Normal Values of Aortic Root Dimensions in Healthy Adults

doi:10.1016/j.amjcard.2014.06.028

The American Journal of Cardiology

Volume 114, Issue 6, 15 September 2014, Pages 921-927

https://doi.org/10.1016/j.amjcard.2014.06.028 Get rights and content

The reported ranges of aortic root (AR) diameters are limited by small sample size, different measurement sites, and heterogeneous cohorts. The aim of this study was to explore the full spectrum of AR diameters by 2-dimensional transthoracic color Doppler echocardiography (TTE) in a large cohort of healthy adults. From June 2007 to December 2013, a total of 1,043 Caucasian healthy volunteers (mean age 44.7 ± 15.9 years, range 16 to 92 years, 503 men [48%]) underwent comprehensive TTE. TTE measurements of the AR were made at end-diastole in parasternal long-axis views at 4 levels: (1) annulus, (2) sinuses of Valsalva, (3) sinotubular junction, and (4) proximal ascending aorta. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas body surface area–indexed aortic diameters were greater in women (p = 0.0001). No significant gender differences were registered for sinuses of Valsalva and sinotubular junction to annulus diameter ratios (p = 0.9), whereas ascending aorta to annulus diameter ratio was higher in women (p = 0.0001). There was a straight correlation between aortic diameters (absolute and indexed values), their ratios, and age in both genders (p = 0.0001). In conclusion, we provide the full range of AR diameters by TTE. Knowledge of upper physiological limits of aortic dimensions is mandatory to detect aorta dilatation, follow up the disease over time, and plan appropriate therapeutic interventions.

Section snippets

Methods

From June 2007 to December 2013, a sample of 1,142 consecutive apparently health adults were referred to echocardiographic laboratories of the Department of Cardiology and Emergency Medicine of San Antonio Hospital, San Daniele del Friuli, Udine, Italy and Division of Cardiology, “Cava de' Tirreni-Amalfi Coast,” Heart Department, University Hospital of Salerno, Italy, for the purpose of present study. The subjects underwent voluntary (or for work ability assessment) full screening for

Results

The studied population included 1,043 healthy subjects: 503 men and 540 women. Women were slightly older, lighter, and smaller than men. They had lower BP but higher heart rate. On TTE, they had smaller LV dimensions and mass but similar E/A ratio (Table 1). The intraobserver variability analysis revealed Pearson correlations as follows: r = 0.90 (p <0.0001) for the aortic annulus, r = 0.97 (p <0.0001) for the sinuses of Valsalva, r = 0.96 (p <0.0001) for the sinotubular junction, and r = 0.86

Discussion

Roman et al² demonstrated, in a series of 135 normal adults and 52 children, that TTE measurements at the sinuses of Valsalva correlated closely with the BSA in the children, moderately in the adults aged ≥40 years, and weakly in the older adults. Gender influenced the AR size at all levels, and although the indexed dimensions were not statistically different between genders, they had the tendency to be greater in women. Age strongly influenced the supra-aortic ridge and ascending aortic

Acknowledgment

The authors are grateful to Dr. Luca Carannante, cardiovascular technologist, for data management and statistical support.

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The adult thoracic aortic diameter is dependent on sex, body size and age, with normal measurements ranging from 3.5 to 4.0 cm at the aortic root, tapering distally to 2.4-2.7 cm at the level of the diaphragm, with larger diameters seen particularly in older males.5 Although the aortic diameter increases slightly with age, the diameter of the mid-ascending aorta should always be less than 4 cm while that of the descending aorta no more than 3 cm.9-11 Ascending aortic diameter of 55 mm or annual increase of more than 5 mm prompts consideration of surgical intervention in patients without a history of genetic predisposition.6
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MiscellaneousNormal Values of Aortic Root Dimensions in Healthy Adults

Section snippets

Methods

Results

Discussion

Acknowledgment

Am J Cardiol

Am J Cardiol

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

Am J Cardiol

Miscellaneous
Normal Values of Aortic Root Dimensions in Healthy Adults