COR PULMONALE AS A RESULT OF CHRONIC NASOPHARYNGEAL OBSTRUCTION DUE TO HYPERTROPHIED TONSILS AND ADENOIDS

Three cases are reported of the syndrome of cor pulmonale in children due to chronic nasopharyngeal obstruction by hypertrophied tonsils and adenoids. The syndrome is characterized by: (1) Stridor in the supine position due to nasopharyngeal obstruction by hypertrophied tonsils and adenoids. (2) Somnolence. (3) Pulmonary hypertension. (4) Right heart failure. (5) Arterial hypoxia and hypercarbia. (6) Electrocardiographic changes suggestive of right atrial and right ventricular hypertrophy and right ventricular strain. (7) Radiographic appearances of cardiomegaly, dilatation of the pulmonary artery, and often pulmonary oedema. The probable pathogenesis of the syndrome is that pulmonary hypoventilation leads to arterial hypoxaemia and acidaemia, which in turn lead to pulmonary vasoconstriction and hypertension. Cardiac failure should first be treated medically, and the tonsils and adenoids should subsequently be removed. Sleeping in the prone position often relieves the upper respiratory obstruction. O2 should be given with care since it may exacerbate the symptoms.