Aortic size in children: Systolic measurements are different from diastolic measurements
Mohammad F Al-mousily1, Leo Lopez2, Juan Carlos Muniz3, Nao Sasaki3, Irwin Seltzer3, Joshua Gruber3, Elizabeth Welch3
1 Department of Cardiology, Nicklaus Children's Hospital, Miami, FL; Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
2 Department of Cardiology, Nicklaus Children's Hospital, Miami, FL; Department of Pediatric Cardiology, Stanford, Palo Alto, CA, USA
3 Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
Mohammad F Al-mousily,
Department of Cardiology, Medical University of South Carolina, 10 McClennan Banks Dr., MSC915, Charleston, SC 29425
Source of Support: None, Conflict of Interest: None
Background : Current guidelines recommended aortic measurements during diastole in adults and during systole in children. Recent studies in adults have demonstrated noteworthy differences in aortic measurements during systole and diastole in the same subjects. In the present study, we aimed to characterize systolic and diastolic differences in aortic measurements in healthy children.
Materials and Methods : This retrospective study included 272 children who had a complete echocardiogram and no heart disease. Aortic measurements at the annulus (ANN), aortic root (AOR), sinotubular junction (STJ), and ascending aorta (AAO) were performed. Systolic and diastolic values were compared by calculating the mean systolic to diastolic (SD) percent difference for each segment; if the SD difference was >5%, it was considered clinically important. Similar measurements were conducted by another observer in 18% of the subjects.
Results : Systolic measurements were larger than diastolic measurements with mean SD percent differences >5% (P < 0.001) for the AOR (7.3% ± 5.5%), STJ (10.24% ± 7.1%), and AAO (9.8% ± 7.4%). There was no clinically significant SD difference for the ANN. There was an excellent intraclass correlation coefficient between observers (0.982–0.995).
Conclusions : Systolic measurements for the AOR, STJ, and AAO were larger than diastolic measurements. Normal reference values are utilized to design treatment for patients with abnormal aortic sizes, and the timing in the cardiovascular cycle used to decide the reference values should be equivalent to the timing used to make measurements in clinical practice. This is particularly imperative as patients transition their care from a pediatric to an adult cardiologist.