH. The Cochrane Collaboration's Review Manager 5.3 software was used for meta-analysis.

RESULTS

A total of 13 studies with 706 participants were included. The meta-analysis demonstrated a significant reduction in mean pulmonary artery pressure (mPAP) of patients after AATE compared with preoperative values. The left ventricular myocardial function index (LVMPI) and the right ventricular myocardial function index (RVMPI) showed a significant decrease after the operation. Moreover, AATE prominently increased left ventricular ejection time (LVET) and right ventricular ejection time (RVET) and reduced the left ventricular interventricular septum diameter (LVIVSD) and the right ventricular end-diastolic diameter (RVedD). There was no significant difference in mPAP, LVMPI, RVMPI, LVET, RVET, LVIVSD, and RVedD between postoperative patients and healthy children (P  > 0.05).

CONCLUSION

AATE can improve cardiovascular function in pediatric patients with AATH. Specifically, it reduces mPAP and LVMPI/RVMPI in pediatric patients. Furthermore, AATE increases LVET and RVET and reduces LVIVSD and RVedD.

The utility of preoperative echocardiography in pediatric obstructive sleep apnea

PURPOSE

The purpose of this study was to determine the associations between cardiac function and postoperative adverse events in pediatric patients with obstructive sleep apnea (OSA).

METHODS

Patients between birth and 18 years of age diagnosed with OSA between January 1, 2015, and December 31, 2018, who underwent echocardiographic evaluation within 6 months of surgery at a tertiary care children's hospital were evaluated. Exclusion criteria included history of neuromuscular disorders, tracheostomy placement, or a predominance of central apneic events recorded during polysomnography (PSG). Patients were grouped by OSA severity. Chi-squared analysis and logistic regression were utilized to determine associations between demographic characteristics, OSA severity, preoperative echocardiographic abnormalities, and postoperative adverse events.

RESULTS

One hundred ten children met inclusion criteria for the study, including 22 with mild OSA, 22 with moderate OSA, and 66 with severe OSA. Race and the presence of congenital heart disease (CHD) were significantly associated with differences in OSA severity. Echocardiographic abnormalities were found in 45 patients, but exclusion of patients with CHD revealed no significant associations with differences in OSA severity. Postoperative adverse events were identified in 18 (16%) patients, and only O₂ saturation nadir was found to be a significant predictor of these complications.

CONCLUSION

Preoperative echocardiogram abnormalities are not commonly found in children with OSA and presence of abnormalities does not predict postoperative adverse events. O₂ saturation nadir measured on preoperative PSG is a significant predictor of postoperative adverse events and should be examined as a clinical indicator of OSA severity.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children

INTRODUCTION

Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP.

METHODS

This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF.

RESULTS

The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm³/s (±112.21, p = 0.01); and 498.93 cm³/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm³/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups.

CONCLUSION

PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

ASSESSMENT OF INDICES OF NONSPECIFIC RESISTANCE OF THE ORGANISM IN CONDITIONS OF NARROWING OF THE LUMEN OF THE TRACHEA IN AN EXPERIMENT

The narrowing of the lumen of the trachea due to cicatricial stenoses of the trachea is one of the urgent problems of the modern surgery.  The processes taking place in the trachea and lungs lead to a change in the state of the immune system. Assessment of the dynamics of  indices of nonspecific resistance is one of the methods for assessing  the severity of the course of the disease. We studied the indices of  nonspecific resistance of the organism in narrowing the lumen of the  trachea in an experiment in the early postoperative period.  The study was carried out on the basis of the scientific department  of experimental surgery with the vivarium of Irkutsk Scientific  Centre of Surgery and Traumatology, on 24 white male Wistar rats  with a body weight of 300–350 g. We simulated narrowing the lumen of the trachea by placing a silicone tube in the lumen of the trachea  for 14 days. The parameters of phagocytosis, the state of phagocytic activity of blood neutrophils, spontaneous NBT-test, induced NBT- test were studied. The animals were withdrawn from the experiment  on the 3rd, 7th and 14th day. We revealed that as a result of  narrowing of the lumen of the trachea with the original procedure,  the nonspecific resistance of the organism was violated with  inhibition of the phagocytic activity of leukocytes. There was  inhibition of phagocytic activity of leukocytes and depletion of the  functional reserve of leukocytes.