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Normal Aortic Root Diameter Range for 21 Y/O
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Normal Aortic Root Diameter Range for 21 Y/O

Hello. I have a slight history of aortic aneurysm in my family (my grandmother has had two, one abdominal and now one aortic root). She is a heavy smoker and there has been no other signs of this in anyone else in my family, however I would like someone to interpret my echo cardiogram results and inform me whether or not I lie within the normal range. These are some of my results:

Ao Root Diameter: 3.0 Cm
LA Dimension: 2.2 Cm
desc Aorta: 1.4 Cm
LA/Ao: .75
AoV annu diam: 2.2 Cm
EF: 65%
FS: 36%

I received this echo a little over a year ago and never had a doctor interpret these results for me. I have searched on line and usually find healthy patients decades older than me with aortic roots at around 2.5-2.8. I know the normal range is from 2.0-3.8 but is 3.0 normal for a 21 year old? Thanks for your time.
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1495448_tn?1326846430
These echo results look fine.  If you are concerned about your aorta dilating over time, find a cardiologist you trust and have them follow you with serial echos.  Right now you have nothing to be concerned about.  If a lot of people in your family have problems with dilated aortas, ask your doctor if you might have a condition called Marfan syndrome.  Hope this helps.
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Avatar_m_tn
Thank you for your response. I have actually talked to my doctor about Marfan Syndrome which is the reason I had my echo cardiogram done initially. There have been no other issues with dilated aortas in my family. I had been doing a lot of online research and kind of got the impression that with my BSA and age that I may have a slightly larger aortic root than most people my age. I am 21 y/o female weighing about 130 lbs and about 5'3. So you believe those numbers are completely normal for my age/weight/height? Sorry to ask you more questions, I just know my mom will think I'm crazy if I ask for another echo since they cost quite a lot of money until we reach our insurance deductible. I know this doesn't replace my doctor's opinion but I would just like some peace of mind for the time being. I guess I'm kind of worried that my aorta has already grown .3 cm or something in the past year, and just wanted to hear a professional's opinion. THANKS AGAIN!
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Avatar_n_tn
Based on your size, your Z score is approximately 1.45, which puts you in the 92nd percentile (assuming the 3.0 is at the sinus of valsalva).  So yes, it's a tad on the large side, but still within normal.  If I was in your shoes, I would get repeat measurements every few years just to make sure there's no growth.  Your grandmother's aortic root issue is likely related to her smoking (and probably high blood pressure and other problems associated therewith).

You are probably fine.
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Avatar_m_tn
Is it true that a dilation is considered when a person lies within the 97.5 percentile? Thank you so much for the information. I wish this was information that the cardiologist that performed the echocardiogram or my physician had given me. It does not sound very promising for me to have a larger aortic root than 92% of people for my age and weight. This has me fairly worried. I know the response is to go see a cardiologist, I guess that's probably what I'll do. I only wish these things weren't so expensive. I really would just like to find out that I am a completely healthy 21 year old and stop having to worry about these things. I am by no means a hypochondriac, but I have never worried about something as much as I have this. Maybe because it involves my heart, and aneurysms are very scary to me. I plan to get the serial echocardiograms done, but do you believe this is something that is going to pose a risk to my health in the future? Although I am currently in the "normal" range, in a few decades if my aorta increases at the rate of .1-.2 cm that it does in the normal population, will I have an aneurysm? Thank you again for your time and knowledge.
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Avatar_n_tn
Well, first off, don't get worried.  There are many formulas out there for calculating Z scores and root sizes and comparing them to "normal."  The numbers I gave you were based on just one of those formulas.  If you look at another, the Z score can be lower and more "normal."  So don't get too hung up on numbers - they're just an estimate.

Nobody can answer your questions - nobody has a crystal ball that can foretell the future.  All someone can do is take a look at your current state and see if there is any underlying pathology.  Right now, you're at 3.0cm.  Aortic roots of that size very rarely if ever dissect.  But it does seem a bit large for someone your gender, age and size.  It's more what you'd expect to see in a larger male in his 20s-30s.  So I doubt you're in any danger right now.  

