Computed tomography-derived normative values and z-scores of the pulmonary valve annulus and sino-tubular junction in the pediatric population

Abstract

Background

Accurate assessment of the pulmonary valve can dictate clinical management of patients with right ventricular outflow tract (RVOT) anomalies. Comparisons with available normal reference values are essential for accurate evaluation. The aim of the study was to generate normative data for the pulmonary valve annulus and sino-tubular (ST) junction using CT measurements derived from a heterogeneous pediatric population and create z-scores useful for clinical practice.

Methods

Patients without heart disease who underwent cardiac CT between April 2014 and February 2021 ​at Children's Hospital Colorado were included. Minimum and maximum diameter (mm) and cross-sectional area (mm²) for the pulmonary valve annulus and ST junction were measured. Previously validated models were used to normalize the measurements and calculate z-scores. Each measurement was plotted against BSA, and z-score distributions were used as reference lines.

Results

Three-hundred-sixty-seven healthy patients with a mean age of 8.8 years (1–21), 56% male, and BSA of 1.1 ​m² (0.4–2.1) were analyzed. The Haycock formula was used to present data as predicted values for a given BSA and within equations relating each measurement to BSA. Predicted values and z-score boundaries for all measurements are graphically re-presented.

Conclusions

CT-derived normative data for the pulmonary valve annulus and ST junction is reported from a heterogenous cohort of healthy children.