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Two-dimensional echocardiographic aortic root dimensions in normal children and adults
M J Roman1, R B Devereux, R Kramer-Fox
1Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
The American Journal of Cardiology
|September 1, 1989
Summary
Two-dimensional echocardiography measurements of the aortic root are influenced by age and body size, not blood pressure. Using M-mode nomograms with 2D data overdiagnoses aortic dilatation, especially in children.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Ultrasound
Background:
- Two-dimensional echocardiography (2D echo) is crucial for assessing aortic root dimensions, offering prognostic insights for conditions like aortic regurgitation and Marfan syndrome.
- Current methods for detecting aortic root dilatation rely on nomograms derived from M-mode echocardiography.
- Discrepancies exist between 2D echo and M-mode measurements, potentially leading to diagnostic inaccuracies.
Purpose of the Study:
- To compare aortic root dimensions measured by 2D echo with M-mode findings in normal adults and children.
- To evaluate the influence of age, gender, body habitus, blood pressure, and stroke volume on 2D echo aortic root measurements.
- To establish accurate diagnostic criteria for aortic root dilatation using 2D echo.
Main Methods:
- 135 normal adults and 52 normal children underwent 2D echocardiography to measure aortic root dimensions at multiple levels.
- Measurements were compared with age, gender, body habitus, blood pressure, stroke volume, and M-mode nomograms.
- Correlation and regression analyses were performed to assess influencing factors and establish normal limits.
Main Results:
- 2D echo measurements at the sinuses of Valsalva were significantly larger than M-mode values, leading to overdiagnosis of dilatation in 40% of children and 19% of adults.
- Aortic root dimensions showed strong correlation with body surface area in children and younger adults, but weaker correlation in older adults.
- Gender influenced aortic root size in adults, but indexing to body surface area normalized dimensions. Age significantly affected supraaortic ridge and ascending aorta diameters.
Conclusions:
- 2D echo aortic root dimensions are primarily influenced by age and body size, independent of blood pressure.
- M-mode nomograms are inappropriate for 2D echo measurements, causing overdiagnosis of aortic dilatation.
- Body surface area-indexed nomograms are recommended for children, and an upper limit of 2.1 cm/m² for the sinuses of Valsalva provides 98% specificity in adults.