Should z-scores be used in adults with congenital heart disease?

Various means have been proposed to account for body size in various cardiac measurements such as ventricular size or aortic diameter. The z-score, a well established process used in pediatrics to account for changes with somatic growth, reflects the position of a measurement, expressed in standard deviations, relative to the mean of the population distribution. Yet the z-score method has not been adapted in adult cardiology practices. In adult congenital heart disease, what is the potential role of z-scores for anthropomorphic indexing? We present arguments for and against the use of z-score nomograms as an indexing method in adults with congenital heart disease.