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Cadoret F, Parinaud J, Bettiol C, Pienkowski C, Letur H, Ohl J, Sentilhes L, Papaxanthos A, Winer N, Mathieu d'Argent E, Catteau-Jonard S, Chauleur C, Biquard F, Hieronimus S, Pimentel C, Le Lous M, Fontaine N, Chevreau J, Parant O. Pregnancy outcome in Turner syndrome: A French multi-center study after the 2009 guidelines. Eur J Obstet Gynecol Reprod Biol 2018; 229:20-25. [PMID: 30096465 DOI: 10.1016/j.ejogrb.2018.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study aimed to assess the application of the French guidelines for pregnancies in Turner syndrome (TS) and their impact on perinatal prognosis. STUDY DESIGN We performed a French multi-center retrospective study (14 centers), including TS pregnant patients (spontaneously or by Assisted Reproductive Technology (ART)) between January 2006 and July 2017. Only clinical pregnancies were analyzed. The adjustment of medical follow-up modalities to French guidelines was evaluated for all pregnancies after 2009. Pregnancies from oocyte donation (OD) after 2009 were compared to those of a cohort of TS pregnancies obtained by OD before 2009, which were reported by the French Study Group for Oocyte Donation. RESULTS One hundred seventy pregnancies in 103 patients were included: 35 spontaneous, 5 by means of intra-conjugal ART, and 130 with OD. No serious maternal complications were observed. We reported two stillbirths and one intra uterine fetal death. The French guidelines were partially respected. The preconceptional assessment was carried out in 74% of cases. Cardiology follow-up during pregnancy was performed in accordance with guidelines in 74% of patients. Postpartum cardiac ultrasonography was performed in 45% of pregnancies but only in 11% within 8 days post-partum. When compared to the 2009 historical cohort, the rates of high blood pressure (19% vs. 38%; p < 0.005) pre-eclampsia (8% vs. 21%; p < 0.005) and prematurity <35 weeks (15% vs 38%; p < 0.0001) were lower. CONCLUSIONS The implementation of guidelines has allowed the standardization of TS pregnancy care and improved perinatal indicators for both mothers and children. However, an effort must be done, in a postpartum survey.
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Affiliation(s)
- Florence Cadoret
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Jean Parinaud
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France; EA 3694 Human Fertility Research Group, University of Toulouse III, France.
| | - Celia Bettiol
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Catherine Pienkowski
- Reference Center for Rare Gynecological Pathologies, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Helene Letur
- Fertility Center, Institut Mutualiste Montsouris, Paris, France
| | - Jeanine Ohl
- Department of Obstetrics, Gynecology and Reproductive Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Loïc Sentilhes
- Department of Obstetrics, Gynecology and Reproductive Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Aline Papaxanthos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Nantes University Hospital, and UMR 1280 Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | | | | | - Celine Chauleur
- Department of Gynecology and Obstetrics, Saint-Etienne University Hospital, and INSERM U1059, Saint-Etienne, France
| | - Florence Biquard
- Department of Gynecology and Obstetrics, Angers University Hospital, Angers, France
| | - Sylvie Hieronimus
- Department of Endocrinology, Diabetology and Reproductive Medicine, Nice University Hospital, Nice, France
| | - Celine Pimentel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Nathalie Fontaine
- Department of Gynecology, La Reunion University Hospital, La Reunion, France
| | - Julien Chevreau
- Department of Obstetrics and Obstetrics and Gynecology, Amiens University Hospital, Amiens, France
| | - Olivier Parant
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France; UMR1027, University of Toulouse III, France
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Clinical and Echocardiographic Prevalence and Detection of Congenital and Acquired Cardiac Abnormalities in Girls and Women with the Turner Syndrome. Am J Cardiol 2018; 122:327-330. [PMID: 29731120 DOI: 10.1016/j.amjcard.2018.03.357] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 01/15/2023]
Abstract
The prevalence of congenital and acquired heart disease in patients with the Turner syndrome (TS) is based on historic cohorts who underwent imaging before the advent of modern day echocardiography. Recent small studies suggest a higher prevalence of cardiac defects. We reviewed clinical and echocardiographic data on 564 girls and women with TS to assess the prevalence of cardiac defects. Echocardiographic review on a subset of this population was performed to assess for diagnostic limitations of echocardiography in assessing for congenital and acquired defects in this patient cohort. Bicuspid aortic valve was present in 39%, aortic coarctation in 21%, and some forms of structural cardiac anomaly in 56%. Failure to perform a complete congenital echocardiogram with suprasternal and high right or left parasternal windows was associated with failure to identify congenital and acquired cardiac defects. In conclusion, major cardiac defects are present in the majority of patients with TS. Echocardiographic technique can be optimized to avoid missing cardiac lesions of potential hemodynamic significance.
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Obara-Moszynska M, Rajewska-Tabor J, Rozmiarek S, Karmelita-Katulska K, Kociemba A, Rabska-Pietrzak B, Janus M, Siniawski A, Mrozinski B, Graczyk-Szuster A, Niedziela M, Pyda M. The Usefulness of Magnetic Resonance Imaging of the Cardiovascular System in the Diagnostic Work-Up of Patients With Turner Syndrome. Front Endocrinol (Lausanne) 2018; 9:609. [PMID: 30459711 PMCID: PMC6232706 DOI: 10.3389/fendo.2018.00609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/25/2018] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular defects occur in 50% of patients with Turner syndrome (TS). The aim of the study was to estimate the usefulness of cardiac magnetic resonance imaging (CMR) and magnetic resonance angiography (angio-MR) as diagnostics in children and adolescents with TS. Forty-one females with TS, aged 13.9 ± 2.2 years, were studied. CMR was performed in 39 patients and angio-MR in 36. Echocardiography was performed in all patients. The most frequent anomalies diagnosed on CMR and angio-MR were as follows: elongation of the ascending aorta (AA) and aortic arch, present in 16 patients (45.7%), a bicuspid aortic valve (BAV), present in 16 patients (41.0%), and partial anomalous pulmonary venous return (PAPVR), present in six patients (17.1%). Aortic dilatation (Z-score > 2) was mostly seen at the sinotubular junction (STJ) (15 patients; 42.8%), the AA (15 patients; 42.8%), the thoracoabdominal aorta at the level of a diaphragm (15 patients; 42.8%), and the transverse segment (14 patients; 40.0%). An aortic size index (ASI) above 2.0 cm/m2 was present in six patients (17.1%) and above 2.5 cm/m2 in three patients (8.6%). The left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) were diminished (Z-score < -2) in 10 (25.6%), 9 (23.1%), and 8 patients (20.5%), respectively. A webbed neck was correlated with the presence of vascular anomalies (p = 0.006). The age and body mass index (BMI) were correlated with the diameter of the aorta. Patients with BAV had a greater aortic diameter at the ascending aorta (AA) segment (p = 0.026) than other patients. ASI was correlated with aortic diameter and descending aortic diameter (AD/DD) ratio (p = 0.002; r = 0.49). There was a significant correlation between the right ventricular (p = 0.002, r = 0.46) and aortic diameters at the STJ segment (p = 0.0047, r = 0.48), as measured by echocardiography and CMR. Magnetic resonance can identify cardiovascular anomalies, dilatation of the aorta, pericardial fluid, and functional impairment of the ventricles not detected by echocardiography. BMI, age, BAV, and elongation of the AA influence aortic dilatation. The ASI and AD/DD ratio are important markers of aortic dilatation. The performed diagnostics did not indicate a negative influence of GH treatment on the cardiovascular system.
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Affiliation(s)
- Monika Obara-Moszynska
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Monika Obara-Moszynska
| | - Justyna Rajewska-Tabor
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Szymon Rozmiarek
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Anna Kociemba
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Rabska-Pietrzak
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Janus
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Siniawski
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartlomiej Mrozinski
- Department of Pediatric Cardiology, Nephrology and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Graczyk-Szuster
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Malgorzata Pyda
- Cardiac Magnetic Resonance Unit, First Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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Abstract
Over several decades, much has been learned about the diverse physical impacts of exercise. Those who excel, such as elite athletes, have physiologic differences compared with the general population. There is a growing body of data suggesting that gender may play a role in these adaptations. Further, certain cardiac conditions may exhibit a gender predilection. This article explains the particular cardiac nuances of the female athlete.
