Body surface area as a predictor of aortic and pulmonary valve diameter

Background: Predicting cardiac valve size from noncardiac anatomic measurements would benefit pediatric cardiologists, adult cardiologists, and cardiac surgeons in a number of decision-making situations. Previous studies correlating valve size with body size have been generated with the use of fixed autopsy specimens, angiography, and echocardiography, but primarily in the young. This study examines the relation of body surface area to measurements of the left ventricular–aortic junction (aortic valve anulus diameter) and the right ventricular–pulmonary trunk junction (pulmonary valve anulus diameter) in 6801 hearts across a wide spectrum of ages. Methods: From June 1985 to October 1998, cardiac valves from 6801 donated hearts were analyzed morphologically. Donor age was newborn to 59 years (mean 31 ± 17 years; median 32 years). Calculated body surface areas ranged from 0.18 to 3.55 m 2. Aortic (n = 4636) and pulmonary valve diameters (n = 5480) were measured from enucleated valves suitable for allograft transplantation. Mean valve sizes were computed for ranges in body surface area in 0.1-m 2 increments. Results: For adult men (age ≥ 17 years), the mean aortic valve diameter was 23.1 ± 2.0 mm (n = 2214) and the mean pulmonary valve diameter was 26.2 ± 2.3 mm (n = 2589). For adult women, the mean aortic valve diameter was 21.0 ± 1.8 mm (n = 1156) and the mean pulmonary valve diameter was 23.9 ± 2.2 mm (n = 1408). The mean indexed aortic valve area was 2.02 ± 0.52 cm 2/m 2 and the pulmonary valve area 2.65 ± 0.52 cm 2/m 2. Between 82% and 85% of the variability was explained by the size of the patient. Regression equations were developed both overall and separately for men and women, although the additional contribution of sex above that of body size was less than 1%. Conclusions: Aortic and pulmonary valve diameters are closely related to body size. Thus, body surface area, when used in conjunction with other clinically accepted evaluations, is a useful tool for estimating normal aortic and pulmonary valve size. (J Thorac Cardiovasc Surg 2000;119:975-82)