CHRONIC NASOPHARYNGEAL OBSTRUCTION AS A CAUSE OF CARDIOMEGALY, COR PULMONALE, AND PULMONARY EDEMA
1 Cardiac Clinic of The Children's Medical and Surgical Center, The Johns Hopkins Hospital, Baltimore, Maryland
Partial airway obstruction and respiratory abnormality due to enlargement of tonsils and adenoids is a well-recognized clinical entity, but the cardiorespiratory changes which severe chronic obstruction may cause have not been widely documented. Four patients with severe nasopharyngeal obstruction have been observed to have cardiorespiratory complications ranging from moderate cardiac enlargement and right ventricular hypertrophy to cor pulmonale and pulmonary edema. Hemodynamic studies showed swings in pulmonary artery and aortic pressures; pCO2 was varyingly elevated in arterialized capillary blood.
It is believed that hypoxia leads to increased pulmonary resistance and elevated pulmonary artery pressure which, over a period of months, results in right heart hypertrophy and failure. Furthermore, hypoxia may contribute to the development of pulmonary edema in a manner similar to that which occurs at high altitudes. Wide swings in intrathoracic pressure also probably played an important role in the etiology of pulmonary edema. Individual susceptibility to hypoxia and pressure changes is suspected to be an important etiologic factor.
The problem of chronic upper airway obstruction caused by tremendously enlarged tonsils and adenoids in children warrants further investigation and more widespread recognition as being potentially dangerous from cardiorespiratory standpoints.
Submitted on August 30, 1965Accepted on December 10, 1965
This article has been cited by other articles:
![]() |
M. Rappai, N. Collop, S. Kemp, and R. deShazo The Nose and Sleep-Disordered Breathing: What We Know and What We Do Not Know Chest, December 1, 2003; 124(6): 2309 - 2323. [Abstract] [Full Text] [PDF] |
||||
![]() |
G. M. MEREDITH Adenotonsillectomy Arch Otolaryngol Head Neck Surg, June 1, 1990; 116(6): 741 - 741. [Abstract] [PDF] |
||||
![]() |
A. M. Talaat and M. M. Nahhas Cardiopulmonary Changes Secondary to Chronic Adenotonsillitis Arch Otolaryngol Head Neck Surg, January 1, 1983; 109(1): 30 - 33. [Abstract] [PDF] |
||||
![]() |
M. G. Lind and B. P. W. Lundell Tonsillar Hyperplasia in Children: A Cause of Obstructive Sleep Apneas, CO2 Retention, and Retarded Growth Arch Otolaryngol Head Neck Surg, October 1, 1982; 108(10): 650 - 654. [Abstract] [PDF] |
||||
![]() |
R. LaPenna and G. M. Folger JR Extreme Upper Airway Obstruction with the Marshall Syndrome Clinical Pediatrics, August 1, 1982; 21(8): 507 - 510. [PDF] |
||||
![]() |
O. R. Levine and M. Simpser Alveolar Hypoventilation and Cor Pulmonale Associated with Chronic Airway Obstruction in Infants with Down Syndrome Clinical Pediatrics, January 1, 1982; 21(1): 25 - 29. [Abstract] [PDF] |
||||
![]() |
T. W. Rowland, L. G. Nordstrom, M. S. Bean, and H. Burkhardt Chronic Upper Airway Obstruction and Pulmonary Hypertension in Down's Syndrome Arch Pediatr Adolesc Med, November 1, 1981; 135(11): 1050 - 1052. [Abstract] [PDF] |
||||
![]() |
L. Fan and S. Murphy Pectus Excavatum From Chronic Upper Airway Obstruction Arch Pediatr Adolesc Med, June 1, 1981; 135(6): 550 - 552. [Abstract] [PDF] |
||||
![]() |
K. Kuban Recurrent Hypersomnia Secondary to Sleep Apnea Arch Neurol, November 1, 1978; 35(11): 772 - 772. [Abstract] [PDF] |
||||
![]() |
D. Mangat, W. C. Orr, and R. O. Smith Sleep Apnea, Hypersomnolence, and Upper Airway Obstruction Secondary to Adenotonsillar Enlargement Arch Otolaryngol Head Neck Surg, July 1, 1977; 103(7): 383 - 386. [Abstract] [PDF] |
||||
![]() |
A. G. TILKIAN, C. GUILLEMINAULT, J. S. SCHROEDER, K. L. LEHRMAN, F. B. SIMMONS, and W. C. DEMENT Hemodynamics in Sleep-Induced Apnea: Studies during Wakefulness and Sleep Ann Intern Med, December 1, 1976; 85(6): 714 - 719. [Abstract] [PDF] |
||||
![]() |
G. Coccagna, G. di Donato, P. Verucchi, F. Cirignotta, M. Mantovani, and E. Lugaresi Hypersomnia With Periodic Apneas in Acquired Micrognathia: A Bird-like Face Syndrome Arch Neurol, November 1, 1976; 33(11): 769 - 776. [Abstract] [PDF] |
||||
![]() |
A. A. Clairmont, N. J. Hart, D. T. Rooker, and R. H. Franch Upper Airway Obstruction and Ventricular Septal Defect JAMA, August 18, 1975; 233(7): 813 - 814. [Abstract] [PDF] |
||||
![]() |
A. R. Talbot and L. W. Robertson Cardiac Failure With Tonsil and Adenoid Hypertrophy Arch Otolaryngol Head Neck Surg, October 1, 1973; 98(4): 277 - 281. [Abstract] [PDF] |
||||
![]() |
W. T. Shearer, H. F. Biller, J. H. Ogura, and D. Goldring Congenital Laryngeal Web and Interventricular Septal Defect: First Reported Cases Arch Pediatr Adolesc Med, June 1, 1972; 123(6): 605 - 607. [Abstract] [PDF] |
||||
![]() |
R. E. WALSH, E. D. MICHAELSON, L. E. HARKLEROAD, A. ZIGHELBOIM, and M. A. SACKNER Upper Airway Obstruction in Obese Patients with Sleep Disturbance and Somnolence Ann Intern Med, February 1, 1972; 76(2): 185 - 192. [Abstract] [PDF] |
||||
![]() |
E. L. Gresham and J. G. Armstrong Cardiac Failure from Tonsillar Enlargement A Reminder Clinical Pediatrics, April 1, 1971; 10(4): 236 - 238. [PDF] |
||||
![]() |
G. G. Cayler, E. E. Johnson, B. E. Lewis, J. D. Kortzeborn, J. Jordan, and G. A. Fricker Heart Failure Due to Enlarged Tonsils and Adenoids: The Cardiorespiratory Syndrome of Increased Airway Resistance Arch Pediatr Adolesc Med, November 1, 1969; 118(5): 708 - 717. [Abstract] [PDF] |
||||
![]() |
R. M. Jeresaty, R. J. Huszar, and S. Basu Pierre Robin Syndrome: Cause of Respiratory Obstruction, Cor Pulmonale, and Pulmonary Edema Arch Pediatr Adolesc Med, June 1, 1969; 117(6): 710 - 716. [Abstract] [PDF] |
||||
![]() |
H. E. Evans Tonsillectomy and Adenoidectomy: Review of Published Evidence For and Against the T and A Clinical Pediatrics, February 1, 1968; 7(2): 71 - 75. [Abstract] [PDF] |
||||











