Development of algorithms for proximal thoracic aortic dilatation diagnostics for pediatric practitioners

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Aortic dilation may manifest in childhood subsequently resulting in the formation of an intramural hematoma or dissection. The asymptomatic nature of the disease and the absence of unified echocardiographic algorithms for its detection contribute to its underestimation and the inability to implement timely monitoring of patients. The purpose of this research was to develop algorithms for diagnosing dilation of various parts of the thoracic aorta in children using cardiac ultrasound - echocardiography (ECHO). Materials and methods used: a single-center cross-sectional study had been carried out on the basis of the cardiological department of the Z.A. Bashlyaeva Children’s City Clinical Hospital of the Moscow Department of Healthcare (Moscow, Russia): 11,516 primary ECHO protocols in patients aged 7 and up to 18 y/o, 7.5% (869) of which had records regarding aortic dilation, were identified. 572 with hemodynamically significant CHD were excluded from the study therefore the remaining 297 (76.8% (228) boys) with a median age of 14.2 (11.3; 16.4) y/o were studied for the parameters as follows: internal diameters of the aorta at the level of the sinuses of the Valsalva (SV), sinotubular junction (STJ) and ascending aorta (AAo) in systole. Aortic dilation was defined as a size exceeding 2z at any level, and an aneurysm was defined as exceeding 3z. Results: a total of 116 had a bicuspid aortic valve (BAV), 181 demonstrated a tricuspid valve (TAV) without significant concomitant heart pathology (“idiopathic dilation” (IDAo)). Dilation and AAo aneurysm were more prevalent than in the SV region (73.4% v 28%, р<0.001 and 25.2% v 3.7%, р<0.001, respectively). The presence of BAV was identified as a significant risk factor, in which AAo dilation occurred more frequently than in TAV (1.96 times higher, 95% CI 1.12-3.44, p=0.017) and AAo aneurysm occurred with a 3.07 times higher frequency (95% CI 1.79-5.25 р<0.001). Conclusion: the structure of aortic pathology in children is dominated by AAo dilation. ECHO requires visualization of the entire proximal aorta, not merely the aortic valve and SV that are typically assessed in outpatient practice. Authors represent a diagnostic algorithm and methodological guidelines for assessing the condition of the aorta in children.

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