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Affiliation(s)
- Shelby C White
- Division of Pediatric Cardiology, Department of Pediatrics, UVA Children's Hospital Heart Center, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA
| | - Jana M Goldberg
- Department of Cardiovascular Disease, Hospital of the University of Pennsylvania, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Robert W Battle
- Division of Pediatric Cardiology, University of Virginia Health System, University of Virginia, PO Box 800158, Charlottesville, VA 22908-0158, USA
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Digilio MC, Gnazzo M, Lepri F, Dentici ML, Pisaneschi E, Baban A, Passarelli C, Capolino R, Angioni A, Novelli A, Marino B, Dallapiccola B. Congenital heart defects in molecularly proven Kabuki syndrome patients. Am J Med Genet A 2017; 173:2912-2922. [DOI: 10.1002/ajmg.a.38417] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Maria Cristina Digilio
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Maria Gnazzo
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Francesca Lepri
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Elisa Pisaneschi
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Anwar Baban
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Chiara Passarelli
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Rossella Capolino
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Adriano Angioni
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Antonio Novelli
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
| | - Bruno Marino
- Department of Pediatrics; Pediatric Cardiology; Sapienza University; Rome Italy
| | - Bruno Dallapiccola
- Medical Genetics Unit; Medical Genetics Laboratory; Pediatric Cardiology; Bambino Gesù Pediatric Hospital; IRCCS; Rome Italy
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Bejarano Ramírez N, Redondo Calvo FJ, Galán Gómez E. Complicaciones asociadas a niñas con síndrome de Turner. Med Clin (Barc) 2017; 149:39-40. [DOI: 10.1016/j.medcli.2017.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Murdock DR, Donovan FX, Chandrasekharappa SC, Banks N, Bondy C, Muenke M, Kruszka P. Whole-Exome Sequencing for Diagnosis of Turner Syndrome: Toward Next-Generation Sequencing and Newborn Screening. J Clin Endocrinol Metab 2017; 102:1529-1537. [PMID: 28324009 PMCID: PMC5443329 DOI: 10.1210/jc.2016-3414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/17/2017] [Indexed: 12/12/2022]
Abstract
CONTEXT Turner syndrome (TS) is due to a complete or partial loss of an X chromosome in female patients and is not currently part of newborn screening (NBS). Diagnosis is often delayed, resulting in missed crucial diagnostic and therapeutic opportunities. OBJECTIVES This study sought to determine if whole-exome sequencing (WES) as part of a potential NBS program could be used to diagnose TS. DESIGN, SETTING, PATIENTS Karyotype, chromosomal microarray, and WES were performed on blood samples from women with TS (n = 27) enrolled in the Personalized Genomic Research study at the National Institutes of Health. Female control subjects (n = 37) and male subjects (n = 27) also underwent WES. Copy number variation was evaluated using EXCAVATOR2 and B allele frequency was calculated from informative single nucleotide polymorphisms. Simulated WES data were generated for detection of low-level mosaicism and complex structural chromosome abnormalities. RESULTS We detected monosomy for chromosome X in all 27 TS samples, including 1 mosaic for 45,X/46,XX and another with previously unreported material on chromosome Y. Sensitivity and specificity were both 100% for the diagnosis of TS with no false-positive or false-negative results. Using simulated WES data, we detected isochromosome Xq and low-level mosaicism as low as 5%. CONCLUSION We present an accurate method of diagnosing TS using WES, including cases with low-level mosaicism, isochromosome Xq, and cryptic Y-chromosome material. Given the potential use of next-generation sequencing for NBS in many different diseases and syndromes, we propose WES can be used as a screening test for TS in newborns.
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Affiliation(s)
- David R. Murdock
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Frank X. Donovan
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Settara C. Chandrasekharappa
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Nicole Banks
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
| | - Carolyn Bondy
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
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Klásková E, Zapletalová J, Kaprálová S, Šnajderová M, Lebl J, Tüdös Z, Pavlíček J, Černá J, Mihál V, Stará V, Procházka M. Increased prevalence of bicuspid aortic valve in Turner syndrome links with karyotype: the crucial importance of detailed cardiovascular screening. J Pediatr Endocrinol Metab 2017; 30:319-325. [PMID: 28236629 DOI: 10.1515/jpem-2016-0301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) represents one of the strongest risk factors for aortic dissection in Turner syndrome (TS). An exact relation between the occurrence of BAV and a particular karyotype has not been established yet. The aim of this study was to determine the association between karyotype and prevalence of BAV. METHODS Sixty-seven TS patients aged between 6.6 and 32.5 years underwent cardiac magnetic resonance imaging (MRI) study. They were divided into four cytogenetic subgroups-45,X karyotype (n=27); 45,X/46,XX mosaicism (n=17); structural abnormalities of the X chromosome (n=10); and 45,X/structural abnormality of the X chromosome mosaicism (n=13). Prevalence of BAV and odds ratio (OR) compared with the general population in the whole study group, and statistical comparison of prevalences of BAV among the individual subgroups were determined. RESULTS Prevalence of BAV in the whole study group was established as 28.4% [OR 208.3 (95% CI - 103.8-418.0); p-value<0.0001]. Individuals with 45,X karyotype had the highest prevalence of BAV - 40.7%, p-value<0.0001. Presence of any 45,X cell line in karyotype significantly predisposed to BAV (p-value=0.05). CONCLUSIONS The 45,X karyotype is associated with the highest prevalence of BAV. Also, the presence of the 45,X cell line in any mosaic karyotype increases the probability of BAV.
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Devos DGH, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E. Proximal aortic stiffening in Turner patients may be present before dilation can be detected: a segmental functional MRI study. J Cardiovasc Magn Reson 2017; 19:27. [PMID: 28222756 PMCID: PMC5320803 DOI: 10.1186/s12968-017-0331-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To study segmental structural and functional aortic properties in Turner syndrome (TS) patients. Aortic abnormalities contribute to increased morbidity and mortality of women with Turner syndrome. Cardiovascular magnetic resonance (CMR) allows segmental study of aortic elastic properties. METHOD We performed Pulse Wave Velocity (PWV) and distensibility measurements using CMR of the thoracic and abdominal aorta in 55 TS-patients, aged 13-59y, and in a control population (n = 38;12-58y). We investigated the contribution of TS on aortic stiffness in our entire cohort, in bicuspid (BAV) versus tricuspid (TAV) aortic valve-morphology subgroups, and in the younger and older subgroups. RESULTS Differences in aortic properties were only seen at the most proximal aortic level. BAV Turner patients had significantly higher PWV, compared to TAV Turner (p = 0.014), who in turn had significantly higher PWV compared to controls (p = 0.010). BAV Turner patients had significantly larger ascending aortic (AA) luminal area and lower AA distensibility compared to both controls (all p < 0.01) and TAV Turner patients. TAV Turner had similar AA luminal areas and AA distensibility compared to Controls. Functional changes are present in younger and older Turner subjects, whereas ascending aortic dilation is prominent in older Turner patients. Clinically relevant dilatation (TAV and BAV) was associated with reduced distensibility. CONCLUSION Aortic stiffening and dilation in TS affects the proximal aorta, and is more pronounced, although not exclusively, in BAV TS patients. Functional abnormalities are present at an early age, suggesting an aortic wall disease inherent to the TS. Whether this increased stiffness at young age can predict later dilatation needs to be studied longitudinally.
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Affiliation(s)
- Daniel G. H. Devos
- Department of Radiology, MRI (-1K12), Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Katya De Groote
- Pediatric Cardiology, Department of Pediatrics and Turner Clinic, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Danilo Babin
- Telecommunications and Information Processing, TELIN-IPI-iMinds, Faculty of Engineering and Architecture, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Laurent Demulier
- Department of Cardiology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Yves Taeymans
- Department of Cardiology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Jos J. Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Luc Van Bortel
- Heymans Institute of Pharmacology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Patrick Segers
- IBiTech-bioMMeda, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Eric Achten
- Department of Radiology, MRI (-1K12), Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Jean De Schepper
- Pediatric Endocrinology, Department of Pediatrics and Turner Clinic, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
| | - Ernst Rietzschel
- Department of Cardiology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium
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Sheng Yang X, Ping Sun J, Yan B. Clinical Syndromes Associated with Cardiovascular Diseases: A Review. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Increased aortic stiffness in prepubertal girls with Turner syndrome. J Cardiol 2017; 69:201-207. [DOI: 10.1016/j.jjcc.2016.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 01/15/2023]
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Yoon CW, Lee E, Yoon BN, Park HK, Rha JH. A Case of Turner Syndrome with Multiple Embolic Infarcts. Case Rep Neurol 2016; 8:199-203. [PMID: 27790125 PMCID: PMC5073681 DOI: 10.1159/000449282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022] Open
Abstract
Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.
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Affiliation(s)
- Cindy W Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Eungseok Lee
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Byung-Nam Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Hee-Kwon Park
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
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Lara DA, Ethen MK, Canfield MA, Nembhard WN, Morris SA. A population-based analysis of mortality in patients with Turner syndrome and hypoplastic left heart syndrome using the Texas Birth Defects Registry. CONGENIT HEART DIS 2016; 12:105-112. [PMID: 27685952 DOI: 10.1111/chd.12413] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/25/2016] [Accepted: 08/25/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hypoplastic left heart syndrome (HLHS) is strongly associated with Turner syndrome (TS); outcome data when these conditions coexist is sparse. We aimed to investigate long-term survival and causes of death in this population. METHODS The Texas Birth Defects Registry was queried for all live born infants with HLHS during 1999-2007. We used Kaplan-Meier and Cox regression analyses to compare survival among patients with HLHS with TS (HLHS/TS+) to patients who had HLHS without genetic disorders or extracardiac birth defects (HLHS/TS-). RESULTS Of the 542 patients with HLHS, 11 had TS (2.0%), 71 had other extracardiac birth defects or genetic disorders, and 463 had neither. The median follow-up time was 4.2 y (interquartile range [IQR] 2.1-6.5). Comparing those with HLHS/TS+ to HLHS/TS-, 100% versus 35% were female (P < .001), and median birth weight was 2140 g (IQR 1809-2650) versus 3196 g (IQR 2807-3540, P < .001). Neonatal mortality was 36% in HLHS/TS+ versus 27% in HLHS/TS- (log rank = 0.431). Ten of the 11 TS+ patients died during the study period for cumulative mortality of 91% versus 50% (hazard ratio (HR) for TS+: 2.90, 95% CI 1.53-5.48). Six patients died prior to surgery, 5 underwent Stage 1 palliation (S1P), 3 died after S1P, 2 survived past S2P, and one of these died at age 19 mo. The underlying cause of death was listed as congenital heart disease on all the death certificates of HLHS/TS+ patients. In multivariable analysis controlling for low birth weight (<2500 g), TS remained associated with significantly increased cumulative mortality, although females without TS had higher mortality than males (HR for TS+ versus males: 2.42, 95% CI 1.24-4.73; HR for TS- females versus males: 1.41, 95% CI 1.08-1.83). CONCLUSION TS with HLHS is associated with significant mortality. The increased mortality in females without documented TS calls to question if TS is undetected in a portion of females with HLHS.
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Affiliation(s)
- Diego A Lara
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mary K Ethen
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX, USA
| | - Wendy N Nembhard
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Shaine A Morris
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Somerville S, Rosolowsky E, Suntratonpipat S, Girgis R, Goot BH, Tham EB. Cardiac Magnetic Resonance Imaging in Pediatric Turner Syndrome. J Pediatr 2016; 175:111-115.e1. [PMID: 27233524 DOI: 10.1016/j.jpeds.2016.04.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/17/2016] [Accepted: 04/22/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare the detection of cardiac lesions with the use of cardiac magnetic resonance imaging (CMR) and conventional echocardiography in children with Turner syndrome. STUDY DESIGN Twenty-four girls with Turner syndrome, 8-18 years of age, were recruited through the Pediatric Endocrinology Program. Participants underwent CMR and echocardiography within a 2-year period, and discrepancies between the results of each modality were identified. RESULTS Fifteen of 24 (63%) girls had a cardiac lesion identified on CMR or echocardiography. Both modalities identified the same lesion in 10 of 15 (67%); however, 6 of 15 (40%) participants had a lesion identified on CMR but not echocardiography. Participants with a missed lesion had a trend towards greater body mass index. Aortic dilation and bicuspid aortic valve were the most commonly missed lesions by echocardiography. CONCLUSIONS CMR identifies significant cardiac lesions missed by echocardiography in pediatric patients with Turner syndrome, particularly along the aorta. These findings support the current guidelines that recommend screening CMR in addition to echocardiogram. Early identification of cardiac abnormalities in patients with Turner syndrome will allow for a greater understanding of the natural history in these patients and potentially identify candidates for earlier intervention.
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Affiliation(s)
- Scott Somerville
- Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Somjate Suntratonpipat
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Rose Girgis
- Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin H Goot
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Edythe B Tham
- Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Granger A, Zurada A, Zurada-Zielińska A, Gielecki J, Loukas M. Anatomy of turner syndrome. Clin Anat 2016; 29:638-42. [PMID: 27087450 DOI: 10.1002/ca.22727] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 01/15/2023]
Abstract
Turner syndrome (TS) is one of the most common sex chromosome abnormalities and results from total or partial monosomy of the X chromosome. It occurs in 1 in 2000 newborn girls and is also believed to be present in a larger proportion of conceptuses. There are various anatomic anomalies that have been associated with TS and the consequences of late recognition of these anomalies can be devastating. Aortic dilation and dissection occur at increased rates in TS patients and contribute to the decreased life expectancy of these patients. Such cases have prompted the need for early identification and continuous monitoring. Other anatomic variations increase morbidity in this population, and negatively impact the social and reproductive aspects of their lives. In this review, we summarize the cardiovascular, neurological, genitourinary, otolaryngolical, craniofacial, and skeletal defects associated with TS. To elucidate these morphological variations, novel illustrations have also been constructed. Clin. Anat. 29:638-642, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andre Granger
- Department of Anatomical Sciences, St George's University, Grenada, West Indies
| | - Anna Zurada
- Department of Anatomy, Varmia and Mazury Medical School, Olsztyn, Poland
| | | | - Jerzy Gielecki
- Department of Anatomy, Varmia and Mazury Medical School, Olsztyn, Poland
| | - Marios Loukas
- Department of Anatomical Sciences, St George's University, Grenada, West Indies
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Azamian M, Lalani SR. Cytogenomic Aberrations in Congenital Cardiovascular Malformations. Mol Syndromol 2016; 7:51-61. [PMID: 27385961 DOI: 10.1159/000445788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Congenital cardiovascular malformations are the most common birth defects, with a complex multifactorial etiology. Genetic factors play an important role, illuminated by numerous cytogenetically visible abnormalities, as well as submicroscopic genomic imbalances affecting critical genomic regions in the affected individuals. Study of rare families with Mendelian forms, as well as emerging next-generation sequencing technologies have uncovered a multitude of genes relevant for human congenital cardiac diseases. It is clear that the complex embryology of human cardiac development, with an orchestrated interplay of transcription factors, chromatin regulators, and signal transduction pathway molecules can be easily perturbed by genomic imbalances affecting dosage-sensitive regions. This review focuses on chromosomal abnormalities contributing to congenital heart diseases and underscores several genomic disorders linked to human cardiac malformations in the last few decades.
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Affiliation(s)
- Mahshid Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Tex., USA
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Tex., USA
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68
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Sherif HM. Turner syndrome and guidelines for management of thoracic aortic disease: Appropriateness and utility. Artery Res 2016. [DOI: 10.1016/j.artres.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Yu MK, Jung MK, Kim KE, Kwon AR, Chae HW, Kim DH, Kim HS. Turner syndrome with spinal hemorrhage due to vascular malformation. Ann Pediatr Endocrinol Metab 2015; 20:235-7. [PMID: 26817012 PMCID: PMC4722165 DOI: 10.6065/apem.2015.20.4.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/08/2015] [Accepted: 10/15/2015] [Indexed: 01/15/2023] Open
Abstract
Turner syndrome (TS) is a relatively common chromosomal disorder and is associated with a range of comorbidities involving the cardiovascular system. Vascular abnormalities, in particular, are a common finding in cases of TS. However, dissection involving the vertebral arteries is rare. Here, we report the case of a 9-year-old girl with TS who had been treated with growth hormone replacement therapy for the past 3 years. She presented with weakness of both lower legs, and was ultimately diagnosed with spinal hemorrhage due to vascular malformation. We treated her with intravenous high dose dexamethasone (0.6 mg/kg) and she could walk without assistance after 6 days of treatment. In conclusion, when a patient with TS shows sudden weakness of the lower limbs, we should consider the possibility of spinal vessel rupture and try to take spine magnetic resonance imaging as soon as possible. We suggest a direction how to make a proper diagnosis and management of sudden vertebral artery hemorrhage in patients with TS.
