Echocardiographic assessment of aortic root dimensions in normal children based on measurement of a new ratio of aortic size independent of growth

Abstract

Two-dimensional echocardiography is commonly used as a method of monitoring aortic root dimensions in children with connective tissue disease. Measurements are usually standardized to body surface area (BSA) to account for growth. However, there are several theoretical and practical disadvantages to adopting this approach, and there has been little investigation of alternative methods of standardization. This study of 48 normal children and adolescents (age range 2 weeks to 23 years) was performed to determine the relation of 2-dimensional echocardiographic aortic root dimensions to indexes of body size and growth, and to examine a simple means of internally standardizing aortic root measurements to create an index of aortic root size independent of growth. Maximal diameters in the parasternal long-axis view were recorded at 4 levels: annulus, sinuses of Valsalva (SOV), supraaortic ridge (SAR), and ascending aorta (AAO). Ratios of aortic root size were created by internally standardizing aortic root diameters to aortic annular size. All diameters correlated closely with age, height, weight, and BSA (all r > 0.87). Linear regression in each case showed a significant positive slope (all p < 0.0001). The best predictor of aortic dimensions was height, with r values of 0.93 for annulus, SOV, and AAO, and 0.95 for SAR. Ratios of SOV/annulus, SAR/annulus, and AAO/annulus remained constant, with no correlation with age or any growth parameters. Mean values and 95% confidence limits were: SOV/annulus 1.37 (1.18-1.56); SAR/annulus 1.11 (0.95-1.28); and AAO/annulus 1.16 (0.97-1.35). Standardization to height, or the use of internally standardized aortic root ratios, provides a simple and accurate alternative to standardization to BSA for assessing aortic root dimensions in normal growing children.