Clinical stratification of pediatric patients with idiopathic thoracic aortic aneurysm

Benjamin J. Landis, Stephanie M. Ware, Jeanne James, Amy R. Shikany, Lisa J. Martin, Robert B. Hinton

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Objectives To describe the global phenotypes of pediatric patients with thoracic aortic aneurysm (TAA) who do not have a clinical diagnosis of Marfan syndrome (MFS) or related connective tissue disorders. We hypothesized that the presence of noncardiovascular abnormalities correlate with TAA severity and that medical therapy reduces TAA progression. Study design This is a retrospective case series of patients with TAA age ≤21 years evaluated in a cardiovascular genetics clinic. Patients meeting clinical criteria for MFS or related disorders were excluded. Repeated measures analyses of longitudinal echocardiographic measurements of the aorta were used to test associations between TAA severity and noncardiovascular phenotype and to assess the impact of medical therapy. Results Sixty-nine patients with TAA at mean age 12.5 ± 5.3 years were included. Noncardiovascular abnormalities, including skeletal (65%) or craniofacial (54%) findings, were frequently observed. Increased rate of aortic root enlargement was associated with ocular (P =.002) and cutaneous (P =.003) abnormalities, and increased rate of ascending aorta enlargement was associated with craniofacial (P <) abnormalities. Beta blocker or angiotensin receptor blocker therapy (n = 41) was associated with reduction in the rate of aortic root growth (P =.018). Conclusions Children with TAA not satisfying diagnostic criteria for MFS or related disorders frequently have noncardiovascular findings, some of which are associated with TAA progression. Because therapy initiation may reduce risk of progression and long-term complications, comprehensive assessment of noncardiovascular findings may facilitate early risk stratification and improve outcomes.

Original languageEnglish (US)
Pages (from-to)131-137.e5
JournalJournal of Pediatrics
Volume167
Issue number1
DOIs
StatePublished - Jul 1 2015

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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