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Budrys D, Tarutis V, Jonas K. Giant aortic aneurysm repair in a child due to arterial tortuosity syndrome. Cardiol Young 2024:1-3. [PMID: 38557429 DOI: 10.1017/s1047951124000544] [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] [Indexed: 04/04/2024]
Abstract
Arterial tortuosity syndrome is an extremely rare hereditary connective tissue disorder. We present a case of an incidentally diagnosed aneurysm of the aortic root and the ascending aorta caused by arterial tortuosity syndrome, which was confirmed genetically. The aneurysm was repaired surgically. One year after the procedure, there was no further dilation of the aorta or formation of new aneurysms.
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Affiliation(s)
| | - Virgilijus Tarutis
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Department of Cardiovascular Diseases, Cardiothoracic Surgery Center, Vilnius, Lithuania
| | - Karolis Jonas
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Department of Cardiovascular Diseases, Cardiothoracic Surgery Center, Vilnius, Lithuania
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2
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Ajayan N, Hrishi AP, Kumar A, Sethuraman M. Anesthetic Management of a Patient With Arterial Tortuosity Syndrome Undergoing Cerebral Revascularization Surgery—A Case Report. A A Pract 2022; 16:e01593. [DOI: 10.1213/xaa.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Luo Y, Cao Z, Wu S, Sun X. Ring Finger Protein 213 in Moyamoya Disease With Pulmonary Arterial Hypertension: A Mini-Review. Front Neurol 2022; 13:843927. [PMID: 35401401 PMCID: PMC8987108 DOI: 10.3389/fneur.2022.843927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022] Open
Abstract
Moyamoya disease (MMD), most often diagnosed in children and adolescents, is a chronic cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Recently, many investigators show a great interest in MMD with pulmonary arterial hypertension (PAH). Ring finger protein 213 (RNF213) is a major susceptibility gene for MMD and also has strong correlations with PAH. Therefore, this review encapsulates current cases of MMD with PAH and discusses MMD with PAH in the aspects of epidemiology, pathology, possible pathogenesis, clinical manifestations, diagnosis, and treatment.
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Affiliation(s)
- Yuting Luo
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhixin Cao
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoqing Wu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Shaoqing Wu
| | - Xunsha Sun
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Xunsha Sun
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Al-Khaldi A, Abuzaid AD, Tamimi O, Alsahari A, Alotay A, Momenah T, Alfonso JJ. Late outcomes of surgical reconstruction of peripheral pulmonary arteries. J Thorac Cardiovasc Surg 2021; 163:1448-1457.e6. [PMID: 34649717 DOI: 10.1016/j.jtcvs.2021.07.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The ideal management of peripheral pulmonary artery stenosis is still controversial. We adopted a primary surgical approach to this complex lesion with excellent early outcomes. In this study, we analyzed our late outcomes. METHODS We performed a retrospective review of 91 patients with biventricular anatomy who underwent peripheral pulmonary artery reconstruction from March 2008 to July 2020. Our surgical approach included either a single-stage complete repair through median sternotomy or a 2-stage repair through sternotomy/left thoracotomy, depending on the degree of distal involvement of the left pulmonary artery branches. RESULTS Median age was 26 months. Syndromic etiology was established in 54 patients (59.3%) versus nonsyndromic etiology in 37 patients (40.7%). Single-stage repair was achieved in 68 patients (74.7%). There were 2 (2.2%) in-hospital mortalities. The mean right ventricular to aortic systolic pressure ratio decreased from 1.07 ± 0.20 preoperatively to 0.32 ± 0.07 immediately postoperatively (P < .001), representing a 70.1% reduction. At 1-year postoperative catheterization, the mean right ventricular to aortic systolic pressure ratio was 0.28 ± 0.05 (P < .001 compared with immediately postoperative value). With a median follow-up of 68 months (IQR, 39-117.5 months), there was no late mortality after discharge. All patients were active and asymptomatic on the most recent follow-up. There were no early or late reinterventions on pulmonary arteries. CONCLUSIONS Late outcomes of surgical reconstruction of peripheral pulmonary arteries are excellent and durable in various pathologies (syndromic and nonsyndromic) with a significant reduction in right ventricular to aortic systolic pressure ratio, low mortality, and no reintervention.
