Efficacy of Tonsillectomy on Pulmonary Vascular Hemodynamics in Patients on the Fontan Track

Abstract

Background: Hypertrophy of the tonsils and adenoids is the most common cause of airflow obstruction in the upper airway of pediatric patients. In severe cases, chronic upper airway obstruction presents pulmonary hypertension and cor pulmonale.
Objective: Effect of tonsillectomy and/or adenoidectomy in pediatric patients on the Fontan track was assessed.
Subjects: From 1993 to 2009, tonsillectomies were performed for 9 patients on the so-called Fontan track with upper airway obstruction due to tonsillar hypertrophy.
Methods: We assessed the clinical effects of a tonsillectomy by measuring SpO₂ in all cases and blood gases and catheterization data both before and after the procedure in available 4 cases.
Results: All patients eventually underwent a Fontan operation except 1 who is waiting Fontan completion with good Fontan candidacy after Glenn operation. SpO₂ was increased in all patients from 81±7 % (mean±SD) preoperatively to 85 ± 6 % after the procedure. Mean pulmonary arterial pressure was measured using cardiac catheterization in 4 patients before and after the tonsillectomy, and decreased from 22 ± 12 mmHg to 13 ± 4 mmHg.
Conclusions: A tonsillectomy for patients on various stages of Fontan track with upper airway obstruction due to tonsillar hypertrophy may relieve pulmonary vascular resistance and improve Fontan hemodynamics.