The question is what to do for the future.  As I suggested, repeat echocardiograms would be ideal to watch for any abnormal growth rate.  If it doesn't grow over a period of a few years, you are probably fine, you just have a slightly larger aortic root, and that is your "normal."  If it does grow abnormally, then it would help to find out the underlying pathology causing it to grow.  In someone your age, it would possibly be a connective tissue problem like Marfan syndrome (do you meet any criteria?) instead of age-related factors.  

Here's the good news.  The GREAT news.  There's a class of drugs called angiotensin receptor blockers (ARB).  They are commonly available at your local drugstore and are sold by the millions.  They have been shown to halt and even reverse aortic root growth in many individuals WHEN TAKEN IN SUFFICIENTLY HIGH DOSAGES (for someone your size, perhaps the FDA-approved maximum for that drug).  For instance, telmisartan 80mg/day.  These drugs block the signaling in your body (TGF-beta) that causes the aortic root to grow, thus allowing your body to heal itself.  There are academic papers out of Johns Hopkins and other institutions regarding this if you want to dig for them.  It is cutting edge research.

So, take heart.  Your 3.0 could be entirely normal.  Or it could be growing.  But if it is growing, you caught it early and can take medication that will quite possibly halt and even reverse the growth, putting it back at a normal size, and you can go on and enjoy your life.  This is a God-sent miracle drug.  Prior to 2006, when this discovery was made, you wouldn't have had this option.  People with fast-growing aortas faced surgery or death.  Now, it's no big deal, praise God.

The best thing you could do right now is to find a cardiologist who is knowledgeable about Marfan syndrome or at least aortic disease and consult them.  (Many run of the mill cardios are ignorant about aortic disease treatments.)  Ask whether they will do repeat imaging to make sure it's not growing and if they'll prescribe ARBs if it IS growing.  Those two factors, in my non-medical-professional opinion, are the keys to success.


N
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Avatar_m_tn
First off, I cannot thank you enough for the information that you have given me. I am covered under my parents health insurance since I am still in college, but we have a deductible to meet every year and echocardiograms aren't too cheap so I really wanted some information like what you have provided. I plan to tell my mom about the information that has been given to me and hopefully the echo cardiogram will then be performed again, I just really wanted to get some opinions about it for the time being.

I have read online that although echocardiograms are very reliable, sometimes the dimensions can be overestimated or (hopefully not in my case at least) underestimated. What bothers me is that there are certain "normal" limits that cardiologists go by and it seems like all of the other factors such as age and weight are not taken in to account. It seems like even if my aortic root measured 3.7 cm they still would have put "normal" on my report and if I had not decided to do further research I would never have second guessed the results. I have no choice but to put my trust in my doctors and I feel like I have been cheated out of information that could be life threatening.

In regards to Marfan Syndrome, I actually went to my doctor which at the time was my pediatrician who had been my doctor since I was born (he also apparently was a certified geneticist which seemed like a God send to me at the time). He informed me that he had never suspected me to have the condition yet ordered the EKG and echo anyways which is where these results came from in the first place. So all of that information was actually taken when I was only barely 20 years old. This is why I began to worry. The results for my aortic diameter seems much larger than any other normal echo results that I had researched online, especially for anyone around my age. I have looked at A LOT of charts and blogs about aortic roots and the diameters seem to reach 3.0 on women in their 50s or 60s. Anyways, back to Marfan Syndrome. He did all of the ratios for my arms and trunk, etc and felt like I didn't have it. However, I do have flexible fingers even though they are not abnormally long. I can do the positive wrist/thumb sign and I also have a high arched palate. However I am not abnormally skinny and not tall at all. I have no stretch marks, pectus excavatum, or any other physical characteristics.

I will definitely look in to the drug that you have suggested. I will do anything that will ease my worry and make me feel healthy, which I have always felt up until now. Thanks so much for your time, I am very grateful for the information.
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Avatar_n_tn
Your second paragraph shows an understanding that many people never achieve.  You are your own best advocate.  Do your own homework and don't settle for docs who brush  you off.

