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Forum Name: Valvular Heart Diseases

Question: Aortic Root Dilatation


 CT93 - Thu Apr 30, 2009 6:43 pm

After a doctor heard a heart murmur on my child we went in for an echocardiogram. She had aortic root dilatation listed under the findings. I have an appointment for my child with a pediatric cardiologist, however, it is going to be 6 weeks before they can get me in and I'm looking for some answers.

How is an aortic root dilatation diagnosed on an echocardiogram under findings & conculsions? Is it strictly taken from the measurments not being what they are predicted to be? Or is it also visual?

Are there errors in the interpretation of echocardiograms?

The only thing negative on the report was the aortic root dilatation, everything else noted was good. What other conditions (other than Marfan) might result in an aortic root dilatation of a 16 year old?

Thank you for your help.
 John Kenyon, CNA - Sun May 03, 2009 9:41 pm

User avatar Hello --

Aortic root dilation is usually correctly diagnosed via echo, but there can be errors. It is properly diagnosed by measurement deviations, although if it is grossly dilated it might first be noted visually alone. This would be very unusual. Dilation is not, in itself, necessarily problematic, but often is, and should be followed periodically.

The most common cause, aside from Marfan syndrome, is bicuspid aortic valve (two leaves instead of three), although it is unclear exactly what the connection is. If this finding wasn't noted and your daughter doesn't appear to have Marfan's then this may be a one-time misread or oddity which may not show up in followup. If it does persist, then it's there, but still may not mean anything. It can be simply idiosyncratic. So long as it doesn't undergo significant change it shouldn't cause any problems. The measurement could be very minimal.

I hope this answers your question. Please follow up with us here as needed.
 CT93 - Fri May 15, 2009 2:19 pm

I would like to thank you so much for replying to my post. I thought the appointment would be 6 weeks, however, the ped. card. dept. called me up and said it will be mid-August. We're trying to look at that like that is a good thing since they do not want to see her right away and the person who called said that the doctors (who reviewed her echo. report) would have asked her to come in right away if they thought she was in danger.

My daughter is 5' 7" and weighs 114 pounds. I came up with a BSA of 1.55. There was no bicuspid valve noted in the report so hopefully that means that the radiologist saw that area and it was normal. Under m-mode, her aortic root diam. was 31. Under 2-D her AV Ann. was 22, Sin. of Val. was 24 and her ST junction was 28. I called up the hospital that did the echo. because I noticed her height & weight incorrect on the report (they had her BSA at 1.45 with the wrong height & weight). I was asking a pediatric echo. tech. if that could account for why the dilation was noted in the report. She said it would make a slight difference, but not enough to run another report. She brought up my daughter's echo. on her computer and she said she could not actually see where the 31 was measured, but said that she would have probably measured the S of V just a little larger and the ST j. a little smaller. She said it didn't really look too worry-some. She said sometimes it could be the angle of the picture, they way she was lying or she may be growing (which I think she just grew 1/2 inch since the echo). Are those possibilities? She also said the radiologist that read it probably meant the aortic root was just mildly dilated.

Other than the items listed below, everything else was noted as normal size &/or functioning.
Left heart:
• systolic bowing without evidence of prolapse
• trace mitral regurgitation
• aortic root dilatation present
Right heart:
• trace physiologic tricuspid regurgitation; trace pulmonary valve regurgitation

Also, can you explain the systolic bowing and if that is a problem? The echo. tech. told me it is not perfect, but is only a problem if it is with prolapsed. Does this mean she is more likely to develop prolapse?

When the doctor originally heard the murmur, my daughter was extremely worried. The doctor just mentioned she wanted to have her blood drawn for some testing. I could see the panic come over my daughter’s face. The doctor then continued to ask her other questions (because it was an annual physical) and I could just see my daughter getting more nervous as the doctor spoke, she could hardly think. After that, she examined her (her blood pressure had already been taken when she was calm) and listened to her heart. She had asked me if she had ever had a murmur before which she has not. I asked her what did it sound like and she said “woosh”. Not sure that that means. But, could murmurs sometimes be caused by a sudden increase of blood pressure with stress? I didn’t even think to ask it at that time.

Sorry for so many questions, but 3 months is a long way away. I really appreciate your help and this forum.
 John Kenyon, CNA - Wed May 20, 2009 9:16 pm

User avatar Hello, and thanks for the comprehensive followup. I'm inclined to think as you do, that if the doctor felt there was an issue of great concern he'd have moved the appointment up instead of pushing it ahead. So that's probably a good thing. Also the information you were able to gather is sufficiently vague (on its own merits) to sound pretty benign. The variations were trivial, there was no mention of bicuspid aoritic valve, and while your daughter is tall and thin, that alone doesn't relegate her to Marfan's status. There is actually now a very simple single, non-invasive test using a slit lamp to examine the retina, which will expose nearly all cases of Marfan's so, there being no other problems in the meantime, this is probably fine. All the specific findings were close enough to be fine, and as for the "bowing without prolapse", this is, first, a splitting of hairs, second, not important, and third, could be a precursor of slight prolapse, but even then it is almost never of any significance anyway (except in terms of the disruptive-but-benign symptoms that sometimes accompany it, and she'd already have those now most likely and doesn't). MVP is very rarely a big deal clinically. The bowing is not a problem at all, and is very common.

The murmur, a "whoosh", is pretty vague also, and is not the click murmur heard with MVP. It may be due to the trace tricuspid or pulmonary regurge. When a murmur is described this vaguely it's often meaningless.

One other thing: to answer your question about sudden anxiety can definitely cause a blood pressure spike in certain individuals, and with this the heart's valves, especially the mitral, can expand (the tissues are cardiac, like arteries, and respond to adrenaline rush); this can cause momentary technical MVP or slight changes in the shape of other valves and pretty much everything, but not in an abnormal way. It certainly could account for a vague, nonspecific "whooshing" murmur. It is entirely possible.

Thanks again for followuing up with us, and please update us after the cardiology consult and any other time you may have any questions or concerns. Right now things sound very stable and normal.
 CT93 - Wed Aug 12, 2009 9:37 pm

I was just going to follow up to my original post. My daughter had a new echo done at the pediatric cardiologists office today and the echo came back completely normal. We met with a team of cardiologist as well as a geneologist. They do not suspect marfan and after listening to her heart, the doctor told me her murmur is benign. She is to come back in one year just to make sure no changes since she did have one abnormal echo before, but that every looks good and she can resume eating and doing whatever she wants - great news!

Note: I have to wonder if the echo done the first time was accurate. The person got about 3 phone calls during the echo, she input incorrect weight & height and it looked like some of her measurements were not taken accurately (I have a copy of the actual echo). I watched both echos being done and the echo today was so much clearer to see than the first one (I believe this one is 3-d).
 John Kenyon, CNA - Mon Aug 17, 2009 4:21 pm

User avatar This is really wonderful news even though it does sound the original exam was done carelessly and the distractions and incorrect information entered could/would have likely skewed the results. Is a great relief to know all is normal. Thanks for followup. I feel greatly relieved for all of you.

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