ORIGINAL ARTICLE Evaluation of Cardiac Functions and Atrial Electromechanical Delay in Children With Adenotonsillar Hypertrophy Abdullah Kocabas ¸ • Nergis Salman • Filiz Ekici • I ˙ lker C ¸ etin • Fatih Alper Akcan Received: 26 September 2013 / Accepted: 28 November 2013 Ó Springer Science+Business Media New York 2013 Abstract Deterioration of the right ventricular (RV) func- tions and the increase in the pulmonary arterial pressure (PAP) of children with moderate to severe adenotonsillar hypertrophy (ATH) have been well described. In addition to these complications, this study aimed to investigate the influence of ATH on the conduction system. The study investigated 46 patients with a diagnosis of ATH and 46 healthy control subjects. Conventional echocardiography, P-wave dispersion (Pd), tissue Doppler imaging (TDI) find- ings, and atrial electromechanical delay (AED) were com- pared between the patients and the control subjects before and after adenotonsillectomy. The maximum P-wave duration and Pd were significantly higher in the patients than in the control subjects (p \ 0.001). The patient group showed significantly greater RV end-diastolic dimension (p = 0.01), right atrial area (p \ 0.001), and mean PAP (p = 0.03) but lower E/A ratios for the mitral (p = 0.04) and tricuspid (p = 0.01) valves and a shorter pulmonary flow trace acceleration time (p = 0.03). The tricuspid annular-plane systolic excursion was similar between these groups (p = 0.21). In the patient group, TDI studies showed significantly lower E 0 /A 0 ratios for the tricuspid lateral (p = 0.006) and mitral septal (p = 0.003) segments than in the control group. The myocardial perfor- mance index was lower for the mitral lateral, mitral septal, and tricuspid lateral segments in patient group (p \ 0.001). Similarly, AED was prolonged in the patient group at all three segments (p \ 0.001). Also, the patient group showed a sig- nificantly longer interatrial (p = 0.03) and intraatrial (p = 0.04) electromechanical delay. However, all the electro- and echocardiographic parameters were similar between the patients and the control subjects after adenotonsillectomy (p [ 0.05). The prolongations in P-wave duration, Pd, and inter- and intraatrial electromechanical delays were first shown in this population. The cardiac changes induced by ATH-associated hypoxia may facilitate arrhythmias during the long term. Keywords Adenotonsillar hypertrophy  Atrial electromechanical delay  P-wave dispersion  Tissue Doppler imaging Adenotonsillar hypertrophy (ATH) is the leading cause of upper respiratory tract obstruction, obstructive sleep apnea (OSA), and hypoxia in children [2, 23, 35]. It can delete- riously affect the quality of life, somatic growth, and school performance of children [26]. Furthermore, a rela- tionship of ATH with cardiovascular and pulmonary dis- orders is well described in previous studies [1, 2, 7, 13, 15, 17, 23, 25, 38]. Severe upper respiratory tract obstruction causes apnea or obstructive hypoventilation. Hypoxemia and hypercar- bia, by inducing respiratory acidosis, are potent mediators of pulmonary vasoconstriction. Also, neurohumoral factors produced in response to hypoxemia may promote the changes in pulmonary vasculature. Consequently, the pathway may result in cor pulmonale and right ventricular (RV) dysfunction. Echocardiography currently is most preferred noninva- sive method for assessing the right and left ventricular A. Kocabas ¸(&)  F. Ekici  I ˙ .C ¸ etin Department of Pediatric Cardiology, Ankara Children’s Hematology and Oncology Research and Training Hospital, Ankara, Turkey e-mail: dr.akocabas@gmail.com N. Salman  F. A. Akcan Department Ear, Nose, and Throat, Ankara Children’s Hematology and Oncology Research and Training Hospital, Ankara, Turkey 123 Pediatr Cardiol DOI 10.1007/s00246-013-0853-7