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Affiliation(s)
- Abdulaziz Al-Khaldi
- Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Ahmad D Abuzaid
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Omar Tamimi
- Department of Pediatric Cardiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Liang M, Wen H, Li S. Two fetuses in one family of arterial tortuosity syndrome: prenatal ultrasound diagnosis. BMC Pregnancy Childbirth 2021; 21:548. [PMID: 34384376 PMCID: PMC8359025 DOI: 10.1186/s12884-021-03960-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Arterial tortuosity syndrome (ATS) is a rare autosomal recessive connective tissue disorder chiefly characterized by elongated and tortuosity of the large and medium sized arteries and anomalies of the vascular elastic fibers. Here we reported cases of brother about ATS from the same family on the prenatal ultrasound diagnosis. Reports of this case are rare in antenatally and we draw the vessel simulated diagram to display visually. Case presentation Prenatal ultrasound scanning at 29 weeks of gestation of the first fetus showed obvious tortuous and elongated of the aortic arch, ductus arteriosus, left and right pulmonary arteries, carotid and subclavian arteries. Three months after delivery, Contrast-enhanced computed tomography images (CTA) were performed to clearly display vascular abnormalities consistent with prenatal diagnosis of ultrasound. Whole exome sequencing (WES) was performed eight months after birth, two heterozygous variants of SLC2A10 gene was detected in newborn and their father and mother, respectively. Prenatal ultrasound scan at 22 weeks of gestation of the second fetus showed similar cardiovascular imaging. After birth the siblings have facial characteristic features gradually as aging. No surgical intervention was performed in the siblings follow up 19 months. Conclusions The key points of prenatal ultrasound diagnosis of ATS are the elongation and tortuosity of the large and medium sized arteries. Genetic counseling is the process of providing individuals and families with information on the nature, inheritance, and implications of genetic disorders to help them make informed medical and personal decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03960-w.
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Affiliation(s)
- Meiling Liang
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Huaxuan Wen
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Shengli Li
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
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Boel A, Veszelyi K, Németh CE, Beyens A, Willaert A, Coucke P, Callewaert B, Margittai É. Arterial Tortuosity Syndrome: An Ascorbate Compartmentalization Disorder? Antioxid Redox Signal 2021; 34:875-889. [PMID: 31621376 DOI: 10.1089/ars.2019.7843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significance: Cardiovascular disorders are the most important cause of morbidity and mortality in the Western world. Monogenic developmental disorders of the heart and vessels are highly valuable to study the physiological and pathological processes in cardiovascular system homeostasis. The arterial tortuosity syndrome (ATS) is a rare, autosomal recessive connective tissue disorder showing lengthening, tortuosity, and stenosis of the large arteries, with a propensity for aneurysm formation. In histopathology, it associates with fragmentation and disorganization of elastic fibers in several tissues, including the arterial wall. ATS is caused by pathogenic variants in SLC2A10 encoding the facilitative glucose transporter (GLUT)10. Critical Issues: Although several hypotheses have been forwarded, the molecular mechanisms linking disrupted GLUT10 activity with arterial malformations are largely unknown. Recent Advances: The vascular and systemic manifestations and natural history of ATS patients have been largely delineated. GLUT10 was identified as an intracellular transporter of dehydroascorbic acid, which contributes to collagen and elastin cross-linking in the endoplasmic reticulum, redox homeostasis in the mitochondria, and global and gene-specific methylation/hydroxymethylation affecting epigenetic regulation in the nucleus. We revise here the current knowledge on ATS and the role of GLUT10 within the compartmentalization of ascorbate in physiological and diseased states. Future Directions: Centralization of clinical, treatment, and outcome data will enable better management for ATS patients. Establishment of representative animal disease models could facilitate the study of pathomechanisms underlying ATS. This might be relevant for other forms of vascular dysplasia, such as isolated aneurysm formation, hypertensive vasculopathy, and neovascularization. Antioxid. Redox Signal. 34, 875-889.
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Affiliation(s)
- Annekatrien Boel
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Krisztina Veszelyi
- Institute of Clinical Experimental Research, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Csilla E Németh
- Department of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Aude Beyens
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Andy Willaert
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Paul Coucke
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Éva Margittai
- Institute of Clinical Experimental Research, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
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Alkhaldi A, Momenah T, Alsahari A, Alotay A, Alfonso JJ, Abuzaid A, Alwadai A. Late Outcomes After Pulmonary Arterial Reconstruction in Patients With Arterial Tortuosity Syndrome. Ann Thorac Surg 2021; 113:1569-1574. [PMID: 33811889 DOI: 10.1016/j.athoracsur.2021.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical pulmonary artery reconstruction in patients with Arterial Tortuosity Syndrome (ATS) has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions. METHODS We conducted a retrospective review of 33 ATS patients who underwent pulmonary artery reconstruction. The mean pre-operative right ventricular/left ventricular pressure (RVp/LVp) ratio was 1.19 ± 0.2. Our surgical approach included either a single-stage complete repair through a median sternotomy (17 patients) or a two-stage repair through sternotomy / left thoracotomy (16 patients), depending on the degree of distal involvement in the left pulmonary artery. RESULTS Median age was 36 months. All patients had distal segmental peripheral pulmonary artery stenosis. Thirty patients (90.1%) were symptomatic before surgery. There was one hospital mortality due to viral pneumonia 78 days after the surgery (in-hospital mortality = 3%). The mean RVp/LVp ratio decreased to 0.31±0.07 early postoperatively (P<0.001), representing a 74% reduction compared with pre-operative values. Follow-up was 100% complete for all hospital survivors (32/33) with a mean follow-up of 70.42±43.32 months (range was 2 to 143 months). There was no late mortality or need for re-intervention (surgical or catheter-based) after hospital discharge. In late postoperative catheterization, the mean RVp/LVp ratio was 0.27±0.05 (P=0.003 compared to early post-operative value). All patients were asymptomatic on their most recent follow-up. CONCLUSIONS A strategy of complete surgical reconstruction of all stenotic pulmonary artery segments in patients with ATS is recommended for sustainable successful outcomes more than a decade later.
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Affiliation(s)
- Abdulaziz Alkhaldi
- Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmad Abuzaid
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Alwadai
- Department of Pediatric Cardiac Intensive care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Alkhaldi A, Alsahari A, Alotay A, Momenah T, Alfonso JJ. Peripheral Pulmonary Artery Stenosis is Not a Contraindication to Single Ventricle Pathway. Ann Thorac Surg 2021; 113:1563-1568. [PMID: 33811885 DOI: 10.1016/j.athoracsur.2021.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The presence of peripheral pulmonary artery stenosis (PPAS) involving lobar and/or segmental pulmonary artery (PA) branches might preclude proceeding to single ventricle pathway. We adopted strict strategy for PA rehabilitation and surgical reconstruction in patients who are unable to progress in single ventricle pathway. METHODS We conducted a retrospective review of 22 patients with single ventricle physiology who underwent surgical reconstruction for PPAS from April 2008 to March 2020. Our surgical approach was single stage in 15 patients (68.2%) and two-stage in 7 patients (31.8%) depending on the presence or absence of PA hypoplasia distal to the PPAS. RESULTS The PPAS was type 3 (lobar) in 19 patients (86.4%) and type 4 (segmental) in 3 patients (13.6%). The mean number of PA angioplasties performed was 8±5.6 per patient. There was no mortality in this series with median 52 months (range, 8 to 143 months) follow-up. Twenty patients (90.9%) were able to progress in the single ventricle pathway with 12 patients (54.5%) achieving Fontan operation and 8 patients (36.4%) achieving bi-directional Glenn shunt and awaiting Fontan operation. Two patients (9.1%) were not suitable to progress in the single ventricle pathway due to elevated PA pressure. All patients who achieved cavopulmonary connection are alive and asymptomatic with no signs of elevation of PA pressure. No patient required further re-interventions for the PA. CONCLUSIONS PPAS is not a contraindication for single ventricle palliation. With careful planning and aggressive early surgical reconstruction, most of these patients can successfully progress to cavopulmonary connections.
