Aortic dilatation of 2.7 cm in 3 year old

[heartmama]

My son recently had an echo before a double ventral/inscisional hernia repair.  His past echos have showed history of aortic diltation but it was always Mild and had stabilized at his 2 year check up. Here is the info from his latest echo 8 months later.

Height:100.cm  Weight: 17.7kg   BSA: .71 m^2   Age: 2.8 years
Blood Pressure: 96/58
Aortic Root: 2.7 cm Z-score: 5.27
LV Ejection Fraction: 0.55

Repair for TGA/VSD/ASD  
Moderate Aortic Dilatation
Coartation of the Aorta Ruled Out
Supravalvar Aortic Stenosis Ruled Out
Mitral Valve Abnormality - redundant chordal apparatus

This was the first time an abnormal mitral valve has been on a report. Is something that can change over time? At what point should I be concerned about the size of his aortic root, from what I can read online this is fairly large for his age?

Thank you very much!  

[Jeffrey R Boris, M.D.]

Dear Heartmama,

It appears that your son's aoratic root increased by 5 mm, but caused the Z-score to increase drastically.  We do see aortic dilation in patients who have transpostion of the great arteries (TGA).  There is concern that the aorta can rupture, although there also is some thought that the scar tissue in the chest and around the aorta may potentially limit the ability of the aorta to rupture (but this is not known for sure).  In adult patients with Marfan syndrome (a totally different disease), the indications for surgical intervention for aortic dilation are a diameter of 5 cm or an increase of 5 mm in one year.  It certainly sounds like he has had the latter, and it is something you will need to discuss with your cardiologist.

With regard to the redundant mitral valve chordae, this can remain stable OR it can progress with time and lead to mitral valve prolapse, in which the valve doesn't close correctly.  Your son will require lifelong cardiac follow-up, anyway, so this will be easy to include in his routine assessments.

[heartmama]

Here is some additional info from my sons' last echo 8 months ago.  His aortic root was 2.2 cm and z-score was 2.8.  The last echo said there was a poor acoustic window from the parasternal notch, could this account for the drastic change in diameter?