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Affiliation(s)
- Min Kyung Yu
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mo Kyung Jung
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Eun Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Reum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hee Kim
- Department of Pediatrics, Sohwa Children's Hospital, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Preliminary Evidence for Aortopathy and an X-Linked Parent-of-Origin Effect on Aortic Valve Malformation in a Mouse Model of Turner Syndrome. J Cardiovasc Dev Dis 2015; 2:190-199. [PMID: 29371518 PMCID: PMC5753145 DOI: 10.3390/jcdd2030190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 01/15/2023] Open
Abstract
Turner syndrome (TS), most frequently caused by X-monosomy (45,X), is characterized in part by cardiovascular abnormalities, including aortopathy and bicuspid aortic valve (BAV). There is a need for animal models that recapitulate the cardiovascular manifestations of TS. Extracellular matrix (ECM) organization and morphometrics of the aortic valve and proximal aorta were examined in adult 39,XO mice (where the parental origin of the single X was paternal (39,XPO) or maternal (39,XMO)) and 40,XX controls. Aortic valve morphology was normal (tricuspid) in all of the 39,XPO and 40,XX mice studied, but abnormal (bicuspid or quadricuspid) in 15% of 39,XMO mice. Smooth muscle cell orientation in the ascending aorta was abnormal in all 39,XPO and 39,XMO mice examined, but smooth muscle actin was decreased in 39,XMO mice only. Aortic dilation was present with reduced penetrance in 39,XO mice. The 39,XO mouse demonstrates aortopathy and an X-linked parent-of-origin effect on aortic valve malformation, and the candidate gene FAM9B is polymorphically expressed in control and diseased human aortic valves. The 39,XO mouse model may be valuable for examining the mechanisms underlying the cardiovascular findings in TS, and suggest there are important genetic modifiers on the X chromosome that modulate risk for nonsyndromic BAV and aortopathy.
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71
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Turtle EJ, Sule AA, Webb DJ, Bath LE. Aortic dissection in children and adolescents with Turner syndrome: risk factors and management recommendations. Arch Dis Child 2015; 100:662-6. [PMID: 25573747 DOI: 10.1136/archdischild-2014-307080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/10/2014] [Indexed: 01/15/2023]
Abstract
There is a general lack of awareness of the risk of aortic dissection in Turner syndrome (TS) from both patients with TS and their physicians. Patients often ignore symptoms for up to 24 h before seeking medical advice, significantly increasing their risk of death. A clinical profile of those at risk of dissection is emerging and includes the presence of congenital heart defects, aortic dilatation and hypertension. MRI has revolutionised the visualisation of cardiovascular anatomy in TS but remains underutilised, especially in children and adolescents, and there is currently little guidance on blood pressure (BP) assessment or hypertension management. Children and adolescents with TS at risk of dissection could be easily identified by timely imaging and BP assessment. This would allow medical management or surgical intervention to be put in place to reduce the risk of this major, and often fatal, complication. Since guidance is lacking, we have reviewed the literature on the risk factors for dissection in TS during childhood and adolescence, and make recommendations on the assessment and management of these patients.
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Affiliation(s)
- E J Turtle
- Edinburgh Centre for Endocrinology, Western General Hospital, Edinburgh, UK
| | - A A Sule
- Tan Tock Seng Hospital, Singapore, Singapore
| | - D J Webb
- Queen's Medical Research Institute, University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh, UK
| | - L E Bath
- Edinburgh Centre for Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
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Quezada E, Lapidus J, Shaughnessy R, Chen Z, Silberbach M. Aortic dimensions in Turner syndrome. Am J Med Genet A 2015; 167A:2527-32. [PMID: 26118429 DOI: 10.1002/ajmg.a.37208] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 06/03/2015] [Indexed: 12/15/2022]
Abstract
In Turner syndrome, linear growth is less than the general population. Consequently, to assess stature in Turner syndrome, condition-specific comparators have been employed. Similar reference curves for cardiac structures in Turner syndrome are currently unavailable. Accurate assessment of the aorta is particularly critical in Turner syndrome because aortic dissection and rupture occur more frequently than in the general population. Furthermore, comparisons to references calculated from the taller general population with the shorter Turner syndrome population can lead to over-estimation of aortic size causing stigmatization, medicalization, and potentially over-treatment. We used echocardiography to measure aortic diameters at eight levels of the thoracic aorta in 481 healthy girls and women with Turner syndrome who ranged in age from two to seventy years. Univariate and multivariate linear regression analyses were performed to assess the influence of karyotype, age, body mass index, bicuspid aortic valve, blood pressure, history of renal disease, thyroid disease, or growth hormone therapy. Because only bicuspid aortic valve was found to independently affect aortic size, subjects with bicuspid aortic valve were excluded from the analysis. Regression equations for aortic diameters were calculated and Z-scores corresponding to 1, 2, and 3 standard deviations from the mean were plotted against body surface area. The information presented here will allow clinicians and other caregivers to calculate aortic Z-scores using a Turner-based reference population. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Emilio Quezada
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Sciences University, Portland, Oregon
| | - Jodi Lapidus
- Department of Public Health & Preventive Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Robin Shaughnessy
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Sciences University, Portland, Oregon
| | - Zunqiu Chen
- Department of Public Health & Preventive Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Michael Silberbach
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health & Sciences University, Portland, Oregon
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Moosmann J, Uebe S, Dittrich S, Rüffer A, Ekici AB, Toka O. Novel loci for non-syndromic coarctation of the aorta in sporadic and familial cases. PLoS One 2015; 10:e0126873. [PMID: 25984793 PMCID: PMC4436177 DOI: 10.1371/journal.pone.0126873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) accounts for 5-8% of all congenital heart defects. CoA can be detected in up to 20% of patients with Ullrich-Turner syndrome (UTS), in which a part or all of one of the X chromosomes is absent. The etiology of non-syndromic CoA is poorly understood. In the present work, we test the hypothesis that rare copy number variation (CNV) especially on the gonosomes, contribute to the etiology of non-syndromic CoA. METHODS We performed high-resolution genome-wide CNV analysis using the Affymetrix SNP 6.0 microarray platform for 70 individuals with sporadic CoA, 3 families with inherited CoA (n=13) and 605 controls. Our analysis comprised genome wide association, CNV burden and linkage. CNV was validated by multiplex ligation-dependent probe amplification. RESULTS We identified a significant abundance of large (>100 kb) CNVs on the X chromosome in males with CoA (p=0.005). 11 out of 51 (~ 22%) male cases had these large CNVs. Association analysis in the sporadic cohort revealed 14 novel loci for CoA. The locus on 21q22.3 in the sporadic CoA cohort overlapped with a gene locus identified in all familial cases of CoA (candidate gene TRPM2). We identified one CNV locus within a locus with high multipoint LOD score from a linkage analysis of the familial cases (SEPT9); another locus overlapped with a region implicated in Kabuki syndrome. In the familial cases, we identified a total of 7 CNV loci that were exclusively present in cases but not in unaffected family members. CONCLUSION Of all candidate loci identified, the TRPM2 locus was the most frequently implicated autosomal locus in sporadic and familial cases. However, the abundance of large CNVs on the X chromosome of affected males suggests that gonosomal aberrations are not only responsible for syndromic CoA but also involved in the development of sporadic and non-syndromic CoA and their male dominance.
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Affiliation(s)
- Julia Moosmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Pediatric Cardiology, Loschgestraße 15, 91054 Erlangen, Germany
| | - Steffen Uebe
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Human Genetics, Schwabachanlage 10, 91054 Erlangen, Germany
| | - Sven Dittrich
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Pediatric Cardiology, Loschgestraße 15, 91054 Erlangen, Germany
| | - André Rüffer
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Pediatric Cardiac Surgery, Loschgestraße 15, 91054 Erlangen, Germany
| | - Arif B. Ekici
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Institute of Human Genetics, Schwabachanlage 10, 91054 Erlangen, Germany
| | - Okan Toka
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Pediatric Cardiology, Loschgestraße 15, 91054 Erlangen, Germany
- * E-mail:
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Marin A, Weir-McCall JR, Webb DJ, van Beek EJR, Mirsadraee S. Imaging of cardiovascular risk in patients with Turner's syndrome. Clin Radiol 2015; 70:803-14. [PMID: 25917542 PMCID: PMC4509713 DOI: 10.1016/j.crad.2015.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/17/2015] [Accepted: 03/19/2015] [Indexed: 01/14/2023]
Abstract
Turner's syndrome is a disorder defined by an absent or structurally abnormal second X chromosome and affects around 1 in 2000 newborn females. The standardised mortality ratio in Turner's syndrome is around three-times higher than in the general female population, mainly as a result of cardiovascular disorders. Most striking is the early age at which Turner's syndrome patients develop the life-threatening complications of cardiovascular disorders compared to the general population. The cardiovascular risk stratification in Turner's syndrome is challenging and imaging is not systematically used. The aim of this article is to review cardiovascular risks in this group of patients and discuss a systematic imaging approach for early identification of cardiovascular disorders in these patients.
