title: Nomograms for aortic root diameters in children using two-dimensional echocardiography.
abstract: The evaluation of aortic root dilation is of major importance for the diagnosis and follow-up of patients with diverse diseases, including the Marfan syndrome. However, we noted that the available nomograms suggested a lower aortic root dilation rate in adults (75%) than in children (90%), when the opposite would have been expected. To establish new nomograms, we selected a population of 353 normal children. We took transthoracic echocardiographic measurements of the aortic root diameters at the level of the aortic annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta according to the American Society of Echocardiography recommendations. All diameters correlated well with the height, weight, body surface area, and age (r = 0.75 to 0.84, p <0.0001). Covariance analysis adjusting for body surface area showed slightly larger diameters at the level of the sinuses of Valsalva in male children than in female children (+1 mm, p = 0.0002). Equations and derived nomograms were developed, giving the upper limit of normal (allowing simple recognition of aortic dilation) and the Z score (allowing fine quantification of dilation and differentiation of normal growth from pathologic dilation) for all 4 aortic root diameters (ie, aortic annulus, sinuses of Valsalva, sinotubular junction, and proximal ascending aorta) according to body surface area and gender. We applied the nomograms to 282 children with confirmed Marfan syndrome, of whom 65.2% presented with dilation of the sinuses of Valsalva. In conclusion, we propose equations to calculate the upper limit of normal and Z-score for aortic root diameters measured by 2-dimensional echocardiography, which should be useful tools for the diagnosis and follow-up of aortic root aneurysms in children.
authors.affiliation: Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, Paris, France; Service de Cardiologie, Hôpital Bichat, AP-HP, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gautier
authors.forename: Delphine
authors.initials: D
authors.lastname: Detaint
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: Gabriel
authors.initials: G
authors.lastname: Delorme
authors.forename: Florence
authors.initials: F
authors.lastname: Arnoult
authors.forename: Olivier
authors.initials: O
authors.lastname: Milleron
authors.forename: François
authors.initials: F
authors.lastname: Raoux
authors.forename: Chantal
authors.initials: C
authors.lastname: Stheneur
authors.forename: Catherine
authors.initials: C
authors.lastname: Boileau
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
mesh_terms: D000293:Adolescent; D001011:Aorta / Q000000981:diagnostic imaging* / Q000473:pathology; D015992:Body Mass Index; D001830:Body Surface Area; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D049451:Nomograms; D012016:Reference Values; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging