Journal of the American Society of Echocardiography
Volume 25, Issue 2 , Pages 142-152 , February 2012

Limitations of Current Echocardiographic Nomograms for Left Ventricular, Valvular, and Arterial Dimensions in Children: A Critical Review

  • Massimiliano Cantinotti, MD

      Affiliations

    • Fondazione Toscana G. Monasterio, Massa and Pisa, Italy
    • Corresponding Author InformationReprint requests: Massimiliano Cantinotti, MD, Fondazione G. Monasterio, Ospedale del Cuore, via Aurelia Sud, 54100 Massa, Italy.
    • ,
  • Marco Scalese, MD

      Affiliations

    • Institute of Clinical Physiology, Pisa, Italy
    • ,
  • Sabrina Molinaro, PhD

      Affiliations

    • Institute of Clinical Physiology, Pisa, Italy
    • ,
  • Bruno Murzi, MD

      Affiliations

    • Fondazione Toscana G. Monasterio, Massa and Pisa, Italy
    • ,
  • Claudio Passino, MD

      Affiliations

    • Fondazione Toscana G. Monasterio, Massa and Pisa, Italy
    • Scuola Superiore Sant'Anna, Pisa, Italy

References 

  1. Kaski JP, Daubeney PE. Normalization of echocardiographically derived paediatric cardiac dimensions to body surface area: time for a standardized approach. Eur J Echocardiogr. 2009;10:44–45
  2. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Adel K, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465–495
  3. Vasan RS, Levy D, Larson MG, Benjamin EJ. Interpretation of echocardiographic measurements: a call for standardization. Am Heart J. 2000;139:412–422
  4. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108
  5. Cayler GG, Rudolph AM, Nadas AS. Systemic blood flow in infants and children with and without heart disease. Pediatrics. 1963;32:186–201
  6. Graham TP, Jarmakani JM, Canent RV, Morrow MN. Left heart volume estimation in infancy and childhood. Reevaluation of methodology and normal values. Circulation. 1971;43:895–904
  7. Hagan AD, Deely WJ, Sahan D, Friedman WF. Echocardiographic criteria for normal newborn infants. Circulation. 1973;48:1221–1226
  8. Solinger R, Elbl F, Minhas K. Echocardiography in the normal neonate. Circulation. 1973;47:108–118
  9. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–1083
  10. Epstein ML, Goldberg SJ, Allen HD, Konecke L, Wood J. Great vessel, cardiac chamber, and wall growth patterns in normal children. Circulation. 1975;51:1124–1129
  11. Gutgesell HP, Paquet M, Duff DF, McNamara DG. Evaluation of left ventricular size and function by echocardiography. Results in normal children. Circulation. 1977;56:457–462
  12. Roge CL, Silverman NH, Hart PA, Ray RM. Cardiac structure growth pattern determined by echocardiography. Circulation. 1978;57:285–290
  13. Lange L, Fabecic-Sabadi V, Bein G. Echocardiographic normal data for premature and normal newborn infants. [author’s translation] Z Kardiol. 1978;67:534–539
  14. Henry WL, Ware J, Gardin JM, Hepner SI, McKay J, Weiner M. Echocardiographic measurements in normal subjects. Growth-related changes that occur between infancy and early adulthood. Circulation. 1978;57:278–285
  15. Henry WL, Gardin JM, Ware JH. Echocardiographic measurements in normal subjects from infancy to old age. Circulation. 1980;62:1054–1061
  16. Oberhansli I, Brandon G, Lacourt G, Friedli B. Growth patterns of cardiac structures and changes in systolic time intervals in the newborn and infant. A longitudinal echocardiographic study. Acta Peaediatr Scand. 1880;69:239–247
  17. Oberhansli I, Brandon G, Friedli B. Echocardiographic growth pattern of Intracardiac dimension and determinant of function indices during the first year of life. Helv Paediatr Acta. 1981;36:325–340
  18. Riggs TW, Lapin GD, Paul MH, Muster AJ, Berry TE. Measurement of mitral valve orifice area in infants and children by two-dimensional echocardiography. J Am Coll Cardiol. 1983;1:873–878
  19. Sievers HH, Onnasch DG, Lange PE, Bernhard A, Heintzen PH. Dimensions of the great arteries, semilunar valve roots, and right ventricular outflow tract during growth: normative angiocardiographic data. Pediatr Cardiol. 1983;4:189–196
  20. Lange L, Fabecic-Sabadi V, Bein G. Comparative review of normal echocardiographic values from the premature infant to the adolescent. Herz. 1983;8:105–121
  21. Lappen RS, Riggs TW, Lapin GD, Paul MH, Muster AJ. Two-dimensional echocardiographic measurement of right pulmonary artery diameter in infants and children. J Am Coll Cardiol. 1983;2:121–126
  22. Voogd PJ, Rijsterborgh H, Lubsen J, Arntzenius AC, Monsjou LK, Godijn EH. Reference ranges of echocardiographic measurements in the Dutch population. Eur Heart J. 1984;5:762–770
  23. Snider AR, Enderlein MA, Teitel DF, Juster RP. Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects. Am J Cardiol. 1984;53:218–224
  24. Gutgesell HP, Bricker JT, Latson LA, Hawkins EP. Atrioventricular valve annular diameter: two-dimensional echocardiographic-autopsy correlation. Am J Cardiol. 1984;53:1652–1655
  25. King DH, Smith EO, Huhta JC, Gutgesell HP. Mitral and tricuspid valve annular diameter in normal children determined by two-dimensional echocardiography. Am J Cardiol. 1985;55:787–789
  26. Wessel A. Normal values of two-dimensional echocardiographic evaluation of left and right ventricular geometry in children. Herz. 1985;10:248–254
  27. Walther FJ, Siassi B, King J, Wu PY. Echocardiographic measurements in normal preterm and term neonates. Acta Paediatr Scand. 1986;75:563–568
  28. Akiba T, Yoshikawa M, Otaki S, Kobayashi Y, Nakasato M, Suzuki H, et al. Echocardiographic measurements of left ventricle in normal infants and children. Tohoku J Exp Med. 1986;149:31–37
  29. Arjunan K, Daniels SR, Meyer RA, Schwartz DC, Barron H, Kaplan S. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study. J Am Coll Cardiol. 1986;8:1119–1124
  30. Lester LA, Sodt PC, Hutcheon N, Arcilla RA. M-mode echocardiography in normal children and adolescents: some new perspectives. Pediatr Cardiol. 1987;8:27–33
  31. Ichida F, Aubert A, Denef B, Dumoulin M, Van der Hauwaert LG. Cross sectional echocardiographic assessment of great artery diameters in infants and children. Br Heart J. 1987;58:627–634
  32. Burke GL, Arcilla RA, Culpepper WS, Webber LS, Chiang YK, Berenson GS. Blood pressure and echocardiographic measures in children: the Bogalusa Heart Study. Circulation. 1987;75:106–114
  33. Ichida F, Denef B, Dumoulin M, Van der Hauwaert LG. Cardiac chamber growth pattern determined by two-dimensional echocardiography. Heart Vessels. 1988;4:26–33
  34. Regen DM, Graham TP, Wyse RK, Deanfield J, Franklin RC. Left-ventricular cavity dimensions in children with normal and dilated hearts. Pediatr Cardiol. 1988;9:17–24
  35. Hanséus K, Björkhem G, Lundström NR. Dimensions of cardiac chambers and great vessels by cross-sectional echocardiography in infants and children. Pediatr Cardiol. 1988;9:7–15
  36. Oberhoffer R, Lang D, Feilen K. The diameter of coronary arteries in infants and children without heart disease. Eur J Pediatr. 1989;148:389–392
  37. Roman MJ, Devereux RB, Kramer-Fox R, O’Loughlin J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol. 1989;64:507–512
  38. Jarosch S, Döhlemann C. Echocardiography determination of the diameter of the heart and great vessels near the heart and their quotients in the newborn infant and infant. Z Kardiol. 1989;78:172–180
  39. Gutgesell HP, Rembold CM. Growth of the human heart relative to body surface area. Am J Cardiol. 1990;65:662–668
  40. Gutgesell HP, French M. Echocardiographic determination of aortic and pulmonary valve areas in subjects with normal hearts. Am J Cardiol. 1991;68:773–776
  41. Vogel M, Staller W, Buhlmeyer K. Left ventricular myocardial mass determined by cross-sectional echocardiography in normal newborns, infants and children. Pediatr Cardiol. 1991;12:143–149
  42. Sairanen H, Louhimo I. Dimensions of the heart and great vessels in normal children. A postmortem study of cardiac ventricles, valves and great vessels. Scand J Thorac Cardiovasc Surg. 1992;26:83–92
  43. Huwez FU, Houston AB, Watson J, McLaughlin S, Macfarlane PW. Age and body surface area related normal upper and lower limits of M mode echocardiographic measurements and left ventricular volume and mass from infancy to early adulthood. Br Heart J. 1994;72:276–280
  44. Picard MH. M-mode echocardiography: principles and examination techniques. In:  Weyman AE editors. Principles and practice of echocardiography. 2nd ed.. Philadelphia: Lea & Febiger; 1994;p. 282–301
  45. Singh B, Mohan JC. Atrioventricular valve orifice areas in normal subjects: determination by cross-sectional and Doppler echocardiography. Int J Cardiol. 1994;44:85–91
  46. Sheil ML, Jenkins O, Sholler GF. Echocardiographic assessment of aortic root dimensions in normal children based on measurement of a new ratio of aortic size independent of growth. Am J Cardiol. 1995;75:711–715
  47. De Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relation and impact of overweight. J Am Coll Cardiol. 1992;20:1251–1260
  48. Hanseus K, Bjorkhem G, Lundstrom N-R. Cardiac function in healthy infants and children: Doppler echocardiographic evaluation. Pediatr Cardiol. 1994;15:211–218
  49. Tacy TA, Vermilion RP, Ludomirsky A. Range of normal valve annulus size in neonates. Am J Cardiol. 1995;75:541–543
  50. Gruppo Ligure Della Società Italiana di Ecografia Cardiovascolare. Development of allometric equations to establish normal limits for M-mode echocardiographic measurements in the Italian population. G Ital Cardiol. 1996;26:503–517
  51. Lourenço A, Quelhas I, Varandas L, Machado I, Reis F, Sousa F, et al. Echocardiographic evaluation of the aortic and pulmonary valve areas in the newborn infant. Normal patterns. Rev Port Cardiol. 1996;15:225–229
  52. Daubeney PE, Blackstone EH, Weintraub RG, Slavik Z, Scanlon J, Webber SA. Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Cardiol Young. 1999;9:402–410
  53. Kampmann C, Wiethoff CM, Wenzel A, Stolz G, Betancor M, Wippermann CF, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart. 2000;83:667–672
  54. George K, Sharma S, Batterham A, Whytes G, McKenna W. Allometric analysis of the association between cardiac dimension and body size variables in 464 junior athletes. Clinical Science. 2001;100:47–54
  55. Poutanen T, Tikanoja T, Sairanen H, Jokinen E. Normal aortic dimension and flow in 168 children and young adults. Clin Physiol Funct Imaging. 2003;23:224–229
  56. Sluysmans T, Colan SD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol. 2005;99:445–457
  57. Huicho L, Muro M, Pacheco A, Silva J, Gloria E, Marticorena E, et al. Cross-sectional study of echocardiographic characteristics in healthy children living at high altitude. Am J Hum Biol. 2005;17:704–717
  58. Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children: gender-specific differences. [published erratum appears in Pediatr Cardiol 2008;29:475] Pediatr Cardiol. 2005;26:356–360
  59. Poutanen T, Tikanoja T, Sairanen H, Jokinen E. Normal mitral and aortic valve areas assessed by three- and two-dimensional echocardiography in 168 children and young adults. Pediatr Cardiol. 2006;27:217–225
  60. Overbeek LI, Kapusta L, Peer PG, de Korte CL, Thijssen JM, Daniels O. New reference values for echocardiographic dimensions of healthy Dutch children. Eur J Echocardiogr. 2006;7:113–121
  61. Bonatto RC, Fioretto JR, Okoshi K, Matsubara BB, Padovani CR, Manfrin TC, et al. Percentile curves of normal values of echocardiographic measurements in normal children from the central-southern region of the State of São Paulo, Brazil. Arq Bras Cardiol. 2006;87:711–721
  62. Kaldararova M, Balazova E, Tittel P, Stankovicova I, Brucknerova I, Masura J. Echocardiographic measurements of the aorta in normal children and young adults. Bratisl Lek Listy. 2007;108:437–441
  63. Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008;21:922–934
  64. Lytrivi ID, Bhatla P, Ko HH, Yau J, Geiger MK, Walsh R, et al. Normal values for left ventricular volume in infants and young children by the echocardiographic subxiphoid five sixth area by length (bullet) method. J Am Soc Echocardiogr. 2011;24(214):8
  65. Neilan TG, Pradhan AD, King ME, Weyman AE. Derivation of a size-independent variable for scaling of cardiac dimensions in a normal paediatric population. Eur J Echocardiogr. 2009;10:50–55
  66. Gautier M, Detaint D, Fermanian C, Aegerter P, Delorme G, Arnoult F, et al. Nomograms for aortic root diameters in children using two-dimensional echocardiography. Am J Cardiol. 2010;105:888–894
  67. Boyd E. The growth of the surface area of the human body. Minneapolis: University of Minnesota Press; 1935;
  68. Musteller RD. Simplified calculation of body surface area. New Engl J Med. 1987;317:1098
  69. Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr. 1978;93:62–66
  70. Dreyer G, Ray W. Further experiments upon the blood volume of mammals and its relation to the surface area of the body. Phil Trans R Soc Lond. 1912;202:191–212
  71. Boothby W, Sandiford RB. Normographic charts for the calculation of the metabolic rate by the gasometer method. Boston Med Surg J. 1921;185:337
  72. DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med. 1916;17:863–871
  73. Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery z scores in healthy children. J Am Soc Echocardiogr. 2011;24:60–74
  74. Lai WW, Geva T, Shirali GS. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiog. 2006;19:1413–1430
  75. Feigenbaum H, Amstrong WF, Ryan T. Evaluation of systolic and diastolic function of the left ventricle. In: Feigenbaum’s echocardiography. Philadelphia: Lippincott William & Wilkins; 2005;p. 138–180
  76. Foster GP, Dunn AK, Abraham S, Ahmadi N, Sarraf G. Accurate measurement of mitral annular dimensions by echocardiography: importance of correctly aligned imaging planes and anatomic landmarks. J Am Soc Echocardiogr. 2009;22:458–463
  77. Beroukhim RS, Roosevelt G, Yetman AT. Comparison of the pattern of aortic dilatation in children with the Marfan’s syndrome versus children with a bicuspid aortic valve. Am J Cardiol. 2006;98:1094–1095
  78. Helbing WA, Bosh HG, Maliepaard C, Rebergen SA, van der Geest RJ, Hansen B, et al. Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. Am J Cardiol. 1995;76:589–594
  79. Lai WW, Gauvreau K, Rivera ES, Saleeb S, Powell AJ, Geva T. Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography. Int J Cardiovasc Imaging. 2008;24:691–698
  80. Levine RA, Gibson TC, Aretz T, Grillam LD, Guyer DE, King ME, et al. Echocardiographic measurement of right ventricular volume. Circulation. 1984;69:497–505
  81. Dell’Italia LJ. The right ventricle: anatomy, physiology and clinical importance. Curr Probl Cardiol. 1991;16:653–720
  82. Jiang L, Wiegers SE, Weyman AE. Right ventricle. In:  Weyman AE editors. Principles and practice of echocardiography. 2nd ed.. Philadelphia: Lea & Febiger; 1994;p. 901–921

PII: S0894-7317(11)00790-5

doi: 10.1016/j.echo.2011.10.016

Journal of the American Society of Echocardiography
Volume 25, Issue 2 , Pages 142-152 , February 2012

Article Tools