BACKGROUND: In adult patients, aortic root and cusp dimensions help predict successful surgical aortic valvuloplasty (SAV). While a tailored surgical approach has improved valve repair in young adults, a systematic approach to pediatric SAV remains to be determined. The aim of this study is to determine a normogram for aortic root and cusp dimensions in healthy pediatric population .
METHODS AND RESULTS: All patients under 18 years old (n=714, 52% male) who had a normal transthoracic echocardiogram at our institution between January and July 2017 were included. Patients with aortic valve regurgitation, other cardiac lesions and syndromic children were excluded. Patients were divided in 3 groups: neonates and infants ( < 1 year old), children (1–12 years) and adolescent (13–18 years). The primary endpoint was the effective height defined as the height difference between the central free margins and the atrioventricular junction. Secondary endpoints were geometric height (the two-dimensional cusp height) and aortic root dimensions (aortic annulus, Sinus of Valsalva diameter and sinotubular junction). Regression models were tested to examine the relationships between parameters of body size and each of the echocardiography variables. The model with the highest R2 value was considered to provide the best fit.
A logarithmic model was used for all the correlations. The effective height correlated with the body surface area (BSA) (R2=0.52 and R=0.72), Figure 1. Similarly the geometric height (R2=0.81 and R=0.90), the aortic annulus (R2=0.80 and R=0.89), the sinus of Valsalva (R2=0.89 and R=0.94) and the sinotubular junction (R2=0.89 and R=0.94) correlated with the body surface area. A chart of normal values has been derived from these models and presented in Figure 2.
CONCLUSION: This normogram provides a guiding tool for SAV in pediatric patients. A validation study is needed to assess the value of this chart in predicting long-term SAV durability.