Your post is a great example of why you need to see a Marfan specialist.  The disease lies on a spectrum.  You can fail to meet the criteria by a long shot and still have aortic problems.  I know some people who exhibit just a couple signs but have severe aortic involvement.  If you have a high palate and can do the hand and wrist signs and have a slightly large aorta, I'd say you almost certainly have something going on.  Find a Marfan specialist and remember the serial imaging and ARBs.  
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Avatar_m_tn
Only one more question, it seems that in patients with Marfan Syndrome aortic dilation occurs early in life, so wouldn't my aortic root be larger than 3.0 by 20 years of age? I believe I can do positive thumb and wrist signs but my pediatrician told me that mine weren't significant enough because my thumb and pinky and barely overlap. My dad also has a high palate. Maybe it is possible that I just have issues with my connective tissue. Regardless, I am getting this checked out. Thanks for your time, I will stop bothering you now.
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Avatar_n_tn
No, it's not true that Marfan patients have aortic dilatation early in life.  It can occur at any time.  Some people can have serial echos that are technically "normal" but that show a clear pattern of growth that ultimately results in an abnormally large aorta.  Remember with connective tissue diseases that there are no absolutes; no hard and fast rules.  There is a LOT of variability.

I've never heard of disregarding the wrist sign because the fingers "barely" overlap.  Ask 100 people with no CT disease to do it and very few if any will be able to make them overlap at all.  Not even touching.

And feel free to ask questions anytime.  I won't always check this thread but you can always send me a private note on this site.  I know that God has helped me immeasurably in this regard and I feel happy and fortunate to be able to help other people out, too.


Nick
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Avatar_m_tn
So with absolutely no family history, me being normal height (probably a little below average) and weight for my age, normal arm span compared to height, no pectus excavatum, no stretch marks, no dislocated lens, or any other physical characteristics besides the high arch palate and possible positive thumb/wrist signs, it doesn't seem like I meet the criteria for Marfan Syndrome on the National Marfan Syndrome website. There is still a possibility that I can have it? I know there is a lot of variability so I am by no means leaving this out of the question. Are there other connective tissue disorders out there that aren't so life threatening? Or is the fact that I have a slightly larger aortic diameter pretty much guaranteeing that I have some sort of aortic disease? My grandmother is close to 80 years old and her aortic aneurysm was just found. My dad, which is her son is close to 60, so I don't believe there is any possibility that Marfan Syndrome is in my family. I know that there is a percentage of cases that have no family history, but when getting in to the no family history, plus not having the normal physical characteristics such as above average height, being very skinny, and having abnormally long arms, legs, fingers, etc it seems like the possibility is pretty slight. I think I am thinking in that direction to try to ease my worry until I can get to the doctor to have an echocardiogram.
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Avatar_n_tn
I think your assessment is reasonable.  What I'm trying to make clear is that CT diseases lie on a spectrum.  On one hand you have Loeys Dietz Syndrome, and on the other you have perhaps isolated mitral valve prolapse.  Categories like "marfan syndrome" are of minimal clinical value because you can fail to meet the criteria for diagnosis but you can still have aortic involvement.  I think it's true that you can often tell by looking at someone carefully whether they have Marfan syndrome, but it's not logically true that you can also infer from that that they also do or do not have aortic involvement.  Basically, what you're telling me is that you have a few things that SUGGEST some kind of connective tissue problem - Marfan or otherwise.  Maybe you meet the criteria and maybe you don't.  But life doesn't fit into neat categories like that, and you may have some kind of CT problem that affects the aorta.  I really would try not to worry.  Even if you have full-blown Marfan (which it really seems you do not), the therapies available today (ARBs and even ACEi's like perindopril) can give you a long and normal lifespan.  Just get serial echos over a few years to check for growth.  If there's growth, consider ARBs, if there's not, you're good.

Let me know if you have more questions.
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Avatar_m_tn
I can't thank you enough for talking with me about this over the past few days. I have been really stressed out and I really appreciate the questions you have answered for me. If I have any further questions in the future I would love to be able to contact you. Again, thanks so much for everything.
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Avatar_n_tn
Sure.  You're always free to send me a private note or message on this website.
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Avatar_m_tn
Are you familiar with MASS phenotype? This sounds like something that could explain my case instead of something such as Marfan Syndrome.
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