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Affiliation(s)
- A Marin
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - J R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - D J Webb
- Queen's Medical Research Institute, University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh EH16 4TJ, UK
| | - E J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - S Mirsadraee
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK.
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Yeşilkaya E, Bereket A, Darendeliler F, Baş F, Poyrazoğlu Ş, Küçükemre Aydın B, Darcan Ş, Dündar B, Büyükinan M, Kara C, Sarı E, Adal E, Akıncı A, Atabek ME, Demirel F, Çelik N, Özkan B, Özhan B, Orbak Z, Ersoy B, Doğan M, Ataş A, Turan S, Gökşen D, Tarım Ö, Yüksel B, Ercan O, Hatun Ş, Şimşek E, Ökten A, Abacı A, Döneray H, Özbek MN, Keskin M, Önal H, Akyürek N, Bulan K, Tepe D, Emeksiz HC, Demir K, Kızılay D, Topaloğlu AK, Eren E, Özen S, Abalı S, Akın L, Selver Eklioğlu B, Kaba S, Anık A, Baş S, Ünüvar T, Sağlam H, Bolu S, Özgen T, Doğan D, Çakır ED, Şen Y, Andıran N, Çizmecioğlu F, Evliyaoğlu O, Karagüzel G, Pirgon Ö, Çatlı G, Can HD, Gürbüz F, Binay Ç, Baş VN, Fidancı K, Polat A, Gül D, Açıkel C, Demirbilek H, Cinaz P, Bondy C. Turner syndrome and associated problems in Turkish children: a multicenter study. J Clin Res Pediatr Endocrinol 2015; 7:27-36. [PMID: 25800473 PMCID: PMC4439889 DOI: 10.4274/jcrpe.1771] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. METHODS Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. RESULTS The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. CONCLUSION This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan.
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Affiliation(s)
- Ediz Yeşilkaya
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey. E-mail:
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Banu Küçükemre Aydın
- İstanbul University Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Bumin Dündar
- Katip Çelebi University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Muammer Büyükinan
- Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Erkan Sarı
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Erdal Adal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Ayşehan Akıncı
- Inönü University Faculty of Medicine, Department of Pediatric Endocrinology, Malatya, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Fatma Demirel
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Nurullah Çelik
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Bayram Özhan
- Pamukkale University Faculty of Medicine, Department of Pediatric Endocrinology, Denizli, Turkey
| | - Zerrin Orbak
- Atatürk University Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Betül Ersoy
- Celal Bayar University Faculty of Medicine, Department of Pediatric Endocrinology, Manisa, Turkey
| | - Murat Doğan
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Ali Ataş
- Harran University Faculty of Medicine, Department of Pediatric Endocrinology, Şanlıurfa, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Oya Ercan
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Ayşenur Ökten
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hakan Döneray
- Atatürk University Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Mehmet Nuri Özbek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Keskin
- Gaziantep University Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep, Turkey
| | - Hasan Önal
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Nesibe Akyürek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Kezban Bulan
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Derya Tepe
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Hamdi Cihan Emeksiz
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Korcan Demir
- Dr. Behçet Uz Children Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Deniz Kızılay
- Celal Bayar University Faculty of Medicine, Department of Pediatric Endocrinology, Manisa, Turkey
| | - Ali Kemal Topaloğlu
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Saygın Abalı
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Leyla Akın
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Beray Selver Eklioğlu
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Sultan Kaba
- Yüzüncü Yıl University Faculty of Medicine, Department of Pediatric Endocrinology, Van, Turkey
| | - Ahmet Anık
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Serpil Baş
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Tolga Ünüvar
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Halil Sağlam
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Semih Bolu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Tolga Özgen
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Durmuş Doğan
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Esra Deniz Çakır
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Yaşar Şen
- Selçuk University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Nesibe Andıran
- Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Filiz Çizmecioğlu
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, Kocaeli, Turkey
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Gülay Karagüzel
- Karadeniz Technical University Faculty of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Özgür Pirgon
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology, Isparta, Turkey
| | - Gönül Çatlı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hatice Dilek Can
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Çiğdem Binay
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Veysel Nijat Baş
- Kayseri Training and Research Hospital, Clinic of Pediatric Endocrinology, Kayseri, Turkey
| | - Kürşat Fidancı
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Adem Polat
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Davut Gül
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Cengizhan Açıkel
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
| | - Peyami Cinaz
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Carolyn Bondy
- National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Wonkam A, Veigne SW, Abass A, Ngo Um S, Noubiap JJN, Mbanya JC, Sobngwi E. Features of Turner syndrome among a group of Cameroonian patients. Int J Gynaecol Obstet 2015; 129:264-6. [PMID: 25912411 DOI: 10.1016/j.ijgo.2014.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/25/2014] [Accepted: 01/30/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the features of Turner syndrome among a group of Cameroonian patients. METHODS A descriptive cross-sectional study was conducted among patients with amenorrhea and/or short stature who attended the genetic unit of Yaoundé Gynecology, Obstetrics and Pediatric Hospital (Yaoundé, Cameroon) for a specialist consultation between July 1, 2007, and December 31, 2008. Sociodemographic, clinical, and cytogenetic data were collected. RESULTS Turner syndrome was confirmed among 11 of the 14 participants (seven had monosomy of the X chromosome; four had mosaicism involving a structural abnormality of the second X chromosome). The mean age at diagnosis was 18.4±2.8years. The reasons for consultation were delayed puberty (n=10) and short stature (n=1). Nine patients had a short neck, nine had a forearm carrying-angle deformity, eight had a low hairline, and two had a webbed neck. Abdominal ultrasonography identified a horseshoe kidney in two patients and a rudimentary uterus in nine patients. None of the patients displayed cardiac abnormalities. Hypergonadotropic hypogonadism was reported among five patients. Eight patients did not receive hormonal treatment owing to advanced bone age or economic reasons. CONCLUSION Late diagnosis and variable phenotypic expression were key features of Cameroonian patients with Turner syndrome.
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Affiliation(s)
- Ambroise Wonkam
- Department of Clinical Laboratory Sciences, Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Sandra W Veigne
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ali Abass
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Suzanne Ngo Um
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Jean-Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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77
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[Pemphigoid gestationis and Turner syndrome; an uncommon association]. ACTA ACUST UNITED AC 2015; 44:675-8. [PMID: 25613827 DOI: 10.1016/j.jgyn.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
Abstract
The authors report an uncommon case of a pregnant woman with Turner syndrome (TS) whose pregnancy (with favorable outcome) was complicated by a pemphigoid gestationis in third trimester. This case points out that monitoring of these pregnancies is not limited to cardiac monitoring. Prevalence of auto-immune diseases is increased in the TS. Auto-immune dermatoses, such as pemphigoid gestationis, are one of the potential complications during pregnancy and should be known to practitioners.
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78
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D'Andrea A, Della Corte A, Padalino R, Limongelli G, Scarafile R, Fratta F, Pezzullo E, Fusco A, Pisacane F, Coppola G, Caso P, Calabrò R, Russo MG. The Role of Multimodality Cardiac Imaging for the Assessment of Sports Eligibility in Patients with Bicuspid Aortic Valve. J Cardiovasc Echogr 2015; 25:9-18. [PMID: 28465922 PMCID: PMC5353454 DOI: 10.4103/2211-4122.158418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bicuspid aortic valve (BAV) cannot be considered an innocent finding, but it is not necessarily a life-threatening condition. Athletes with BAV should undergo a thorough staging of the valve anatomy, taking into consideration hemodynamic factors, as well as aortic diameters and looking for other associated significant cardiovascular anomalies by use of a multimodality cardiac imaging approach. Furthermore an accurate follow-up is mandatory with serial cardiological controls in those allowed to continue sports.
