Tonsillar Hypertrophy, Airway Obstruction, Alveolar Hypoventilation, and Cor Pulmonale in Twin Brothers

¹ Chief Cardiologist, District of Columbia General Hospital. Associate Professor of Medicine, George Washington University School of Medicine
² Cardiopulmonary-Angio Laboratory, The District of Columbia General Hospital, Washington, D.C.; George Washington University Medical Division
³ Chief, Pediatrics Department, District of Columbia General Hospital
⁴ Medical Officer, Pediatrics Department, District of Columbia General Hospital
⁵ Cardiologist, District of columbia General Hospital; Instructor in Medicine, George Washington University School of Medicine
⁶ Chief Resident, Pediatrics Department, District of Columbia General Hospital

Twin brothers suffering from severe alveolar hypoventilation secondary to tonsillar hypertrophy are presented. The ventilatory abnormalities were more severe in the child with greater degree of upper airway obstruction. Pulmonary hypertension and right ventricular failure developed only in the latter twin thus confirming a cause-effect relationship between upper airway obstruction and the cardiac complications. The cardiac abnormalities were completely relieved after tonsillectomy, but not after adenoidectomy in the child who had both procedures. The procedure of cardiac catheterization was complicated by considerable respiratory difficulty and cardiac arrest in the twin with larger tonsils. When the right heart catheter was left open to air for a short time, large quantities of air were sucked into the heart causing near fatal air embolism. This danger should be kept in mind when patients with upper airway obstructions are catheterized. There seems to be a definite place for tonsillectomy when the tonsils are sufficiently large to interfere with ventilation.