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Pulmonary Vascular Complications of Chronic Airway Obstruction in Children

Pulmonary Vascular Complications of Chronic Airway Obstruction in Children Abstract Objective: To study the clinical presentation, treatment, and outcome of pulmonary artery hypertension (PAH) that develops in children with chronic airway obstruction. Design: Case study. Setting: Academic tertiary care children's hospital. Patients: A 3-year (October 1, 1992, to September 30, 1995) review of the medical records of all children with chronic airway obstruction in whom PAH developed. Main Outcome Measure: The clinical course, including objective laboratory data to measure PAH (cardiac catheterization, echocardiography, electrocardiography) both before and after treatment. Results: Pulmonary artery hypertension developed in 18 patients. It was diagnosed using cardiac catheterization in 13 patients and echocardiography in 5 patients. Obstructive problems include chronic lung disease (9 patients), tracheobronchomalacia (6 patients), adenotonsillar hypertrophy (5 patients), laryngomalacia (4patients), macroglossia (5 patients), subglottic stenosis (2patients), and pharyngeal collapse (2 patients). Nine patients were born prematurely and 7 had Down syndrome. Treatments included tracheotomy (7), adenotonsillectomy (5), adenoidectomy (3), laser epiglottoplasty (1), and supplemental oxygen (12). Fourteen patients had documented improvement of PAH as seen from the cardiac catheterization, echocardiography, or electrocardiography findings; in 4 patients, PAH worsened (3 deaths). Conclusions: Chronic airway obstruction may lead to PAH. In this study, PAH was more likely to develop in premature infants or children with Down syndrome and cardiac anomalies. Surgery or supplemental oxygen will usually improve PAH, but fixed and irreversible PAH developed in patients with the most severe airway disease.Arch Otolaryngol Head Neck Surg. 1997;123:700-704 References 1. Noonan JA. Reversible cor pulmonale due to hypertrophied tonsils and adenoids: studies in two cases . Circulation . 1965;32( (suppl II) ):164. 2. Bland JW, Edwards FK, Brinsfield W. Pulmonary hypertension and congestive heart failure with chronic upper airway obstruction . Am J Cardiol . 1969;23:830-837.Crossref 3. Cayler GG, Johnson EE, Lewis BE. Heart failure due to enlarged tonsils and adenoids . AJDC . 1969;118:708-717. 4. Levy AM, Tabakin BS, Hanson JS, Narkewicz RM. Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure . N Engl J Med . 1967;277:506-511.Crossref 5. Bridges ND, Freed MD. Cardiac cathterization . In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP, eds. Heart Disease in Infants, Children and Adolescents . Baltimore, Md: Williams & Wilkins; 1995;1:310-329. 6. Jackson FN, Rowland V, Corssen C. Laryngospasm-induced pulmonary edema . Chest . 