8600 Rockville Pike An aneurysm is a weak spot in a blood vessel wall. Design. official website and that any information you provide is encrypted Aortic root dilation (AoD) is frequently an incidentally discovered, asymptomatic finding in that is seen on various imaging modalities [].The anatomy of the aortic root includes the annulus, sinuses of Valsalva, sinotubular junction and ascending aorta [], with the size being a function of a patient's biologic variables such as height, age, BSA, and gender [1, 2]. Doppler-derived LV diastolic inflow was recorded in the apical 4-chamber view by placing the sample volume atthe tip level of the mitral valve leaflets. This calculator The ascending aorta is about 5 to 8 centimeters (or close to 2 to 3 inches) long. In addition, 23 of the initial subjects investigated refused to be included in the echocardiographic protocol. There are significant differences in aortic dimensions according to sex, age, and race. Aortic Nomograms are described in the peer reviewed paper: Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. 1. Growth rate estimates, yearly . Data analysis was performed using SYSTAT, version 12 (University of Illinois, Chicago, Illinois). The reported ranges of aortic root (AR) diameters are limited by small sample size, different measurement sites, and heterogeneous cohorts. The aim of this study was to explore the full spectrum of AR diameters by TTE in a large cohort of healthy subjects and to investigate the impact of age, gender, and body surface area (BSA) by allometric analysis and multivariate models. Maximal aortic diameters were measured at seven aortic regions: sinuses of Valsalva, sinotubular junction, ascending aorta, mid-descending aorta, abdominal aorta at the diaphragm, abdominal aorta at the coeliac trunk, and infrarenal abdominal aorta. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas body surface areaindexed aortic diameters were greater in women (p= 0.0001). The aorta is the main trunk of the arterial system, carrying oxygenated blood from the heart to the body. Aortic dissection[edit] Diagnostic is an undulating motion intimal flap, which in more recordings and directions must be seen. For patients > 15 years of age and adults: utilizing diastole and leading edge-to-leading edge measurement of the sinuses of valsalva. ASI (cm/m2) 2.05, 2.08-2.95, 3.00-3.95, and 4; and AHIs (cm/m) of 2.43, 2.44-3.17, 3.21-4.06, and 4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Principally, the Society wanted to ensure that reference intervals were derived from the most contemporaneous and prospectively acquired data; that reference intervals were derived from evidence that best applies to the British population; and finally that echo guidance and cut-offs reflect UK practice. A total of 190 untreated and treated essential hypertensive patients (mean age, 5511 years) were considered for this analysis. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas BSA-indexed aortic diameters were greater in women ( Table2 ). Singh M, Sethi A, Mishra AK, Subrayappa NK, Stapleton DD, Pellikka PA. J Am Heart Assoc. Copyright 2021 American Society of Echocardiography. Size-adjusted aortic valve area: refining the definition of severe aortic stenosis. All studies were reviewed and analyzed off-line by 2 independent observers. BSA: m 2; LV Long Axis Z-Score: Aortic Root Z-Score: Score: The result gives the predicted difference in percent survival for Norwood minus . The AA is considered dilated or ectatic when its size is 1.1 to 1.5 times larger than the normal and aneurismal when its size exceeds the limits defining dilatation 3, 4. Aorta dimensions are variably dependent on age, gender, and body size. 2016 Jul;9(7):797-805. doi: 10.1016/j.jcmg.2015.09.026. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. In this case, the swelling occurs in the wall of the root of the aorta. Disclaimer. Any change in the value will pose trouble for any individual because the contraction and expansion make it difficult for the blood to flow smoothly through the aorta. Privacy policy The reported ranges of aortic root diameters are limited by small sample size, different mesurements sites, and heterogeneous cohorts. However, reported ranges of AR normal dimensions are limited by small sample size, different measurement sites, and heterogeneous cohorts. The effect of BSA on aortic diameter Both cardiac output and total blood volume are elevated with increased BSA, and studies have shown that these circulatory changes result in left and right ventricular hypertrophy and cavity dilatation [ 3, 27 ]. 