ACUTE RIGHT HEART-FAILURE DUE TO ADENOTONSILLAR HYPERTROPHY

A case is presented in which a child with underlying chronic lung dise ase, developed cor pulmonale and severe pulmonary hypertension as a re sult of adenotonsillar hypertrophy. His cardiac function acutely decom pensated with an upper respiratory infection which exacerbated his obs tructive sleep symptoms. Pre and postoperative documentation of cardio pulmonary function was critical in the peri-operative management of th is patient. His severe pulmonary hypertension was stabilized using a n asopharyngeal airway and medications pre-operatively, in order to mini mize his risk of anesthesia. He continued to require careful monitorin g and manipulation of his medications after adenolonsillectomy and bro nchoscopy. Serial echocardiograms documented the effects of the variou s interventions implemented in this patient. Severe acute right heart failure is an unusual complication of obstructive sleep apnea. However , this may become more common as more children survive prematurity and its associated chronic lung disease. These children may have subclini cal lung disease and/or chronic pulmonary hypertension even after they no longer require supplemental oxygen and bronchodilators. Because th ese children are often tenuous, with regard to their cardiopulmonary f unction, they may be at increased risk to develop significant complica tions related to obstructive sleep apnea. It is important that a physi cian familiar with the management of pulmonary hypertension be involve d in the care of these patients. (C) 1997 Elsevier Science Ireland Ltd .