الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 138 |  |  |
| | | from | 138 | | |
Abstract
SUMMARY
Adenotonsillar hypertrophy (ATH) and mouth breathing syndrome (MBS) is a common condition in pediatric patients with upper respiratory airways complaints, pulmonary hypertension (PH) may be one complication of that condition.
Chronic oral respiration, consequent malocclusion and abnormal maxillofacial development may develop as a result of upper respiratory tract obstruction in these children. Furthermore, snoring, sleeping with the mouth open, enuresis, bad academic performance and sleep disorders secondary to decrease the oxygenation have been observed.
Chronic upper airway obstruction may lead to alveolar hypoventilation, which consequently lead hypoxemic pulmonary vasoconstriction and increase pulmonary artery pressure.
Pulmonary hypertension (PH) is considered when mean pulmonary artery pressure higher than or equal to 25 mmHg.
There are some conditions that can be considered as predisposing factors for mouth breathing syndrome (MBS):
Long-faced, slender persons in whom the pharyngeal space is normally long, but very narrow (narrow airway)
Craniofacial disorders: Down syndrome,etc….
Septal deviation, chronic sinusitis, nasopharyngeal stenosis
Obesity
Gastroesophageal reflux (infant)
Cleft palate following pharyngeal flap surgery
Echocardiography, as a noninvasive and reproducible diagnostic method, is quite useful in evaluating the Cardiac functions and pulmonary artery pressure in these patients.
The present study was a prospective cohort study, carried out from the ENT outpatient clinics of 6th October University teaching Hospital, it takes 2 years to collect all the patient’s data and to complete the investigations. It included 75 patients diagnosed with mouth breathing syndrome, for adenotonsillectomy or adenoidectomy aged between (2-14) years.
All cases were subjected to:
History taking:
o Personal history of name, age, sex, etc…
o History of Symptoms of mouth breathing syndrome (snoring, secondary enuresis, night terrors, sleep walking,etc…).
o History of Cardiac Symptomes (Dizziness, Syncope, Lower limbs swelling,etc…)
o History of previous cardiac investigations.
General examination
o Anthropometric measurements: height, weight, body surface area was calculated (BSA).
Signs of adenoid hypertrophy (Drowsy-looking eyes, Dark circles under the eyes, Narrow, pinched-in nostrils, Open mouth expression, Elongated facial shape, V-shaped dental arches, etc…).
o Signs of right sided heart failure (congested neck vein, lower limbs edema, abdominal swelling).
o Signs of low cardiac output (tachycardia, hypotension, increased capillary refill time, decreased urine output,etc)
Local cardiac examination
o Signs of pulmonary hypertension and right ventricular enlargement (Inspection, Palpation and Auscultation)
Investigations:
Routine:
o Complete blood picture (CBC)
Specific:
o Transthorathic Echocardiography
The following measurement were recorded from the from M-mode:
• Aortic root diameter
• Left atrial diameter
• Left ventricular end systolic& diastolic diameter
• Left ventricular ejection fraction&fraction shorting
Doppler Echocardiography was used to measure:
• Right ventricular systolic function (TAPSE)
• Right ventricular systolic pressure
• Right atrial pressure
• Pressure pulmonary flow acceleration time
• TR maximum velocity.
• PG across tricuspid valve.
• Pulmonary artery pressure was estimated according to the Bernoulli’s equation (MPAP=0.61X SPAP+2mmHg).
• Present study results revealed that 27 patients (36%) had no pulmonary hypertension PH (normal pulmonary artery pressure).
o 48 patients (64%) had elevated pulmonary artery pressure (PH) above the normal ranges (pulmonary hypertension PH)
o 44 patients (58.7%) with mild PH
o 4 patients (5.3%) with moderate PH
o Symptomes of pulmonary congestion (Orthopnea, Exertional dyspnea, Recurrent chest infection and Paroxysmal nocturnal dyspnea) found in 61 patients (81.3%)
o Symptomes that suggest right side heart failure (dyspepsia and abdominal distension) was found in24 patients (18%).