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Affiliation(s)
- Antonello D'Andrea
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Roberto Padalino
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaella Scarafile
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Fiorella Fratta
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Enrica Pezzullo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Adelaide Fusco
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Francesca Pisacane
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Guido Coppola
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Pio Caso
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaele Calabrò
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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79
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Cardiovascular aspects in the diagnosis and management of Turner’s syndrome. Cardiovasc Endocrinol 2014. [DOI: 10.1097/xce.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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80
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Epidemiology of Secondary Hypertension in Children. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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81
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Wong SC, Burgess T, Cheung M, Zacharin M. The prevalence of turner syndrome in girls presenting with coarctation of the aorta. J Pediatr 2014; 164:259-63. [PMID: 24172638 DOI: 10.1016/j.jpeds.2013.09.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/14/2013] [Accepted: 09/13/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the prevalence of Turner syndrome in girls presenting with coarctation of the aorta (CoA). STUDY DESIGN A total of 132 girls with known structural CoA was identified. Those girls who had no previous karyotype analysis performed were asked to participate in a research study in which a banded karyotype with 50-cell count was performed. RESULTS Of 132 girls with CoA, 55 (41.7%) had karyotype analysis within 6 months of cardiac diagnosis. Three girls underwent karyotyping later because of clinical concerns. Of the 74 girls with CoA who had not had a karyotype, 38 (51.4%) consented to the study. Results were available for 37 girls. All were 46,XX. Five patients with Turner syndrome were identified in the 95 girls with CoA who had karyotype analysis (4 from early karyotype and 1 diagnosed later), which translated into a minimum prevalence of 5.3% of Turner syndrome in this group of girls with CoA. In addition, one infant with a 20-cell 46,XX karyotype had features of Turner syndrome. CONCLUSION Our study demonstrated for the first time in a large cohort that 5.3% of girls presenting with CoA are found to have Turner syndrome when karyotyping is performed. Given the spectrum of preventable and treatable health problems after the diagnosis of Turner syndrome, we believe that all girls with CoA should have a karyotype analysis, ideally with at least 50-cell count, at the time of diagnosis of CoA.
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Affiliation(s)
- Sze Choong Wong
- Department of Endocrinology, The Royal Children's Hospital, Melbourne, Australia; Center for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Trent Burgess
- Victorian Clinical Genetics Services Pathology, Melbourne, Australia
| | - Michael Cheung
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Margaret Zacharin
- Department of Endocrinology, The Royal Children's Hospital, Melbourne, Australia; Center for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
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82
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The spectrum of congenital heart disease and outcomes after surgical repair among children with Turner syndrome: a single-center review. Pediatr Cardiol 2014; 35:253-60. [PMID: 23933717 DOI: 10.1007/s00246-013-0766-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/18/2013] [Indexed: 12/18/2022]
Abstract
Turner syndrome (TS), a genetic abnormality affecting 1 in 2,500 people, is commonly associated with congenital heart disease (CHD). However, the surgical outcomes for TS patients have not been well described. This study reviewed the spectrum of CHD in TS at the authors' center. The authors report outcomes after coarctation of the aorta (CoA) repair or staged palliation of hypoplastic left heart syndrome (HLHS) and then compare the surgical outcomes with those of non-TS patients undergoing like repair. This retrospective chart review was conducted at the Children's Hospital of Wisconsin from 1999 to 2011. Of the 173 patients with TS, 77 (44.5 %) were found to have CHD. Left-sided obstructive lesions were the most common. However, the spectrum of CHD was wide and included systemic and pulmonary venous abnormalities as well as abnormalities of the coronary arteries. In the comparative analysis of CoA repair, the TS patients younger than 60 days had longer aortic cross-clamp times (24 vs. 16 min; p = 0.001) and longer hospital stays (12 vs. 6 days; p ≤ 0.0001) than the non-TS patients. At the follow-up assessment after 8.8 ± 9.1 years, 17 % of the TS patients had hypertension, but no patient had required reintervention, and no deaths had occurred. Finally, three of the four TS patients with HLHS died within the first year. The spectrum of CHD within TS is wide and not limited to bicuspid aortic valve or CoA. Additionally, patients with TS undergoing CoA repair may have a more challenging early postoperative course but experience outcomes similar to those of non-TS patients. Finally, patients who have TS combined with HLHS remain a challenging population with generally poor survival.
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83
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Muñoz E, Portela S, Remohi J, Pellicer A. Pregnancy in patients with premature ovarian failure. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.6.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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84
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Thomas J, Yetman AT. Management of cardiovascular disease in Turner syndrome. Expert Rev Cardiovasc Ther 2014; 7:1631-41. [DOI: 10.1586/erc.09.149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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85
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Power T, Langlois NEI, Byard RW. The Forensic Implications of Turner's Syndrome. J Forensic Sci 2013; 59:671-5. [DOI: 10.1111/1556-4029.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/25/2013] [Accepted: 02/09/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Theresa Power
- School of Medical Sciences; The University of Adelaide; Frome Rd, 21 Divett Place Adelaide SA 5000 Australia
| | - Neil E. I. Langlois
- School of Medical Sciences; The University of Adelaide; Frome Rd, 21 Divett Place Adelaide SA 5000 Australia
| | - Roger W. Byard
- School of Medical Sciences; The University of Adelaide; Frome Rd, 21 Divett Place Adelaide SA 5000 Australia
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86
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Chen J, Gutmark E, Mylavarapu G, Backeljauw PF, Gutmark-Little I. Numerical investigation of mass transport through patient-specific deformed aortae. J Biomech 2013; 47:544-52. [PMID: 24210472 DOI: 10.1016/j.jbiomech.2013.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 01/15/2023]
Abstract
Blood flow in human arteries has been investigated using computational fluid dynamics tools. This paper considers flow modeling through three aorta models reconstructed from cross-sectional magnetic resonance scans of female patients. One has the normal control configuration, the second has elongation of the transverse aorta, and the third has tortuosity of the aorta with stenosis. The objective of this study is to determine the impact of aortic abnormal geometries on the wall shear stress (WSS), luminal surface low-density lipoproteins (LDLs) concentration, and oxygen flux along the arterial wall. The results show that the curvature of the aortic arch and the stenosis have significant effects on the blood flow, and in turn, the mass transport. The location of hypoxia areas can be predicted well by ignoring the effect of hemoglobin on the oxygen transport. However, this simplification indeed alters the absolute value of Sherwood number on the wall.
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Affiliation(s)
- Jie Chen
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA.
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Goutham Mylavarapu
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Philippe F Backeljauw
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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87
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Olivieri LJ, Baba RY, Arai AE, Bandettini WP, Rosing DR, Bakalov V, Sachdev V, Bondy CA. Spectrum of aortic valve abnormalities associated with aortic dilation across age groups in Turner syndrome. Circ Cardiovasc Imaging 2013; 6:1018-23. [PMID: 24084490 DOI: 10.1161/circimaging.113.000526] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Congenital aortic valve fusion is associated with aortic dilation, aneurysm, and rupture in girls and women with Turner syndrome. Our objective was to characterize aortic valve structure in subjects with Turner syndrome and to determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. METHODS AND RESULTS The aortic valve and thoracic aorta were characterized by cardiovascular MRI in 208 subjects with Turner syndrome in an institutional review board-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve, 64% (n=133); partially fused aortic valve, 12% (n=25); bicuspid aortic valve, 23% (n=47); and unicuspid aortic valve, 1% (n=3). Age and body surface area were similar in the 4 valve morphology groups. There was a significant trend, independent of age, toward larger body surface area-indexed ascending aortic diameters with increasing valve fusion. Ascending aortic diameters were (mean±SD) 16.9±3.3, 18.3±3.3, and 19.8±3.9 mm/m(2) (P<0.0001) for tricuspid aortic valve, partially fused aortic valve, and bicuspid aortic valve+unicuspid aortic valve, respectively. Partially fused aortic valve, bicuspid aortic valve, and unicuspid aortic valve were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. CONCLUSIONS Aortic valve abnormalities in Turner syndrome occur with a spectrum of severity and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased ascending aortic diameters.
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Affiliation(s)
- Laura J Olivieri
- National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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88
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Savio S, Mehta K, Udell T, Coveney J. A survey of the reformulation of Australian child-oriented food products. BMC Public Health 2013; 13:836. [PMID: 24025190 PMCID: PMC3847458 DOI: 10.1186/1471-2458-13-836] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/21/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Childhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009-2011. METHODS In 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time. RESULTS Of 120 products, 40 remained unchanged in nutrient composition from 2009-2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation. CONCLUSION Positive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009-2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.
