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THE NORMAL AORTIC ROOT AND CUSP CONFIGURATION IN PEDIATRIC PATIENTS: GUIDE TO A SUCCESSFUL AORTIC VALVE REPAIR
Ismail Bouhout1, Marien Lenoir1, Rong Wu1, Jean-luc Bigras1, Nagib Dahdah1, Ismail El-Hamamsy2, Marie-Josée Raboisson1, Nancy Poirier1.
1CHU ME SAINTE JUSTINE, Montreal, QC, Canada, 2Montreal Heart Institute, Montreal, QC, Canada.

Objectives: In adults, aortic cusps heights and root dimensions measured intra-operatively have improved valve repair durability. The aim of this study is to determine a normogram for these dimensions in pediatric patients to guide valve repair.Methods:
Healthy patients under 18-years-old (n=714, 52% male) who had a normal transthoracic echocardiogram at our institution in 2017 were included. The primary endpoint was the effective height (eH) (distance between the central free margins and the atrioventricular junction). Secondary endpoints were geometric height (gH) (the two-dimensional cusp height) and aortic root dimensions (annulus, Sinus of Valsalva diameter and sinotubular junction). Regression models were tested to examine the relationships between the body surface area (BSA) and each of the measures.
Results:
A logarithmic model was used. The eH correlated with the BSA (R2=0.52 and R=0.72), Figure. A chart of normal values is displayed in the Table. Similarly the gH (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 BSA.
Conclusions:
This normogram provides a guiding tool for repairs in pediatric patients. A validation study is needed to assess the value of this chart in predicting long-term repair durability.


Effective height normogram
BSA (m2)Cusp effective height (in mm)
0.24 ± 1
0.35 ± 1
0.4-0.56 ± 1
0.6-1.07 ± 1
1.1-1.78 ± 1
1.8-2.09 ± 1