Pediatric Heart Expert Forum
aortic root enlarged
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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aortic root enlarged

my 4 year old son had surgery at birth for Transposition of Greater Arteries and Ventricular septal defect, now his aorta is enlarged to 2.8mm which I believe is significantly large. my question is  at what measurements is surgical intervention necessary or indicated, in cases like this?
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Patients with conotruncal abnormalities like transposition of the great artereis (TGA) with ventricular septal defect (VSD), Tetralogy of Fallot and Truncus arteriosus, all start out life with blood vessels connected to the left ventricle that are larger than normal.  So after open heart surgery, they remain larger than normal.  In TGA with VSD, the new "aorta" actually started out as the pulmonary artery, and we believe that some of the stretching that occurs in the neo-aorta over the years has to do with the fact that pulmonary artery tissue and native aortic tissue are not exactly the same.  Thus, the neo-aorta may stretch in response to the higher blood pressure of the body (compared to the pressure in the lungs).  Regardless, the decision to intervene surgically is based upon how quickly the root is changing in its size and if there is significant leakage of the neo-aortic valve.  So if  the size of the aorta has been relatively stable, and there is little to no valve leakage, it can just be watched.   If the size is changing rapidly, then a consideration for surgery might be entertained.  However, in the big picture, it is only a minority of children who come to another heart surgery for this issue, which is present in many.
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Hi! I'm a parent to a TGA/VSD 3 year old boy : )  We also have aortic dilatation, as do several of the TGA kids I know.  My son's ascending aorta is 2.7, his root is 2.4  and his arch is in the 1's..we have learned that the z-score is important as a measurment tool because it levels the playing field and indicates how abnormal the aorta is in comparison to height and weight.  We have been told not to worry unless it grows .5 or more per year or doubles(?) it's original size.  And as the doctor here said, if it starts to leak a lot.  It is very rare for kids to have surgery for this, but it does happen and for some reason our kids with VSD's are more at risk for dilated aortas, if I remember correctly. I was pretty worried about it for a long time but I noticed on my sons echos he had one year that it grew, one year that was stable, one year that it grew, and one stable..I think a lot of it is his growth spurts..Anyways,  just wanted to say "hi'!  
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
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The Children’s Hospital of Philadelphia
Philadelphia, PA
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