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Affiliation(s)
- Stephanie Savio
- Nutrition and Dietetics, School of Medicine, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia, Australia
| | - Kaye Mehta
- Nutrition and Dietetics, School of Medicine, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia, Australia
| | - Tuesday Udell
- Heart Foundation, Hutt St, Adelaide, South Australia, Australia
| | - John Coveney
- Flinders Prevention, Promotion and Primary Health Care, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia, Australia
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Intervention and Management of Congenital Left Heart Obstructive Lesions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:632-45. [DOI: 10.1007/s11936-013-0260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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90
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Lee SH, Jung JM, Song MS, Choi SJ, Chung WY. Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography. J Korean Med Sci 2013; 28:1169-73. [PMID: 23960443 PMCID: PMC3744704 DOI: 10.3346/jkms.2013.28.8.1169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 05/23/2013] [Indexed: 11/20/2022] Open
Abstract
Turner syndrome is well known to be associated with significant cardiovascular abnormalities. This paper studied the incidence of cardiovascular abnormalities in asymptomatic adolescent patients with Turner syndrome using multidetector computed tomography (MDCT) instead of echocardiography. Twenty subjects diagnosed with Turner syndrome who had no cardiac symptoms were included. Blood pressure and electrocardiography (ECG) was checked. Cardiovascular abnormalities were checked by MDCT. According to the ECG results, 11 had a prolonged QTc interval, 5 had a posterior fascicular block, 3 had a ventricular conduction disorder. MDCT revealed vascular abnormalities in 13 patients (65%). Three patients had an aberrant right subclavian artery, 2 had dilatation of left subclavian artery, and others had an aortic root dilatation, aortic diverticulum, and abnormal left vertebral artery. As for venous abnormalities, 3 patients had partial anomalous pulmonary venous return and 2 had a persistent left superior vena cava. This study found cardiovascular abnormalities in 65% of asymptomatic Turner syndrome patients using MDCT. Even though, there are no cardiac symptoms in Turner syndrome patients, a complete evaluation of the heart with echocardiography or MDCT at transition period to adults must be performed.
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Affiliation(s)
- Sun Hee Lee
- Department of Pediatrics, Sungae Hospital, Seoul, Korea
| | - Ji Mi Jung
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Min Seob Song
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seok jin Choi
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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91
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Bondy C, Bakalov VK, Cheng C, Olivieri L, Rosing DR, Arai AE. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome. J Med Genet 2013; 50:662-5. [PMID: 23825392 PMCID: PMC3786649 DOI: 10.1136/jmedgenet-2013-101720] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Congenital heart disease (CHD) is a cardinal feature of X chromosome monosomy, or Turner syndrome (TS). Haploinsufficiency for gene(s) located on Xp have been implicated in the short stature characteristic of the syndrome, but the chromosomal region related to the CHD phenotype has not been established. Design We used cardiac MRI to diagnose cardiovascular abnormalities in four non-mosaic karyotype groups based on 50-metaphase analyses: 45,X (n=152); 46,X,del(Xp) (n=15); 46,X,del(Xq) (n=4); and 46,X,i(Xq) (n=14) from peripheral blood cells. Results Bicuspid aortic valves (BAV) were found in 52/152 (34%) 45,X study subjects and aortic coarctation (COA) in 19/152 (12.5%). Isolated anomalous pulmonary veins (APV) were detected in 15/152 (10%) for the 45,X study group, and this defect was not correlated with the presence of BAV or COA. BAVs were present in 28.6% of subjects with Xp deletions and COA in 6.7%. APV were not found in subjects with Xp deletions. The most distal break associated with the BAV/COA trait was at cytologic band Xp11.4 and ChrX:41,500 000. One of 14 subjects (7%) with the 46,X,i(Xq) karyotype had a BAV and no cases of COA or APV were found in this group. No cardiovascular defects were found among four patients with Xq deletions. Conclusions The high prevalence of BAV and COA in subjects missing only the X chromosome short arm indicates that haploinsufficiency for Xp genes contributes to abnormal aortic valve and aortic arch development in TS.
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Affiliation(s)
- Carolyn Bondy
- Section on Epigenetics and Development, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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92
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Auer MK, Fuss J, Stalla GK, Athanasoulia AP. Twenty years of endocrinologic treatment in transsexualism: analyzing the role of chromosomal analysis and hormonal profiling in the diagnostic work-up. Fertil Steril 2013; 100:1103-10. [PMID: 23809495 DOI: 10.1016/j.fertnstert.2013.05.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/30/2013] [Accepted: 05/30/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate that adequate pubertal history, physical examination, and a basal hormone profile is sufficient to exclude disorders of sexual development (DSD) in adult transsexuals and that chromosomal analysis could be omitted in cases of unremarkable hormonal profile and pubertal history. DESIGN Retrospective chart analysis. SETTING Endocrine outpatient clinic of a psychiatric research institute. PATIENT(S) A total of 475 subjects (302 male-to-female transsexuals [MtF], 173 female-to-male transsexuals [FtM]). Data from 323 (192 MtF/131 FtM) were collected for hormonal and pubertal abnormalities. Information regarding chromosomal analysis was available for 270 patients (165 MtF/105 FtM). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pubertal abnormalities, menstrual cycle, and hormonal irregularities in relation to chromosomal analysis conducted by karyotype or hair root analysis. RESULT(S) In the MtF group, 5.2% of the patients reported pubertal irregularities and 5.7% hormonal abnormalities, and in the FtM group 3.8% and 19.1%, respectively. Overall chromosomal abnormality in both groups was 1.5% (2.9% in the FtM and 0.6% in the MtF group). The aneuploidies found included one gonosomal aneuploidy (45,X[10]/47,XXX[6]/46,XX[98]), two Robertsonian translocations (45,XXder(14;22)(q10;q10)), and one Klinefelter syndrome (47,XXY) that had already been diagnosed in puberty. CONCLUSION(S) Our data show a low incidence of chromosomal abnormalities and thus question routine chromosomal analysis at the baseline evaluation of transsexualism, and suggest that it be considered only in cases of abnormal history or hormonal examination.
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Affiliation(s)
- Matthias K Auer
- Department of Internal Medicine, Endocrinology, and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany.
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93
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Roche SL, Silversides CK. Hypertension, obesity, and coronary artery disease in the survivors of congenital heart disease. Can J Cardiol 2013; 29:841-8. [PMID: 23688771 DOI: 10.1016/j.cjca.2013.03.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/17/2013] [Accepted: 03/17/2013] [Indexed: 10/26/2022] Open
Abstract
Obesity, hypertension, and coronary artery disease are prevalent in the general population and well recognized as contributors to cardiac morbidity and mortality. With surgical and medical advances, there is a growing and aging population with congenital heart disease who are also at risk of developing these comorbidities. In addition, some congenital cardiac lesions predispose patients to conditions such as hypertension or coronary artery disease. The effect of these comorbidities on the structurally abnormal heart is not well understood, but might be very important, especially in those with residual abnormalities. Thus, in addition to surveillance for and treatment of late complications it is important for the congenital cardiologist to consider and aggressively manage acquired comorbidities. In this review we explore the prevalence of hypertension, obesity, and coronary artery disease, discuss congenital lesions that predispose to these conditions and review management strategies for this unique population.
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Affiliation(s)
- S Lucy Roche
- University of Toronto, Division of Cardiology, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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94
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Turtle EJ, Sule AA, Bath LE, Denvir M, Gebbie A, Mirsadraee S, Webb DJ. Assessing and addressing cardiovascular risk in adults with Turner syndrome. Clin Endocrinol (Oxf) 2013; 78:639-45. [PMID: 23173989 DOI: 10.1111/cen.12104] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 01/09/2023]
Abstract
UNLABELLED Turner syndrome (TS), the result of a structurally abnormal or absent X chromosome, occurs in one in 2 000 live born females. The phenotype is highly variable, but short stature and gonadal dysgenesis are usually present. The main objective in adults with TS is health surveillance, but TS still causes a reduction in life expectancy of up to 13 years, with cardiovascular disease, congenital or acquired, as the major cause of an early death. While it has been established that all women with TS should undergo in-depth cardiovascular examination at diagnosis, advice on the cardiovascular management of women with TS is limited. Here, we provide a summary of our current practice within a multidisciplinary team, supported by our expertise in various aspects of cardiovascular risk management, and the evidence from research where it is available, with the aim of providing optimal support to our patients with TS. BACKGROUND A dedicated Adult Turner Clinic was established in South East Scotland in 2002. This gynaecology-led clinic serves a population of roughly 1·2 million and, currently, reviews around 50 women with TS annually. Referrals for adult care come from paediatrics or general practice. Following a series of individual case discussions regarding the management of more complex cardiovascular problems, we have assembled a dedicated multidisciplinary group to determine a timely cardiovascular screening strategy, a basis for specialist referral, and appropriate hypertension management. This team now includes a paediatric endocrinologist, gynaecologist, cardiologist (with an interest in inherited disorders), vascular radiologist and hypertension specialist. Here, we review the literature on cardiovascular disease in women with TS and, make recommendations, based on relatively limited high-quality evidence, together with our experience, on the optimal timing of cardiovascular screening.