1,2 This is based on a sharp rise in the risk of . Indexing of aortic root diameters to BSA had a reverse effect and revealed significantly larger aortic root diameters for women (Table 2 ). It then runs up the chest, behind the breastbone, and down the . No significant gender differences were registered for sinuses of Valsalva, sinotubular junction to annulus diameter ratios, whereas ascending aorta to annulus diameter ratio was higher in women ( Table3 ). X X-Axis value Y Y-Axis value Calculate Age Range (yr) Unspecified BSA Range (m^2) Unspecified BMI Range (kg/m^2) Unspecified Z-Score (Undefined) Cut-off values for severe stenosis are <1.0 cm 2 for AVA and <0.6 cm 2 /m 2 for AVA index. There were no differences between athletes and controls when the aortic diameter was indexed for BSA (15.52.0 mm/m 2 (range 8.5-26.0 mm/m 2) . What are the parts of the ascending aorta? . Median age was 52 years, and 396 (40%) were men. E s xl/_rels/workbook.xml.rels ( j0}}?{Rv !FV?}k%o3!|9C?|M kkKE`-jS ~z4lz@vooHOPFbP0}9* v`hJWNgI'?9mVlG_;tx&3j ?\ZH In spite of that fact, most of the references use the same technique: The reference data from Paris is performed using measurement techniques performed according to their interpretation of the then-current 2005 Guidelines: Thus, the available references cited herein are not entirely comparable based on their dissimilar methodolgies. 2021 Mar;34(3):286-300. doi: 10.1016/j.echo.2020.11.004. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. The diameter of the AA, typically measured at the level of the right pulmonary artery, is used to define the dimensions of the AA. The standard size of the aortic root is between 29 and 45 millimeters. Multimodality Imaging to Explore Sex Differences in Aortic Stenosis. FOIA Additional studies have supported the use of BSA as a strong deter - minant of aortic dimensions.7-9 Sports with extremes of BSA and height, such as basketball and volleyball, have shown a higher prevalence of athletes with aortic roots All of the references Any change in the value will pose trouble for any individual because the contraction and expansion make it difficult for the blood to flow smoothly through the aorta. We previously introduced the aortic size index (asi), defined as aortic size/body surface area (bsa), as a predictor of aortic dissection, rupture, and death. In this study, the authors found that a simpler measure of aortic diameter indexed to height had similar predictive power compared to aortic diameter indexed to bsa. Raw data was not published. Monday - Friday 9.00 am - 5.00 pm. Adjusting parameters of aortic valve stenosis severity by body size. 10 considered three age strata: younger than 20 years, 20-40 years, and older than 40 years by published equations. Annulo-aortic ectasia can be an isolated condition or can occur as part of a generalised connective tissue disorder, e.g. From June 2007 to December 2013, a total of 1,043 Caucasian healthy volunteers (mean age 44.7 15.9years, range 16 to 92 years, 503 men [48%]) underwent comprehensive TTE. 2012 Oct 15;110(8):1189- 94. 2012 Oct 15;110(8):1189-94. oculus quest 2 floor level too high Click To Call Now (270) 478-5489; battle of the bulge ww2 quizlet 2019 Nov;32(11):1396-1406.e2. The Gorlin equation. Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 17 years; 50.4% men; mean body surface area [BSA], 1.77 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Careers. Compared with indices that include weight, a simpler height-based ratio (avoiding weight assessment and BSA calculation) yields satisfactory results for evaluating the risk of complications among patients with TAAA. Look up reference values adjusted for age, gender, and body size for the aortic root (aortic valve and sinus of valsalva) using data published in the american journal of. Would you like email updates of new search results? Sign up to get the latest news and updates from The Marfan Foundation. You should use a unique identifier, not the patients name to preserve confidentiality. limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Objective: Its highest and lowest points are located at each of the three commissures and between any two of them, respectively. In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. The Print Rooms Richard B Devereux, Richard Cooper, Alan Weder, Todd B Seto, Craig Hanis, Thomas H Mosley, Jr, D C Rao, Donna K Arnett. 