Reversal of pulmonary hypertension in children after adenoidectomy or adenotonsillectomy Viviane Feller Martha a, * , Jose ´ da Silva Moreira b , Aline Silveira Martha c , Fla ´vio Jose ´ Velho d , RenatoGeorgeEick e , SandroCadaval Goncalves f a Department of Otorhinolaryngology, SaoLucas Hospital, Pontifical Catholic University of Rio Grande do Sul,PortoAlegre, RS,Brazil b Pneumologic Sciences (UFRGS and PPF SantaCasa), PortoAlegre, RS,Brazil c Pontifical Catholic University of Rio Grande do Sul,PortoAlegre, RS,Brazil d Technical coordinator of echocardiography laboratory in Hospital Sa ˜ o Lucas da, PUCRS, Masterand PhD in Cardiology (UFRGS), PortoAlegre, RS,Brazil e Divisionof Nephrology, Moinhosde VentoHospital, PortoAlegre, RS,Brazil f Divisionof Cardiology, Hospital de Clinicas of PortoAlegre, PortoAlegre, RS,Brazil 1. Introduction The most frequent causeof upper airway obstruction in the pediatric populationis enlargedpalatineand pharyngeal tonsils. The Waldeyer’s tonsillar ring is an anatomical termdescribing the lymphoidtissue ring located in thepharynx andthebackof theoral cavity. The palatine tonsils are located in the sides of the oropharynx between palatoglossal and palatopharyngeal arches and the pharyngeal tonsils are in the rhinopharinx[1,2]. Adenotonsillarhypertrophy(ATH) has been describedas one cause of pulmonary hypertensionin children; however, studies thathaveattempted to characterize this relationarerare, probably because the methodology involvedin its study and the relatively rapid remissionafter resection[3]. Adenotonsillectomy is gener- ally performed in patientswith ATH and pulmonaryhypertension [4,5]. Although adenotonsillar hypertrophy has been extensively described in the literature, it was not until 1965that Menashe and Farrehi [6] described its relationship with pulmonary hypertension and cor pulmonale. Subsequent studieshavefurther characterized International Journal of PediatricOtorhinolaryngology 77 (2013) 237–240 A R T I C L E I N F O Articlehistory: Received 21 May 2012 Received in revisedform 4 November 2012 Accepted 6 November 2012 Availableonline 11 December 2012 Keywords: Adenoidectomy Tonsillectomy Pulmonaryhypertension Echocardiography A B S T R A C T Introduction: Adenotonsillar hypertrophy is a common condition in pediatric patients with upper respiratoryairwayscomplaints, andpulmonaryarterialhypertension (PAH) maybe onecomplication of that condition. Objectives: To study the occurrence of PAH (mean pulmonary artery pressurehigher than or equal to 25 mmHg) in a group of children with adenotonsillarhypertrophyand upper respiratorycomplaints (snoring or oral breathing), and to verify the pulmonary arterial pressure (PAP) changes after adenotonsillectomy. Studydesign:Case–control prospective study. Settings: Study conductedat Sa ˜o LucasHospital, approaching both public and private sector. Subject and methods: Thirty-three pediatric patientswith adenotonsillar hypertrophyand evidence of obstructive upper airwayscomplaints weretreated with adenotonsillectomy. All 33 patients underwent echocardiogram before and after the surgery with determinationof the pulmonary arterial pressure (PAP), through either the tricuspid regurgitationor artery linear flow accelerationtime estimation. Similar determinations were performedin 10 normal non operatedcontrols. Results: Pulmonary hypertension was verified 12 (36%) of the 33 patients with adenotonsillar hypertrophy.Adenoidectomyor adenotonsillectomy was associated to a significant 27%decrease in mean PAP (27 2.8 to 20 5.1 mmHg, p < 0.001) and to a non significant26%decrease in systolic PAP (35 6.2mmHgto 25 0.5mmHg,p =0.243). ThePAP valuesin childrenwith no pulmonaryhypertension were not changed after the surgery. Conclusions: In children with pulmonary hypertensionassociated to adenotonsillarhypertrophy,the adenotonsillectomy decreased PAP to normal valuesin all patients. ß 2012 ElsevierIreland Ltd. All rights reserved. * Correspondingauthor at: Rua Luiz Manoel Gonzaga200, apto 702, Bairro Petropolis, Porto Alegre, RS,Brazil. Tel.: +5551 33863178; fax: +5551 84013348. E-mail address: vivianefellermartha@hotmail.com (V.F. Martha). Contents lists available at SciVerse ScienceDirect International Journal of PediatricOtorhinolaryngology j ou r n a l ho mep a g e : ww w . e l s e v i e r . c om / l o c a t e / i j p o r l 0165-5876/$ – seefront matterß 2012 ElsevierIreland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2012.11.006