Three children with Down's syndrome, ventricular septal defect, pulmonary hypertension and clinical evidence of upper airway obstruction had the trachea electively intubated while pulmonary artery pressures were monitored. In two, the pulmonary pressures immediately decreased and systemic arterial oxygen saturations increased. Both of these children showed dramatic clinical improvement after tonsillectomy. These cases indicate that elective tracheal intubation is a valuable diagnostic procedure to demonstrate the role of upper airway obstruction in the maintenance of reversible pulmonary hypertension in children with Down's syndrome and right to left shunts.
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