title: The impact of adenotonsillectomy on pulmonary arterial pressure in West African children with adenotonsillar hypertrophy.
abstract: OBJECTIVE
  To assess the improvement or otherwise, in the mean pulmonary arterial pressure (mPAP) among children with adenotonsillar hypertrophy (ATH) after adenotonsillectomy (AT), and to examine the impact of timing of surgery as well as the patients' characteristics on the mPAP changes.
  
  
  METHODS
  We included 39 children with ATH in this study. The adenoidal enlargement was evaluated radiologically with adenoid nasopharyngeal ratio (ANR) parameter from lateral neck radiograph, whereas the clinical assessment of adeno-tonsillar obstruction was conducted with the 'symptom score'. Pulmonary arterial pressure (PAP) measurement was performed noninvasively by Doppler echocardiography. All patients underwent adenotonsillectomy (AT). After 6 weeks, they were subjected again to clinical and echocardiographic assessments, and the mean pulmonary arterial pressures (mPAP) were then compared. The mPAP changes after AT were further related to the grades of ANR, symptom scores, tonsillar size, and timing of AT.
  
  
  RESULTS
  The preoperative mPAP was 23.46 mmHg and was 18.98 mmHg post-operatively (P = 0.003). Seventeen of subjects (43.6%) had pulmonary hypertension (PH) (mPAP ≥ 25 mmHg) preoperatively, out of which 14 (82%) decreased to normal range 6 weeks after AT. Non-reversal of pulmonary hypertension was associated with ANR > 0.75 (P = 0.043), but was not related to the timing of surgery, tonsillar size, and symptom score. Significant reduction in mPAP was more likely with ANR ≤ 0.75 and pre-operative mPAP ≥ 25 mmHg. All the symptoms also improved significantly after AT.
  
  
  CONCLUSIONS
  Elevated PAP due to ATH in children was mostly reversible by AT irrespective of the timing of surgery, symptom severity, and tonsillar size, but gross enlargement of adenoids seem to be associated with non-reversal of PH.
authors.affiliation: Department of Otolaryngology, University of Nigeria Enugu Campus, Nigeria. Electronic address: tochiorji@yahoo.com.
authors.forename: Foster T
authors.initials: FT
authors.lastname: Orji
authors.affiliation: Department of Pediatric Cardiology, University of Nigeria Teaching Hospital Enugu, Nigeria.
authors.forename: Fortune A
authors.initials: FA
authors.lastname: Ujunwa
authors.affiliation: Department of Otolaryngology, University of Nigeria Teaching Hospital Enugu, Nigeria.
authors.forename: Nnaemeka G
authors.initials: NG
authors.lastname: Umedum
authors.affiliation: Department of Otolaryngology, University of Nigeria Enugu Campus, Nigeria.
authors.forename: Onyinyechi
authors.initials: O
authors.lastname: Ukaegbe
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000234:Adenoids / Q000473:pathology*; D000354:Africa, Western; D000402:Airway Obstruction / Q000601:surgery; D062186:Arterial Pressure; D044383:Black People; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D006984:Hypertrophy; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology*; D011651:Pulmonary Artery / Q000502:physiology*; D014068:Tonsillectomy / Q000379:methods*
keywords: Adenotonsillar hypertrophy; Adenotonsillectomy; Children; Echocardiography; Pulmonary arterial pressure