From Roman et al. Am J Cardiol 1989; 64:507-512.

Echocardiographic Protocol for Thoracic Aortic Aneurysms

The initial evaluation for a thoracic aortic aneurysm by echocardiogram should show all the
structures of the heart, including the heart valves and the entire ascending thoracic aorta. It is
critical that the aortic diameter be measured accurately and standard nomograms for aortic
diameter be used that are based on the patients age and body surface area. These nomograms
are attached (Roman et al. Am J Cardiol 1989; 64:507-512).

We strongly recommend obtaining 4-point measurements of the ascending aorta at the
following levels shown on the figure below: (1) annulus; (2) mid-sinuses of Valsalva; (3)
supraaortic ridge or sinotubular junction; (4) the proximal ascending aorta.
Four point measurements are important for the following reasons: (1) some aneurysms
enlarge initially at the sinuses of Valsalva (e.g., Marfan syndrome, Loeys-Dietz syndrome)
while other spare the sinuses and involve the ascending aorta (MYH11 mutations); (2)
standardized measurement allow for more accurate assessment of the aortic diameter over
time.

Recommendations for measurement:
(1) First use parasternal long-axis view
to generate m-mode from mid
sinuses of Valsalva and measure
diameter (described as m-mode
measurement).
(2) Use parasternal long axis view at
the end of diastole (onset of QRS
complex) to measure the 4 sites on
the figure. Measurements are made
from leading edge to leading edge
except at the hingepoints of the
aortic valve cusps (annulus), where
measurements are made from
trailing edge to leading edge. If the rhythm is regular, average the measurements from 2-3
consecutive beats. If the rhythm is irregular, average the measurements from 5-10
consecutive beats.
(3) Use graph for infants and children (ages up to 15 years) for comparison to normal and plot
both measurements (sinuses of Valsalva and supraaortic ridge) requested. Post puberty, may
consider using graph for adults (< age 40 or > 40).
(4) Inspect aortic valve for morphology (trileaflet, bicuspid) and function (by Doppler) for
assessment of insufficiency and/or outflow gradient.


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