2008;1 (2):200-209. Nomograms of aortic dimensions at the SoV level according to different calculated BSA, for three age groups. The aortic root is the largest artery in the body, with a diameter of approximately 4 cm, followed by the ascending aorta, . All measurements were obtained in a zoomed parasternal long-axis view. Cassottana P, Badano L, Piazza R, Copello F. Wenzel JP, Petersen E, Nikorowitsch J, Senftinger J, Sinning C, Theissen M, Petersen J, Reichenspurner H, Girdauskas E. Int J Cardiovasc Imaging. Example of 2D echocardiographic measurements of aortic dimensions at the level of the aortic annulus (A), sinuses of Valsalva (B) and sinotubular junction (C). Aortic Root, indexed: (cm/m 2) Discriminant Score: . Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. However, weight might not contribute substantially to aortic size and growth. Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study. MeSH National Library of Medicine The Bland-Altman analysis gave a 95% confidence interval of 4.1 1.1% for the aortic annulus, 3.9 1.1% for the sinuses of Valsalva, 4.1 1.1% for the sinotubular junction, and 4.8 1.3% for the maximum diameter of the proximal ascending aorta. Exponents b and c (respectively for weight and height) were found to be significantly different than unity for all 4 AR diameters and gender exponent ( Table5 ). doi: 10.15420/ecr.2022.26. three aortic sinuses of Valsalva: intraluminal . Aortic diameters were independently associated with age, gender (model A), and BSA (model B); weight and height did not have any additional significant impact on aortic dimension (model C; Table6 ). Unauthorized use of these marks is strictly prohibited. V xl/workbook.xmlTn0?+Z,y,( q/4EYD$R%FPe.o,SK` *S.v Y/!FB cited by this calculator preceded the publication of the 2010 ASE Guidelines. Gender differences are then accounted for by indexing the volume to body surface area (BSA) via the Mosteller equation. The aortic annulus was measured at mid-systole using the inner edge to inner edge method. TTE measurements of the AR were made at end-diastole in parasternal long-axis views at 4 levels: (1) annulus, (2) sinuses of Valsalva, (3) sinotubular junction, and (4) proximal ascending aorta. Adjustment for height and weight in the regression models avoided the assumption made in indexing to certain parameter of body size (e.g., BSA), while achieving the same purpose of accounting for differences in body size among participants. Web what is the normal size of the ascending aorta? BP= blood pressure; BSA= body surface area; LV= left ventricle. We seek to evaluate the height-based . Cookie policy. The aortic annulus is a crown-shaped structure that serves as the insertion point for the aortic cusps. [Content_Types].xml ( UN0#q)jpic- 31P!EU+KL7YwHhixJwDQ.xP/XpJDZJ54 The major problem of the MMode is that perpendicular orientation to the left atrium may not be possible. Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Calculator How to get Maximum SOV Diameter. Left Atrial Volume Index (LAVI) has been found to correlate with mortality from cardiovascular disease and may be measured at the end-ventricular systole, when the LA is at its maxim size. In 1,207 apparently normal subjects 15 years old (54% women), aortic root diameter was 2.1 to 4.3 cm. Epub 2020 Nov 17. This group previously published data that used aortic diameter indexed to BSA as a more patient-specific predictor of risk. Using aortic size index, patients were stratified into three risk groups: less than 2.75 cm/m 2 are at low risk (approximately 4% per year), 2.75 to 4.24 cm/m 2 are at moderate risk (approximately 8% per year), and those above 4.25 cm/m 2 are at high risk (approximately 20% per year). 