Cross-Sectional and Longitudinal Assessment of Aortic Root Dilation and Valvular Anomalies in Hypermobile and Classic Ehlers-Danlos Syndrome

• Published in: The Journal of pediatrics 2011-05, Vol.158 (5), p.826-830.e1
• Main Authors: Atzinger, Carrie L., MS, Meyer, Richard A., MD, Khoury, Philip R., MS, Gao, Zhiqian, PhD, MSPH, Tinkle, Brad T., MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; adulthood; adults; Aorta, Thoracic - diagnostic imaging; Child; Child, Preschool; childhood; Cross-Sectional Studies; Dilatation, Pathologic; Echocardiography; Ehlers-Danlos Syndrome - complications; Ehlers-Danlos Syndrome - diagnosis; Ehlers-Danlos Syndrome - epidemiology; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Mitral Valve - abnormalities; Mitral Valve - diagnostic imaging; Mitral Valve Prolapse - complications; Mitral Valve Prolapse - diagnosis; Mitral Valve Prolapse - epidemiology; Ohio - epidemiology; patients; Pediatrics; Prevalence; Prognosis; screening; Young Adult
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2010.11.023

Objectives To delineate the prevalence of cardiac findings in hypermobile and classic Ehlers-Danlos syndrome and provide longitudinal analysis of aortic root growth. Study design A retrospective chart review was conducted, and data were analyzed for cross-sectional prevalence of aortic dilation and valvular anomalies. The clinical implications of aortic root growth were determined by assessment of progression of aortic root measurements over time and clinical symptoms. Results Patients whose first echocardiogram was obtained in late childhood or adulthood were less likely to have aortic dilation ( P < .002) than those whose first echocardiogram was obtained in early childhood. Longitudinally, seven individuals had dilated aortas before age 14, and only one individual continued to show dilation after age 14 ( P = .0143). No patient with a normal aortic root in childhood had development of dilation in adulthood. Fifteen of the 252 patients (6.0%) had mitral valve prolapse (MVP), although only one patient (0.4%) had MVP that was mild to moderate. Conclusions Although aortic root size and MVP are increased in patients with these types of Ehlers-Danlos syndrome, they tend to be of little clinical consequence. Echocardiography may still be warranted as part of cardiovascular assessment, but decreased frequency of screening is recommended especially in symptom-free adults.