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Affiliation(s)
- Emma J Turtle
- Queen's Medical Research Institute, University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh, UK
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95
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Gutmark-Little I, Backeljauw PF. Cardiac magnetic resonance imaging in Turner syndrome. Clin Endocrinol (Oxf) 2013; 78:646-58. [PMID: 23336808 DOI: 10.1111/cen.12157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 05/28/2012] [Accepted: 01/17/2013] [Indexed: 01/06/2023]
Abstract
Girls and women with Turner syndrome (TS) have a highly increased morbidity as the result of cardiovascular disease, both congenital and acquired. Increased clinical use of cardiac magnetic resonance imaging (CMR) in patients with TS over recent years has allowed for characterization of disease not always possible with standard imaging modalities, such as echocardiography (echo). In this review, we discuss the current literature regarding CMR in patients with TS and guidelines for its use.
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Affiliation(s)
- Iris Gutmark-Little
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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96
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Hagman A, Loft A, Wennerholm UB, Pinborg A, Bergh C, Aittomaki K, Nygren KG, Bente Romundstad L, Hazekamp J, Soderstrom-Anttila V. Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study. Hum Reprod 2013; 28:1598-609. [DOI: 10.1093/humrep/det082] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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97
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Mortensen KH, Andersen NH, Hjerrild BE, Hørlyck A, Stochholm K, Højbjerg Gravholt C. Carotid intima-media thickness is increased in Turner syndrome: multifactorial pathogenesis depending on age, blood pressure, cholesterol and oestrogen treatment. Clin Endocrinol (Oxf) 2012; 77:844-51. [PMID: 22233516 DOI: 10.1111/j.1365-2265.2012.04337.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Carotid intima-media thickness (IMT) may potentially supplement cardiovascular risk assessment in Turner syndrome (TS), where cardiovascular risk is high and appropriate risk stratification difficult. Knowledge of IMT in TS is scarce, and this study aimed to enhance insight into the cardiovascular risk marker. DESIGN, PATIENTS AND MEASUREMENTS IMT was cross-sectionally assessed by ultrasonography of the common carotid artery (cIMT) and carotid bulb (bIMT) in TS (n = 69, age 40 ± 10 years) and age-matched, healthy female controls (n = 67). Additional prospective IMT assessment was performed in TS over 2·4 ± 0·3 years. Metabolic biomarkers and 24-h ambulatory blood pressure were also assessed. RESULTS cIMT and bIMT (body surface area indexed) were increased in TS (P < 0·05) with 17-18% having IMTs that exceeded the 95th percentile of the controls (P < 0·05). Blood pressure, heart rate, glycosylated haemoglobin A1c and high-density lipoprotein cholesterol were increased in TS, where 43% received antihypertensive treatment. cIMT decreased during follow-up, coinciding with intensified cardiovascular risk prophylaxis, whereas bIMT was unchanged. In multiple regression analyses (R = 0·52-0·69, P < 0·05), baseline IMT in TS increased with age, blood pressure and cholesterol as well as in the presence of diabetes whilst IMT was inversely associated with duration of oestrogen replacement. In an analogue analysis, the prospective changes in cIMT (R = 0·37, P < 0·05) were beneficially influenced by antihypertensive treatment and oestrogen therapy and adversely by the presence of diabetes. CONCLUSION Carotid IMT was abnormal in TS and negatively influenced by age, metabolic biomarkers, blood pressure and short duration of oestrogen treatment. Attention to common cardiovascular and endocrine risk markers over more than 2 years appeared to influence IMT beneficially.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital Aarhus, Denmark.
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98
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Familial Turner syndrome with an X;Y translocation mosaicism: Implications for genetic counseling. Eur J Med Genet 2012; 55:635-40. [DOI: 10.1016/j.ejmg.2012.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/01/2012] [Indexed: 11/23/2022]
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99
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Carlson M, Airhart N, Lopez L, Silberbach M. Moderate Aortic Enlargement and Bicuspid Aortic Valve Are Associated With Aortic Dissection in Turner Syndrome. Circulation 2012; 126:2220-6. [DOI: 10.1161/circulationaha.111.088633] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background—
Girls and women with Turner syndrome are at risk for aortic dissection and rupture. However, the size of the aorta and the clinical characteristics among those with Turner syndrome and dissection have received little attention.
Methods and Results—
We obtained medical records from 20 individuals who voluntarily participated in the International Turner Syndrome Aortic Dissection Registry. Type A dissections occurred in 17 of 20 (85%) cases, and type B occurred in 3 cases of which 1 occurred after coarctation stent placement. Of those with spontaneous aortic dissections, 18 of 19 (95%) had an associated cardiac malformation that included a bicuspid aortic valve. In 1 individual there was no predisposing finding other than the presence of Turner syndrome. Associated pregnancy was documented in 1 of 19 (5%). More than half (13/19, 68%) came to medical attention >24 hours after the onset of symptoms. For those with type A dissections, the mean ascending aortic size index was 2.7±0.6 cm/m
2
(n=9).
Conclusions—
Aortic dissection in Turner syndrome occurs in young individuals at smaller aortic diameters than in the general population or other forms of genetically triggered aortopathy. The absence of aortic valve or other cardiac malformations appears to markedly reduce the risk of aortic dissection However, aortic dissection can occur in Turner syndrome without cardiac malformations or hypertension. Individuals with Turner syndrome who are >18 years of age with an ascending aortic size index >2.5 cm/m
2
should be considered for an aortic operation to prevent aortic dissection.
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Affiliation(s)
- Misty Carlson
- From the Oregon Health & Science University; Portland, OR (M.C., N.A.); and Children's Hospital at Montefiore, Bronx, NY (L.L., M.S.)
| | - Nathan Airhart
- From the Oregon Health & Science University; Portland, OR (M.C., N.A.); and Children's Hospital at Montefiore, Bronx, NY (L.L., M.S.)
| | - Leo Lopez
- From the Oregon Health & Science University; Portland, OR (M.C., N.A.); and Children's Hospital at Montefiore, Bronx, NY (L.L., M.S.)
| | - Michael Silberbach
- From the Oregon Health & Science University; Portland, OR (M.C., N.A.); and Children's Hospital at Montefiore, Bronx, NY (L.L., M.S.)
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100
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Mortensen KH, Andersen NH, Gravholt CH. Cardiovascular phenotype in Turner syndrome--integrating cardiology, genetics, and endocrinology. Endocr Rev 2012; 33:677-714. [PMID: 22707402 DOI: 10.1210/er.2011-1059] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is emerging as a cardinal trait of Turner syndrome, being responsible for half of the 3-fold excess mortality. Turner syndrome has been proposed as an independent risk marker for cardiovascular disease that manifests as congenital heart disease, aortic dilation and dissection, valvular heart disease, hypertension, thromboembolism, myocardial infarction, and stroke. Risk stratification is unfortunately not straightforward because risk markers derived from the general population inadequately identify the subset of females with Turner syndrome who will suffer events. A high prevalence of endocrine disorders adds to the complexity, exacerbating cardiovascular prognosis. Mounting knowledge about the prevalence and interplay of cardiovascular and endocrine disease in Turner syndrome is paralleled by improved understanding of the genetics of the X-chromosome in both normal health and disease. At present in Turner syndrome, this is most advanced for the SHOX gene, which partly explains the growth deficit. This review provides an up-to-date condensation of current state-of-the-art knowledge in Turner syndrome, the main focus being cardiovascular morbidity and mortality. The aim is to provide insight into pathogenesis of Turner syndrome with perspectives to advances in the understanding of genetics of the X-chromosome. The review also incorporates important endocrine features, in order to comprehensively explain the cardiovascular phenotype and to highlight how raised attention to endocrinology and genetics is important in the identification and modification of cardiovascular risk.
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Affiliation(s)
- Kristian H Mortensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
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