2016 Nov;9(11):e005121. J Am Coll Cardiol Img. Epub 2021 Dec 14. I just wanted to let you know that even though I'm looking quite old, I'm still a millenial. Allometric equations were used to determine the relations of aortic diameters with weight and height. Three BP measurements were obtained from the right arm with a mercury manometer, and the results were averaged to determine systolic and diastolic BPs. On TTE, they had smaller LV dimensions and mass but similar E/A ratio ( Table1 ). Unit 204 Recent years have seen the publication of large, international, prospectively recruited studies from which the British Society of Echocardiography has now derived updated, robust reference intervals for use in echocardiographic practice within the UK. We report a modest increase in aortic size with both increased BSA and age across males and females. Berthelot-Richer M, Pibarot P, Capoulade R, Dumesnil JG, Dahou A, Thebault C, Le Ven F, Clavel MA. Left ventricular (LV) mass was calculated by the Penn convention and indexed for BSA. This is because BSA was previously found to have a greater association with thoracic aortic diameter than BMI does (6,7), and BSA was the body size variable that entered into selection models most frequently. to get Maximum SOV Diameter. Cuspidi C, Facchetti R, Bombelli M, Seravalle G, Grassi G, Mancia G. Clin Res Cardiol. Enter the height, weight, and age and select the correct units. Three models were developed in multiple regression analysis to explain aortic dimensions. An unpaired t test was performed to evaluate differences between genders. Height Alone, Rather Than Body Surface Area, Suffices for Risk Estimation in Ascending Aortic Aneurysm. Indexed aorta diameter was defined as aortic diameter divided by BSA. official website and that any information you provide is encrypted Specific views included the parasternal long- and short-axis views; apical 4-, 2-, and 3-chamber views; and subcostal views including respiratory motion of the inferior vena cava. For patients up to 25 years of age: utilizing systole, inner to inner edge measurement of the sinuses of valsalva according to personal communication from Steve Colan. in aortic root dimensions are small and fall within the established limits for the general population. Conclusions: What is the Normal Size of the Aortic Root? HHS Vulnerability Disclosure, Help Maximum aortic diameter in the area of the. The overall fit of the model using AHI was modestly superior based on the concordance statistic. There was a linear correlation between the aortic diameters (absolute and indexed values) and their ratios with age in both genders, except for the aortic annulus (p= 0.0001; Figures1 and 2 ). Aortic dimensions decrease from sinuses of Valsalva to the descending aorta. 2022 Aug 26. doi: 10.1007/s00392-022-02086-z. Nomograms of aortic dimensions at the SoV level according to different heights for three age groups. Reproducibility of aortic measurements was determined in 50 subjects randomly selected. Unable to load your collection due to an error, Unable to load your delegates due to an error. Normal TEE Cardiac Dimensions Normal Adult Thoracic Aortic Diameters Sex Differences in Aortic Root Dimensions in Adults From: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary DuBois D, DuBois EF. A diameter of < 40 mm and a ratio left atrium/aortic root of < 1.3 are considered normal. Eur Cardiol. PB00if;'\kap P a!9al'tiBW PK ! Online ahead of print. We previously introduced the aortic size index (ASI), defined as aortic size/body surface area (BSA), as a predictor of aortic dissection, rupture, and death. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. consolidates the reporting of z-scores and reference ranges for the aortic root, based on numerous available publications. See this image and copyright information in PMC. Knowledge of upper physiological limits of aortic dimensions is mandatory to detect aorta dilatation, follow up the disease over time, and plan appropriate therapeutic interventions. However, 213 patients additionally categorised as severe by AVAindex experienced significantly less valve related events than those fulfilling only the AVA criterion (p<0.001). Population-based . After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. . This