1980;78:819-821.Crossref 7. Guyten A. Medical Physiology . Philadelphia, Pa: WB Saunders Co; 1980:516-528. 8. Vogel JH, Blount SG. The role of the hydrogen ion concentration in the regulation of pulmonary artery pressure: observations in a patient with hypoventilation and obesity . Circulation . 1965;32:788-796.Crossref 9. Simmons DH, Linde LM, Shapiro BJ. Effect of blood gases and acid-base disturbances on the pulmonary circulation . Dis Chest . 1965;48:347-350.Crossref 10. Bressack MA, Bland RD. Alveolar hypoxia increases lung fluid filtration in unanesthetized newborn lambs . Circ Res . 1980;46:111-116.Crossref 11. Hansen TN, Gest AL, Landers, S. Inspiratory airway obstruction does not affect lung fluid balance in lambs . J Appl Physiol . 1985;58:1314-1318.Crossref 12. Bradley TD. The role of daytime hypoxia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome . Am Rev Respir Dis . 1985;131:835-839. 13. Weitzenblum E, Kreiger J, Apprill, et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome . Am Rev Respir Dis . 1988;138:345-349.Crossref 14. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenbaum E, Ramomaharo J. Pulmonary hypertension, hypoxia and hypercapnia in obstructive sleep apnea patients . Chest . 1989;96:729-737.Crossref 15. Laks L. Pulmonary arterial pressure in sleep apnea . Sleep . 1993;16( (suppl) ):S41-S43. 16. Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome . Am J Respir Crit Care Med . 1994;149:416-422.Crossref 17. Vogel JHK, Weaver WF, Rose RL, Blount SG, Grover RF. Pulmonary hypertension on exertion in normal man living at 10,150 feet . Medicina Thoracalis . 1962;19:461-477. 18. Blount SG, Grover RF. Pulmonary hypertension . In: Hurst JW, ed. The Heart, Arteries and Veins . New York, NY: McGraw-Hill Book Co; 1978:1456-1472. 19. Wood P. Diseases of the Heart and Circulation . 2nd ed. London, England: Eyre and Spottiswoode Ltd; 1957:541. 20. Grover RF, Vogel JHK, Averill KH, Blount SG. Pulmonary hypertension: individual and species variability relative to vascular reactivity . Am Heart J . 1963;66:1-3.Crossref 21. Reid L. Structure and function in pulmonary hypertension: new perceptions . Chest . 1986;89:279-288.Crossref 22. Nattie EE, Bartlett D, Johnson K. Pulmonary hypertension and right ventricular hypertrophy caused by intermittent hypoxia and hypercapnia in the rat . Am Rev Respir Dis . 1978;118:653-658. 23. Sun R, Yan Y, Chen X, Si Q, Li H. Role of collagen metabolism changes in the pathogenesis of pulmonary hypertension in rats and its reversibility . Chin Med J . 1994;9:183-186. 24. Johnson GL. Pediatric echocardiography . In: Gewitz M, ed. Primary Pediatric Cardiology . Armonk, NY: Futura Publishing Co; 1995:123. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Pulmonary Vascular Complications of Chronic Airway Obstruction in Children