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Affiliation(s)
| | | | | | | | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Dealing with kinked and swirled pulmonary vessels: surgical treatment of arterial tortuosity syndrome: a case report. Cardiol Young 2020; 30:1960-1963. [PMID: 32988421 DOI: 10.1017/s1047951120003017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the case of a child with arterial tortuosity syndrome, describing the operative findings and our surgical technique to address pulmonary arteries stenosis.
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10
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Abstract
Arterial tortuosity syndrome (ATS) is a rare, autosomal recessive, connective tissue disorder. It predominantly involves the arterial tree with clinical features reflecting the systems involved. There have been few cases of ATS suspected during antenatal screening ultrasound in high-risk families, but none confirmed. We present the first case of ATS confirmed antenatally in the fetus with cascade testing, detecting the disease in the mother as well.
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Dong M, Yang W, Tamaresis JS, Chan FP, Zucker EJ, Kumar S, Rabinovitch M, Marsden AL, Feinstein JA. Image-based scaling laws for somatic growth and pulmonary artery morphometry from infancy to adulthood. Am J Physiol Heart Circ Physiol 2020; 319:H432-H442. [PMID: 32618514 DOI: 10.1152/ajpheart.00123.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary artery (PA) morphometry has been extensively explored in adults, with particular focus on intra-acinar arteries. However, scaling law relationships for length and diameter of extensive preacinar PAs by age have not been previously reported for in vivo human data. To understand preacinar PA growth spanning children to adults, we performed morphometric analyses of all PAs visible in the computed tomography (CT) and magnetic resonance (MR) images from a healthy subject cohort [n = 16; age: 1-51 yr; body surface area (BSA): 0.49-2.01 m2]. Subject-specific anatomic PA models were constructed from CT and MR images, and morphometric information-diameter, length, tortuosity, bifurcation angle, and connectivity-was extracted and sorted into diameter-defined Strahler orders. Validation of Murray's law, describing optimal scaling exponents of radii for branching vessels, was performed to determine how closely PAs conform to this classical relationship. Using regression analyses of vessel diameters and lengths against orders and patient metrics (BSA, age, height), we found that diameters increased exponentially with order and allometrically with patient metrics. Length increased allometrically with patient metrics, albeit weakly. The average tortuosity index of all vessels was 0.026 ± 0.024, average bifurcation angle was 28.2 ± 15.1°, and average Murray's law exponent was 2.92 ± 1.07. We report a set of scaling laws for vessel diameter and length, along with other morphometric information. These provide an initial understanding of healthy structural preacinar PA development with age, which can be used for computational modeling studies and comparison with diseased PA anatomy.NEW & NOTEWORTHY Pulmonary artery (PA) morphometry studies to date have focused primarily on large arteries and intra-acinar arteries in either adults or children, neglecting preacinar arteries in both populations. Our study is the first to quantify in vivo preacinar PA morphometry changes spanning infants to adults. For preacinar arteries > 1 mm in diameter, we identify scaling laws for vessel diameters and lengths with patient metrics of growth and establish a healthy PA morphometry baseline for most preacinar PAs.