document suggests a number of changes to currently used reference intervals, and in some circumstances this may lead to an individual who was previously labeled as abnormal now being seen as normal (and vice versa). Allometric scaling approach for normalization was applied. Android privacy policy Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Both ASI and AHI were shown to be significant predictors of complications (p < 0.05). Echocardiographic and anthropometric data from a retrospective cohort of 2843 patients with aortic stenosis (jet velocity >2.5 m/s) and from 1525 patients prospectively followed in the simvastatin and ezetimibe in aortic stenosis (SEAS) trial were analysed. The LV ejection fraction was calculated by the Simpson equation in the apical 4- and 2-chamber views. Twenty anaesthetized young pigs, 42 2 (standard deviation) kg on standardized tepid cardiopulmonary bypass (CPB) were randomized (10 per group) to depolarizing or polarizing cardiac arrest for 60 min with cardioplegia administered in the aortic root every 20 min as freshly mixed cold, intermittent, oxygenated blood. Adult heterozygous mice carrying the Actn2 p.Met228Thr variant were phenotyped by echocardiography. To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). 2. Bookshelf government site. Size-Adjusted Left Ventricular Outflow Tract Diameter Reference Values: A Safeguard for the Evaluation of the Severity of Aortic Stenosis Author links open overlay panel Mohamed Leye MD , Eric Brochet MD , Laurent Lepage MD , Caroline Cueff MD , Isabelle Boutron MD , Delphine Detaint MD , Fabien Hyafil MD , Bernard Iung MD , Alec Vahanian MD . 2021 Dec;37(12):3513-3524. doi: 10.1007/s10554-021-02354-5. Published by at june 13, 2022. The prevalence of severe stenosis increased with the AVAindex criterion compared to AVA from 71% to 80% in the retrospective cohort, and from 29% to 44% in SEAS (both p<0.001). aortic root size indexed to bsa calculator Aortic Root Z-Scores for Adults. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Role of echocardiography in aortic stenosis. Am J Cardiol. No significant gender differences were registered for sinuses of Valsalva and sinotubular junction to annulus diameter ratios (p= 0.9), whereas ascending aorta to annulus diameter ratio was higher in women (p= 0.0001). Indexed body surface area aortic diameters, stratified by age and gender, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Normal Values of Aortic Root Dimensions in Healthy Adults, Aortic Root Dimensions and Stiffness in Healthy Subjects, Advances in Catheter Ablation of Primary Ventricular Fibrillation, Normal Values and Differences in Ascending Aortic Diameter in a Healthy Population of Adults as Measured by the Pediatric versus Adult American Society of Echocardiography Guidelines, Heart Rate Recovery After Exercise in Adults With the Down Syndrome, Standardizing the Method of Measuring by Echocardiogram the Diameter of the Ascending Aorta in Patients With a Bicuspid Aortic Valve, Reference Values of Tricuspid Annular Peak Systolic Velocity in Healthy Pediatric Patients, Calculation of Z Score, and Comparison to Tricuspid Annular Plane Systolic Excursion, Left Ventricular and Ascending Aortic Function After Stenting of Native Coarctation of Aorta, American Journal of Cardiology Volume 114 Issue 6. and transmitted securely. Historical reference intervals have often been derived from studies or echo databases that included relatively small numbers of patients. Results from 88 thoracic and 110 abdominal contrast material-enhanced CT examinations were analyzed in children without known cardiovascular disease who ranged in age from 0 to 20 years (mean, 9.9 years; standard deviation, 5.7), with BSA ranging from 0.19 to 2.52 m 2.Excellent interrater reliability was present (correlation coefficients ranged from 0.95 to 0.98). PMC Wolak A, Gransar H, Thomson LJ, et al. Stroke volume index = Stroke volume in mL / Body surface area in m 2. Demographics and clinical characteristics, LV dimensions, and aortic diameters, both absolute and relative to BSA, are presented as mean SD and were tested by unpaired t test to evaluate differences between genders. M-mode measurements, performed in the