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900070044007
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Abstract

Abstract Objective: To study the clinical presentation, treatment, and outcome of pulmonary artery hypertension (PAH) that develops in children with chronic airway obstruction. Design: Case study. Setting: Academic tertiary care children's hospital. Patients: A 3-year (October 1, 1992, to September 30, 1995) review of the medical records of all children with chronic airway obstruction in whom PAH developed. Main Outcome Measure: The clinical course, including objective laboratory data to measure PAH (cardiac catheterization, echocardiography, electrocardiography) both before and after treatment. Results: Pulmonary artery hypertension developed in 18 patients. It was diagnosed using cardiac catheterization in 13 patients and echocardiography in 5 patients. Obstructive problems include chronic lung disease (9 patients), tracheobronchomalacia (6 patients), adenotonsillar hypertrophy (5 patients), laryngomalacia (4patients), macroglossia (5 patients), subglottic stenosis (2patients), and pharyngeal collapse (2 patients). Nine patients were born prematurely and 7 had Down syndrome. Treatments included tracheotomy (7), adenotonsillectomy (5), adenoidectomy (3), laser epiglottoplasty (1), and supplemental oxygen (12). Fourteen patients had documented improvement of PAH as seen from the cardiac catheterization, echocardiography, or electrocardiography findings; in 4 patients, PAH worsened (3 deaths). Conclusions: Chronic airway obstruction may lead to PAH. In this study, PAH was more likely to develop in premature infants or children with Down syndrome and cardiac anomalies. Surgery or supplemental oxygen will usually improve PAH, but fixed and irreversible PAH developed in patients with the most severe airway disease.Arch Otolaryngol Head Neck Surg. 1997;123:700-704 References 1. Noonan JA. Reversible cor pulmonale due to hypertrophied tonsils and adenoids: studies in two cases . Circulation . 1965;32( (suppl II) ):164. 2. Bland JW, Edwards FK, Brinsfield W. Pulmonary hypertension and congestive heart failure with chronic upper airway obstruction . Am J Cardiol . 1969;23:830-837.Crossref 3. Cayler GG, Johnson EE, Lewis BE. Heart failure due to enlarged tonsils and adenoids . AJDC . 1969;118:708-717. 4. Levy AM, Tabakin BS, Hanson JS, Narkewicz RM. Hypertrophied adenoids causing pulmonary hypertension and severe congestive heart failure . N Engl J Med . 1967;277:506-511.Crossref 5. Bridges ND, Freed MD. Cardiac cathterization . In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP, eds. Heart Disease in Infants, Children and Adolescents . Baltimore, Md: Williams & Wilkins; 1995;1:310-329. 6. Jackson FN, Rowland V, Corssen C. Laryngospasm-induced pulmonary edema . Chest . 1980;78:819-821.Crossref 7. Guyten A. Medical Physiology . Philadelphia, Pa: WB Saunders Co; 1980:516-528. 8. Vogel JH, Blount SG. The role of the hydrogen ion concentration in the regulation of pulmonary artery pressure: observations in a patient with hypoventilation and obesity . Circulation . 1965;32:788-796.Crossref 9. Simmons DH, Linde LM, Shapiro BJ. Effect of blood gases and acid-base disturbances on the pulmonary circulation . Dis Chest . 1965;48:347-350.Crossref 10. Bressack MA, Bland RD. Alveolar hypoxia increases lung fluid filtration in unanesthetized newborn lambs . Circ Res . 1980;46:111-116.Crossref 11. Hansen TN, Gest AL, Landers, S. Inspiratory airway obstruction does not affect lung fluid balance in lambs . J Appl Physiol . 1985;58:1314-1318.Crossref 12. Bradley TD. The role of daytime hypoxia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome . Am Rev Respir Dis . 1985;131:835-839. 13. Weitzenblum E, Kreiger J, Apprill, et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome . Am Rev Respir Dis . 1988;138:345-349.Crossref 14. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenbaum E, Ramomaharo J. Pulmonary hypertension, hypoxia and hypercapnia in obstructive sleep apnea patients . Chest . 1989;96:729-737.Crossref 15. Laks L. Pulmonary arterial pressure in sleep apnea . Sleep . 1993;16( (suppl) ):S41-S43. 16. Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvoy RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome . Am J Respir Crit Care Med . 1994;149:416-422.Crossref 17. Vogel JHK, Weaver WF, Rose RL, Blount SG, Grover RF. Pulmonary hypertension on exertion in normal man living at 10,150 feet . Medicina Thoracalis . 1962;19:461-477. 18. Blount SG, Grover RF. Pulmonary hypertension . In: Hurst JW, ed. The Heart, Arteries and Veins . New York, NY: McGraw-Hill Book Co; 1978:1456-1472. 19. Wood P. Diseases of the Heart and Circulation . 2nd ed. London, England: Eyre and Spottiswoode Ltd; 1957:541. 20. Grover RF, Vogel JHK, Averill KH, Blount SG. Pulmonary hypertension: individual and species variability relative to vascular reactivity . Am Heart J . 1963;66:1-3.Crossref 21. Reid L. Structure and function in pulmonary hypertension: new perceptions . Chest . 1986;89:279-288.Crossref 22. Nattie EE, Bartlett D, Johnson K. Pulmonary hypertension and right ventricular hypertrophy caused by intermittent hypoxia and hypercapnia in the rat . Am Rev Respir Dis . 1978;118:653-658. 23. Sun R, Yan Y, Chen X, Si Q, Li H. Role of collagen metabolism changes in the pathogenesis of pulmonary hypertension in rats and its reversibility . Chin Med J . 1994;9:183-186. 24. Johnson GL. Pediatric echocardiography . In: Gewitz M, ed. Primary Pediatric Cardiology . Armonk, NY: Futura Publishing Co; 1995:123.

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Jul 1, 1997

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