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Affiliation(s)
- Melody Dong
- Department of Bioengineering, Stanford University, Stanford, California
| | - Weiguang Yang
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - John S Tamaresis
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Frandics P Chan
- Department of Radiology, Stanford University, Stanford, California
| | - Evan J Zucker
- Department of Radiology, Stanford University, Stanford, California
| | - Sahana Kumar
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Marlene Rabinovitch
- Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
| | - Jeffrey A Feinstein
- Department of Bioengineering, Stanford University, Stanford, California.,Department of Pediatrics-Cardiology, Stanford University, Stanford, California
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Nonsyndromic Peripheral Pulmonary Artery Stenosis Is Associated With Homozygosity of RNF213 p.Arg4810Lys Regardless of Co-occurrence of Moyamoya Disease. Chest 2018; 153:404-413. [DOI: 10.1016/j.chest.2017.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/17/2017] [Accepted: 09/06/2017] [Indexed: 12/15/2022] Open
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13
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Kim KM, Hur SM, Yoon JH, Lee EJ, Lee JY. Arterial Tortuosity Syndrome in a Neonate. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kyung Min Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Sun-Mi Hur
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Ji Hong Yoon
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jae Young Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
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Cubero A, Ayala J, Hamzeh G, Cortes A, Udaondo J, Aramendi JI. Severe Arterial Tortuosity. World J Pediatr Congenit Heart Surg 2016; 8:231-234. [PMID: 27095117 DOI: 10.1177/2150135116629396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial tortuosity syndrome is a rare autosomal recessive connective tissue disease characterized by elongation, tortuosity, and aneurysmal formation of the large and middle-sized arteries sometimes associated with stenosis of the pulmonary arteries and/or aorta. We present three cases of severe arterial tortuosity with different manifestations. In two cases, the aortic arch was involved. Angiography showed a very tortuous aortic arch, with many loops and twists and a normal descending aorta. One required operation. The third case presented multiple severe stenoses of both pulmonary arteries with many tortuous segments. Surgical repair consisted of pulmonary artery augmentation utilizing a bovine pericardial patch from hilum to hilum.
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Affiliation(s)
- Alain Cubero
- 1 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Javier Ayala
- 2 Division of Pediatric Cardiology, Cruces University Hospital, Barakaldo, Spain
| | - Gadah Hamzeh
- 1 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Andrés Cortes
- 1 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain
| | - June Udaondo
- 2 Division of Pediatric Cardiology, Cruces University Hospital, Barakaldo, Spain
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15
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Surgical Reconstruction of Peripheral Pulmonary Arteries: Strategies, Outcomes, and New Classification. Ann Thorac Surg 2015; 100:623-30. [PMID: 26138762 DOI: 10.1016/j.athoracsur.2015.04.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 11/24/2022]
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16
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Sheikhzadeh S, De Backer J, Gorgan NR, Rybczynski M, Hillebrand M, Schüler H, Bernhardt AM, Koschyk D, Bannas P, Keyser B, Mortensen K, Radke RM, Mir TS, Kölbel T, Robinson PN, Schmidtke J, Berger J, Blankenberg S, von Kodolitsch Y. The main pulmonary artery in adults: a controlled multicenter study with assessment of echocardiographic reference values, and the frequency of dilatation and aneurysm in Marfan syndrome. Orphanet J Rare Dis 2014; 9:203. [PMID: 25491897 PMCID: PMC4272795 DOI: 10.1186/s13023-014-0203-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echocardiographic upper normal limits of both main pulmonary artery (MPA) diameters (MPA-d) and ratio of MPA to aortic root diameter (MPA-r) are not defined in healthy adults. Accordingly, frequency of MPA dilatation based on echocardiography remains to be assessed in adults with Marfan syndrome (MFS). METHODS We enrolled 123 normal adults (72 men, 52 women aged 42 ± 14 years) and 98 patients with MFS (42 men, 56 women aged 39 ± 14 years) in a retrospective cross-sectional observational controlled study in four tertiary care centers. We defined outcome measures including upper normal limits of MPA-d and MPA-r as 95 quantile of normal persons, MPA dilatation as diameters > upper normal limits, MPA aneurysm as diameters >4 cm, and indication for surgery as MPA diameters >6 cm. RESULTS MPA diameters revealed normal distribution without correlation to age, sex, body weight, body height, body mass index and body surface area. The upper normal limit was 2.6 cm (95% confidence interval (CI) =2.44-2.76 cm) for MPA-d, and 1.05 (95% CI = .86-1.24) for MPA-r. MPA dilatation presented in 6 normal persons (4.9%) and in 68 MFS patients (69.4%; P < .001), MPA aneurysm presented only in MFS (15 patients; 15.3%; P < .001), and no patient required surgery. Mean MPA-r were increased in MFS (P < .001), but ratios >1.05 were equally frequent in 7 normal persons (5%) and in 8 MFS patients (10.5%; P = .161). MPA-r related to aortic root diameters (P = .042), reduced left ventricular ejection fraction (P = .006), and increased pulmonary artery systolic pressures (P = .040). No clinical manifestations of MFS and no FBN1 mutation characteristics related to MPA diameters. CONCLUSIONS We established 2.6 cm for MPA-d and 1.05 for MPA-r as upper normal limits. MFS exhibits a high prevalence of MPA dilatation and aneurysm. However, patients may require MPA surgery only in scarce circumstances, most likely because formation of marked MPA aneurysm may require LV dysfunction and increased PASP.
