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Scansen BA. Advances in the Treatment of Pulmonary Valve Stenosis. Vet Clin North Am Small Anim Pract 2023; 53:1393-1414. [PMID: 37453894 DOI: 10.1016/j.cvsm.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Pulmonary valve stenosis represents the most common congenital heart defect of dogs and appears to be increasing in prevalence due to the growing popularity of brachycephalic breeds. Current treatments include beta-blockade and balloon pulmonary valvuloplasty, though evidence-based approaches to this disease are lacking. Balloon pulmonary valvuloplasty is most effective for fused, doming valves leaving a large population of dogs with thick, dysplastic valves that fail to respond adequately to balloon dilation. Transpulmonary stent implantation is an emerging therapy to consider for dogs with valve dysplasia or who have failed balloon pulmonary valvuloplasty; current experience with transpulmonary stent implantation is provided.
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Affiliation(s)
- Brian A Scansen
- Cardiology & Cardiac Surgery, Department of Clinical Sciences, Colorado State University, 200 West Lake Street, 1678 Campus Delivery, Fort Collins, CO 80523-1678, USA.
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Levitas A, Aspit L, Lowenthal N, Shaki D, Krymko H, Slanovic L, Yagev R, Parvari R. A Novel Mutation in the ADAMTS10 Associated with Weil-Marchesani Syndrome with a Unique Presentation of Developed Membranes Causing Severe Stenosis of the Supra Pulmonic, Supramitral, and Subaortic Areas in the Heart. Int J Mol Sci 2023; 24:8864. [PMID: 37240210 PMCID: PMC10219133 DOI: 10.3390/ijms24108864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Weill-Marchesani syndrome (WMS) is a rare genetic inherited disorder with autosomal recessive and dominant modes of inheritance. WMS is characterized by the association of short stature, brachydactyly, joint stiffness, eye anomalies, including microspherophakia and ectopia of the lenses, and, occasionally, heart defects. We investigated the genetic cause of a unique and novel presentation of heart-developed membranes in the supra-pulmonic, supramitral, and subaortic areas, creating stenosis that recurred after their surgical resection in four patients from one extended consanguineous family. The patients also presented ocular findings consistent with Weill-Marchesani syndrome (WMS). We used whole exome sequencing (WES) to identify the causative mutation and report it as a homozygous nucleotide change c. 232T>C causing p. Tyr78His in ADAMTS10. ADAMTS10 (ADAM Metallopeptidase with Thrombospondin Type 1 Motif 10) is a member of a family of zinc-dependent extracellular matrix protease family. This is the first report of a mutation in the pro-domain of ADAMTS10. The novel variation replaces a highly evolutionary conserved tyrosine with histidine. This change may affect the secretion or function of ADAMTS10 in the extracellular matrix. The compromise in protease activity may thus cause the unique presentation of the developed membranes in the heart and their recurrence after surgery.
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Affiliation(s)
- Aviva Levitas
- Department of Pediatric Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.L.); (H.K.); (L.S.)
| | - Liam Aspit
- The Shraga Segal Department of Microbiology, Immunology & Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Neta Lowenthal
- Pediatric Endocrinology Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (N.L.); (D.S.)
| | - David Shaki
- Pediatric Endocrinology Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (N.L.); (D.S.)
| | - Hanna Krymko
- Department of Pediatric Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.L.); (H.K.); (L.S.)
| | - Leonel Slanovic
- Department of Pediatric Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (A.L.); (H.K.); (L.S.)
| | - Ronit Yagev
- Ophthalmology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel;
| | - Ruti Parvari
- The Shraga Segal Department of Microbiology, Immunology & Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Abumehdi M, Mehta C, Afifi ARSA, Yong SF, Chaudhari M, Bhole V, Dhillon R, Stumper O. Supravalvular pulmonary stenosis: A risk factor for reintervention in Noonan syndrome with pulmonary valve stenosis. Catheter Cardiovasc Interv 2022; 99:1538-1544. [PMID: 35266270 DOI: 10.1002/ccd.30148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022]
Abstract
To assess the short- and long-term outcomes of balloon pulmonary valvuloplasty (BPV) in children with Noonan syndrome (NS). Pulmonary stenosis (PS) is the most common congenital heart lesion in NS. BPV is the accepted first line treatment in PS. However, BPV in NS patients has been reported to be less effective, without specific factors for the need for reintervention being identified. Retrospective case-note review of all patients with NS who underwent BPV between 1985 and 2020. Patients were divided into 2 groups: those with supravalvular pulmonary stenosis (SPS) in addition to valvar PS, and those with isolated valvar PS. A cohort of 54 patients with NS underwent BPV at a median of 275 (interquartile range [IQR]: 108-575) days of age. SPS was present in 32 (59%) patients whereas 22 had (41) isolated PS. The preprocedural invasive gradient was 47 (IQR: 35-69) mmHg, and 44 (IQR: 35-48) mmHg in those with SPS and those without respectively (p = 0.88). Reintervention was required in 22 patients (41%): 17 (77%) -with SPS and 5 (23%) without (p = 0.017). Fourteen patients (11 with SPS) required surgical reintervention and 8 (6 with SPS) required further BPV. There was no significant difference in the age at initial BPV, pre- and postprocedural gradients and interval until reintervention between groups. This is the largest reported cohort of patients with NS undergoing BPV. Although BPV is often successful, the reintervention rates are high. SPS was a risk factor for reintervention.
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Affiliation(s)
- Mohammad Abumehdi
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Chetan Mehta
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Ahmed Reda Sanad Arafa Afifi
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - San-Fui Yong
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Milind Chaudhari
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Vinay Bhole
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Rami Dhillon
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Oliver Stumper
- Department of Paediatric Cardiology, The Heart Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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