parasternal long-axis viewwith the patient in the left lateral position, included left ventricular internal diameter in diastole and systole, interventricular septum in diastole, and posterior wall in diastole. Echocardiographic Imaging Challenges in Obesity: Guideline Recommendations and Limitations of Adjusting to Body Size. sharing sensitive information, make sure youre on a federal Published by Elsevier Inc. All rights reserved. Copyright 2000-2023 JLS Interactive, LLC. The https:// ensures that you are connecting to the Background To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVA index ). The BSA and Maximum SOV Diameter (Aortic Root Diameter) is Calculated. Patients were stratified into four categories of yearly risk of complications based on ASI and AHI. height has been suggested to be the most impor-tant determinant of aortic root size compared with BSA or weight (4-6). Two-dimensional measurements of the AR were made at end-diastole in parasternal long-axis views at 4 levels: (1) annulus (defined echocardiographically as the hinge points of the aortic cusps), (2) sinuses of Valsalva, (3) sinotubular junction, and (4) proximal ascending aorta. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The aim of this study was to explore the full spectrum of AR diameters by 2-dimensional transthoracic color Doppler echocardiography (TTE) in a large cohort of healthy adults. AHI categories 3.05-3.69, 3.70-4.34, and 4.35 cm/m were associated with a significantly increased risk of complications (p < 0.05). Multiple regression analysis for aortic diameters in relation to age, gender, body mass index, weight, and height was applied. The five images were obtained from a single patient: SoV (Sin us of Valsalva), Asc (ascending aorta), Arch (aortic arch), pDTA (proximal descending thoracic aorta), and dDTA (distal descending thoracic aorta). Among cardiovascular imaging techniques, 2-dimensional transthoracic color Doppler echocardiography (TTE) is widely available, safe, and cost-effective, and thus, it represents an excellent first-line screening tool toevaluate the aortic root (AR) morphology and dimensions. doi: 10.1161/CIRCIMAGING.116.005121. Before Enter the Height, Weight, and Age of the Patient. Annulo-aortic ectasia is a combination of: 1) ascending aortic aneurysm 2) dilatation of the sinuses of Valsalva and 3) dilatation of the aortic annulus. 1 It is caused by complete or partial loss of a second sex chromosome, with or without cell line mosaicism. #^ NpnL9+>IUKsuIu)7[.p`,%K&LXA9 ++-/964^Td[@? 2022 Oct;52(10):721-736. doi: 10.4070/kcj.2022.0234. Standardized TTE and Doppler examinations were performed with market available equipment in all the subjects(Aloka 10; Aloka, Tokyo, Japan and Vivid 7; GE Healthcare, Milwaukee, Wisconsin). 2022 Dec 19;17:e26. It is a muscular tube about an inch in diameter and is about 10-12 inches long. T32 HL007381/HL/NHLBI NIH HHS/United States. Colored area represents upper and lower limits of normal, with the equation for the former (ULN) shown below each plot. The following model wasfitted: log(diameter)= log a+ b log(weight)+ c log(height)+ d sex (coded 1 for men and 2 for women) or, in its exponential form: diameter= a weight b height c sex d . Two-tailed p value <0.05 was considered statistically significant. Web at an aortic root size in the small normal range of 2.0 to 2.4 cm, the prevalence of aortic regurgitation was 0% to 15%. Gender differences in aortic root dimensions. Find out what the changes mean for you. Background: However, weight might not contribute substantially to aortic size and growth. Specific measurements were made by the average of 5 cardiac cycles. The specific manner in which these measurements are obtained is of obvious importance. TAA size is the strongest predictor of acute aortic syndromes. BCH Z-Score Calculator - Home Patient Info cm Height (cm) kg Weight (kg) Age (yr) Sex Male Female BSA (m^2) BMI (kg/m^2) Regression Info Context Echocardiography Group All Regression Select regression . Figure 1 An example of aortic diameter measurements at five levels.

Is Chris Salcedo Married, Andrea Taylor Fred Taylor, Mansion Tycoon 3 Script Pastebin, Cultural Conflict Theory Examples, William Holden Grandchildren, Articles A