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Affiliation(s)
- Sara Sheikhzadeh
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Julie De Backer
- Centre for Medical Genetics, University Hospital Ghent, Ghent, Belgium.
| | - Neda Rahimian Gorgan
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Meike Rybczynski
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Mathias Hillebrand
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Helke Schüler
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Alexander M Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dietmar Koschyk
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Britta Keyser
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Kai Mortensen
- Medizinische Klinik II / Kardiologie, Angiologie, am Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany.
| | - Robert M Radke
- Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Germany.
| | - Thomas S Mir
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Peter N Robinson
- Institute of Medical Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Jörg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany.
| | - Jürgen Berger
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.
| | - Stefan Blankenberg
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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17
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Ritelli M, Chiarelli N, Dordoni C, Reffo E, Venturini M, Quinzani S, Monica MD, Scarano G, Santoro G, Russo MG, Calzavara-Pinton P, Milanesi O, Colombi M. Arterial Tortuosity Syndrome: homozygosity for two novel and one recurrent SLC2A10 missense mutations in three families with severe cardiopulmonary complications in infancy and a literature review. BMC MEDICAL GENETICS 2014; 15:122. [PMID: 25373504 PMCID: PMC4412100 DOI: 10.1186/s12881-014-0122-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/23/2014] [Indexed: 01/12/2023]
Abstract
Background Arterial Tortuosity Syndrome (ATS) is a very rare autosomal recessive connective tissue disorder (CTD) characterized by tortuosity and elongation of the large- and medium-sized arteries and a propensity for aneurysm formation and vascular dissection. During infancy, children frequently present the involvement of the pulmonary arteries (elongation, tortuosity, stenosis) with dyspnea and cyanosis. Other CTD signs of ATS are dysmorphisms, abdominal hernias, joint hypermobility, skeletal abnormalities, and keratoconus. ATS is typically described as a severe disease with high rate of mortality due to major cardiovascular malformations. ATS is caused by mutations in the SLC2A10 gene, which encodes the facilitative glucose transporter 10 (GLUT10). Approximately 100 ATS patients have been described, and 21 causal mutations have been identified in the SLC2A10 gene. Case presentation We describe the clinical findings and molecular characterization of three new ATS families, which provide insight into the clinical phenotype of the disorder; furthermore, we expand the allelic repertoire of SLC2A10 by identifying two novel mutations. We also review the ATS patients characterized by our group and compare their clinical findings with previous data. Conclusions Our data confirm that the cardiovascular prognosis in ATS is less severe than previously reported and that the first years of life are the most critical for possible life-threatening events. Molecular diagnosis is mandatory to distinguish ATS from other CTDs and to define targeted clinical follow-up and timely cardiovascular surgical or interventional treatment, when needed. Electronic supplementary material The online version of this article (doi:10.1186/s12881-014-0122-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Ritelli
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, School of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Nicola Chiarelli
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, School of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Chiara Dordoni
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, School of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Elena Reffo
- Pediatric Cardiology, Department of Pediatrics, University of Padova, School of Medicine, Padova, Italy.
| | - Marina Venturini
- Division of Dermatology, Department of Clinical and Experimental Sciences, Spedali Civili University Hospital, Brescia, Italy.
