Abstract
Background: Accurate evaluation of aortic arch dimensions in neonates is crucial for early identification of congenital cardiac anomalies such as aortic coarctation. Although echocardiography is widely used, region-specific normative data integrating anthropometric and anatomical variations remain limited. This study aimed to establish reference echocardiographic measurements of the neonatal aortic arch and examine their relationship with body size and arch branching patterns. Methods: A cross-sectional, retrospective study was conducted at Prince Sultan Cardiac Center between January and December 2023. The cohort consists of 99 neonates, having echocardiograms within the first week of life for different clinical indications and revealing no congenital heart disease. Standard echocardiographic measurements were obtained for the aortic annulus, sinus of Valsalva, sinotubular junction, ascending aorta, proximal and distal transverse arches, and isthmus. Data were analyzed using SPSS version 28. Pearson’s correlation assessed associations between aortic dimensions and neonatal characteristics; linear regression identified predictors; one-way and two-way ANOVA evaluated differences across weight categories and arch types. Results: The mean gestational age was 37.99 ± 1.54 weeks, and the mean weight was 3.01 ± 0.60 kg. Echocardiographic assessment showed that the mean aortic annular diameter was 6.39 mm (SD = 0.69), the sinus of Valsalva measured 7.77 mm (SD = 0.88), and the sinotubular junction was 6.98 mm (SD = 0.75). The mean ascending aorta dimension was 7.88 mm (SD = 0.87), while the proximal transverse arch and distal transverse arch measured 6.73 mm (SD = 1.63) and 5.32 mm (SD = 0.85), respectively. The study showed that larger body weight was associated with greater proximal aortic dimensions. Two-way ANOVA revealed additional effects of arch type, where neonates with a common brachiocephalic trunk had larger ascending aortic dimensions than those with normal branching. Conclusion: This study establishes normative echocardiographic data for neonatal aortic arch dimensions and demonstrates that body weight and arch branching pattern significantly influence proximal aortic size. These findings enhance the precision of neonatal cardiac assessment and support early detection of structural variations and potential aortic abnormalities.Keywords
- Neonates Echocardiography Aortic arch Normative values Coarctation of the aorta Anthropometric predi
References
- [1] Tissot, C., Muehlethaler, V., & Sekarski, N. (2017). Basics of functional echocardiography in children and neonates. Frontiers in Pediatrics, 5, 235.
- [2] Abushaban, L., Mariappa, T. V., Rathinasamy, J., & Sharma, P. N. (2018). Normal reference ranges for aortic diameters in preterm infants. Journal of the Saudi Heart Association, 30(2), 86–94.
- [3] Abarbanell, G., Border, W. L., Schlosser, B., Morrow, G., Kelleman, M., & Sachdeva, R. (2018). Preoperative echocardiographic measures in interrupted aortic arch: Which ones best predict surgical approach and outcome? Congenital Heart Disease, 13(3), 476–482.
- [4] Arya, B., Bhat, A., Vernon, M., Conwell, J., & Lewin, M. (2016). Utility of novel fetal echocardiographic morphometric measures of the aortic arch in the diagnosis of neonatal coarctation of the aorta. Prenatal Diagnosis, 36(2), 127–134.
- [5] Campanale, C. M., Pasquini, L., Santangelo, T. P., Iorio, F. S., Bagolan, P., Sanders, S. P., & Toscano, A. (2019). Prenatal echocardiographic assessment of right aortic arch. Ultrasound in Obstetrics & Gynecology, 54(1), 96–102.
- [6] Dijkema, E. J., Molenschot, M. C., Breur, J. M., de Vries, W. B., & Slieker, M. G. (2017). Normative values of aortic arch structures in premature infants. Journal of the American Society of Echocardiography, 30(3), 227–232.
- [7] Freeman, K., Kronmal, R., Clouse, M., Conwell, J., Bhat, A., Young, L., ... & Arya, B. (2021). Validation of prenatal aortic arch angle measurements in the diagnosis of neonatal coarctation of the aorta. Pediatric Cardiology, 42(6), 1365–1371.
- [8] Nestaas, E. (2022). Neonatologists performed echocardiography for evaluating the newborn infant. Frontiers in Pediatrics, 10, 853205.
- [9] Onalan, M. A., Temur, B., Aydın, S., Basgoze, S., Guzelmeric, F., Odemis, E., & Erek, E. (2021). Management of aortic arch hypoplasia in neonates and infants. Journal of Cardiac Surgery, 36(1), 124–133.
- [10] Parikh, K. J., Fundora, M. P., Sasaki, N., Rossi, A. F., Burke, R. P., & Sasaki, J. (2021). Use of aortic arch measurements in evaluating significant arch hypoplasia in neonates with coarctation. Progress in Pediatric Cardiology, 62, 101410.
- [11] Singh, V., Satheesh, S., Ganapathy, S., Nair, N. P. S., Mondal, N., Selvaraj, R., ... & Anantharaj, A. (2023). Echocardiographic nomograms and Z-scores for term Indian neonates. Annals of Pediatric Cardiology, 16(1), 11–17.
- [12] Tuo, G., Paladini, D., Marasini, L., Buratti, S., De Tonetti, G., Calevo, M. G., & Marasini, M. (2022). Fetal aortic coarctation: A combination of third-trimester echocardiographic parameters to improve the prediction of postnatal outcome. Frontiers in Pediatrics, 10, 866994.
- [13] Van Ark, A. E., Molenschot, M. C., Wesseling, M. H., de Vries, W. B., Strengers, J. L., Adams, A., & Breur, J. M. (2018). Cardiac valve annulus diameters in extremely preterm infants: A cross-sectional echocardiographic study. Neonatology, 114(3), 198–204.
- [14] Van Laere, D., Van Overmeire, B., Gupta, S., El-Khuffash, A., Savoia, M., McNamara, P. J., ... & de Boode, W. P. (2018). Application of neonatologist performed echocardiography in the assessment of a patent ductus arteriosus. Pediatric Research, 84(Suppl 1), 46–56.
- [15] Van Poppel, M. P., Zidere, V., Simpson, J. M., & Vigneswaran, T. V. (2022). Fetal echocardiographic markers to differentiate between a right and double aortic arch. Prenatal Diagnosis, 42(4), 419–427.
- [16] Vigneswaran, T. V., Bellsham-Revell, H. R., Chubb, H., & Simpson, J. M. (2020). Early postnatal echocardiography neonates with a prenatal suspicion of coarctation of the aorta. Pediatric Cardiology, 41(4), 772–780.