| | - Stefano Quinzani
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, School of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Matteo Della Monica
- Unità Operativa di Genetica Medica, Ospedale Gaetano Rummo, Benevento, Italy.
| | - Gioacchino Scarano
- Unità Operativa di Genetica Medica, Ospedale Gaetano Rummo, Benevento, Italy.
| | - Giuseppe Santoro
- Pediatric Cardiology, A.O.R.N. Ospedale dei Colli, II University of Naples, Naples, Italy.
| | - Maria Giovanna Russo
- Pediatric Cardiology, A.O.R.N. Ospedale dei Colli, II University of Naples, Naples, Italy.
| | - Piergiacomo Calzavara-Pinton
- Division of Dermatology, Department of Clinical and Experimental Sciences, Spedali Civili University Hospital, Brescia, Italy.
| | - Ornella Milanesi
- Pediatric Cardiology, Department of Pediatrics, University of Padova, School of Medicine, Padova, Italy.
| | - Marina Colombi
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, School of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
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18
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Asija R, Roth SJ, Hanley FL, Peng L, Liu K, Abbott J, Zhuo H, Matthay M. Reperfusion pulmonary edema in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries undergoing unifocalization procedures: A pilot study examining potential pathophysiologic mechanisms and clinical significance. J Thorac Cardiovasc Surg 2014; 148:1560-5. [DOI: 10.1016/j.jtcvs.2014.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
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19
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Berenguer Potenciano M, Piris Borregas S, Mendoza Soto A, Velasco Bayon JM, Caro Barri A. [Pulmonary reperfusion syndrome after pulmonary stent implants in a patient with vascular tortuosity syndrome]. An Pediatr (Barc) 2014; 82:e17-20. [PMID: 25082128 DOI: 10.1016/j.anpedi.2014.06.016] [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: 05/08/2014] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022] Open
Abstract
Vascular tortuosity syndrome is a rare genetic disorder that causes tortuosity and stenosis of the pulmonary, systemic and / or coronary circulations. As a result of treatment of pulmonary stenosis, symptoms of pulmonary edema, known as lung reperfusion syndrome, may occur. The case is presented of an adolescent patient with vascular tortuosity syndrome who presented with a pulmonary reperfusion syndrome after multiple stent implants in the left pulmonary artery. After the procedure, the patient immediately developed an acute pulmonary edema with severe clinical deterioration, which required assistance with extracorporeal membrane oxygenation for recovery.
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Affiliation(s)
| | - S Piris Borregas
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Mendoza Soto
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, España
| | - J M Velasco Bayon
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Caro Barri
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
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20
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Vida VL, Rito ML, Zucchetta F, Biffanti R, Padalino MA, Milanesi O, Stellin G. Pulmonary Artery Branch Stenosis in Patients with Congenital Heart Disease. J Card Surg 2013; 28:439-45. [DOI: 10.1111/jocs.12121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vladimiro L. Vida
- Department of Thoracic, Cardiac and Vascular Sciences; Pediatric and Congenital Cardiac Surgery Unit; Padua Italy
| | - Mauro Lo Rito
- Department of Thoracic, Cardiac and Vascular Sciences; Pediatric and Congenital Cardiac Surgery Unit; Padua Italy
| | - Fabio Zucchetta
- Department of Thoracic, Cardiac and Vascular Sciences; Pediatric and Congenital Cardiac Surgery Unit; Padua Italy
| | - Roberta Biffanti
- Department of Pediatrics, Pediatric Cardiology Unit; University of Padua; Padua Italy
| | - Massimo A. Padalino
- Department of Thoracic, Cardiac and Vascular Sciences; Pediatric and Congenital Cardiac Surgery Unit; Padua Italy
| | - Ornella Milanesi
- Department of Pediatrics, Pediatric Cardiology Unit; University of Padua; Padua Italy
| | - Giovanni Stellin
- Department of Thoracic, Cardiac and Vascular Sciences; Pediatric and Congenital Cardiac Surgery Unit; Padua Italy
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