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Maraval J, Delahaye-Duriez A, Racine C, Bruel AL, Denommé-Pichon AS, Gaudillat L, Thauvin-Robinet C, Lucain M, Satre V, Coutton C, de Sainte Agathe JM, Keren B, Faivre L. Expanding MNS1 Heterotaxy Phenotype. Am J Med Genet A 2024:e63862. [PMID: 39233552 DOI: 10.1002/ajmg.a.63862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/30/2024] [Accepted: 08/18/2024] [Indexed: 09/06/2024]
Abstract
MNS1 (meiosis-specific nuclear structural protein-1 gene) encodes a structural protein implicated in motile ciliary function and sperm flagella assembly. To date, two different homozygous MNS1 variants have been associated with autosomal recessive visceral heterotaxy (MIM#618948). A French individual was identified with compound heterozygous variants in the MNS1 gene. A collaborative call was proposed via GeneMatcher to describe new cases with this rare syndrome, leading to the identification of another family. The first patient was a female presenting complete situs inversus and unusual symptoms, including severe myopia and dental agenesis of 10 permanent teeth. She was found to carry compound heterozygous frameshift and nonsense variants in MNS1. The second and third patients were sibling fetuses with homozygous in-frame deletion variants in MNS1 and homozygous missense variants in GLDN. Autopsies revealed a complex prenatal malformation syndrome. We add here new cases with the ultra-rare MNS1-related disorder and provide a review of all published individuals.
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Affiliation(s)
- Julien Maraval
- Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Dijon, France
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
| | - Andrée Delahaye-Duriez
- Hôpitaux Universitaires de Paris Seine-Saint-Denis-APHP, UF de médecine génomique et génétique Clinique, Hôpital Jean Verdier, Bondy, France
- UFR Santé Médecine et Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- Inserm UMR1141 NeuroDiderot, Université Paris Cité, Paris, France
| | - Caroline Racine
- Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Dijon, France
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
| | - Ange-Line Bruel
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | - Anne-Sophie Denommé-Pichon
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | - Léa Gaudillat
- Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Dijon, France
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Dijon, France
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | - Marie Lucain
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | - Véronique Satre
- Laboratoire de Biologie Médicale Multi-Sites AURAGEN, CHU Grenoble, Grenoble, France
- Laboratoire de Génétique Chromosomique, CHU Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR2309, Université Grenoble Alpes, Genetic Epigenetic and Therapies of Infertility Team, Grenoble, France
- GCS AURAGEN, Lyon, France
| | - Charles Coutton
- Laboratoire de Biologie Médicale Multi-Sites AURAGEN, CHU Grenoble, Grenoble, France
- Laboratoire de Génétique Chromosomique, CHU Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR2309, Université Grenoble Alpes, Genetic Epigenetic and Therapies of Infertility Team, Grenoble, France
- GCS AURAGEN, Lyon, France
| | | | - Boris Keren
- Hôpital la Pitié-Salpêtrière, Département de Génétique Médicale, APHP Sorbonne Université, Paris, France
| | - Laurence Faivre
- Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Centre de Référence Maladies Rares Anomalies du Développement et Syndromes Malformatifs, Dijon, France
- Inserm UMR1231 GAD, Université Bourgogne-Franche Comté, Dijon, France
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Wang P, Shi W, Liu S, Shi Y, Jiang X, Li F, Chen S, Sun K, Xu R. ccdc141 is required for left-right axis development by regulating cilia formation in the Kupffer's vesicle of zebrafish. J Genet Genomics 2024; 51:934-946. [PMID: 39047937 DOI: 10.1016/j.jgg.2024.07.014] [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: 03/22/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Laterality is a crucial physiological process intricately linked to the cilium-centrosome complex during embryo development. Defects in the process can result in severe organ mispositioning. Coiled-coil domain containing 141 (CCDC141) has been previously known as a centrosome-related gene, but its role in left-right (LR) asymmetry has not been characterized. In this study, we utilize the zebrafish model and human exome analysis to elucidate the function of ccdc141 in laterality defects. The knockdown of ccdc141 in zebrafish disrupts early LR signaling pathways, cilia function, and Kupffer's vesicle formation. Unlike ccdc141-knockdown embryos exhibiting aberrant LR patterns, ccdc141-null mutants show no apparent abnormality, suggesting a genetic compensation response effect. In parallel, we observe a marked reduction in α-tubulin acetylation levels in the ccdc141 crispants. The treatment with histone deacetylase (HDAC) inhibitors, particularly the HDAC6 inhibitor, rescues the ccdc141 crispant phenotypes. Furthermore, exome analysis of 70 patients with laterality defects reveals an increased burden of CCDC141 mutations, with in-vivo studies verifying the pathogenicity of the patient mutation CCDC141-R123G. Our findings highlight the critical role of ccdc141 in ciliogenesis and demonstrate that CCDC141 mutations lead to abnormal LR patterns, identifying it as a candidate gene for laterality defects.
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Affiliation(s)
- Pengcheng Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Wenxiang Shi
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Sijie Liu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yunjing Shi
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xuechao Jiang
- Scientific Research Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Fen Li
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Rang Xu
- Scientific Research Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
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Wicheannarat T, Chungsomprasong P, Chanthong P, Vijarnsorn C, Kanjanauthai S, Pacharapakornpong T, Thammasate P, Durongpisitkul K, Soongswang J, Tocharoenchok T, Nitiyarom E, Tantiwongkosri K, Subtaweesin T. The Clinical Outcomes in Patients With Atrial Isomerism Undergoing Single Ventricular Palliation: Insights From A Single-Center Study in Thailand. World J Pediatr Congenit Heart Surg 2024:21501351241265728. [PMID: 39196646 DOI: 10.1177/21501351241265728] [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: 08/30/2024]
Abstract
Background: The management of atrial isomerism across various countries may impact survival outcomes. Methods: This retrospective study involved patients diagnosed with atrial isomerism undergoing single ventricular palliation between 2000 and 2021. The objective was to evaluate survival outcomes within the right atrial isomerism (RAI) and left atrial isomerism (LAI) groups, as well as overall survival. Results: Of the 125 patients diagnosed with atrial isomerism, 105 (84%) had RAI, and 20 (16%) had LAI. The median age at presentation was 3 days (range: birth to 7.1 years), with median follow-up of 6.6 years (range: 0.59 months to 30.8 years). In the overall cohort, survival rates at one, five, and ten years were 85.6%, 72.3%, and 66.8%, respectively, with no statistically significant difference between RAI and LAI groups (log rank P value = .293). Specifically, survival rates in the RAI group at one, five, and ten years were 83.8%, 69.0%, and 62.6%, respectively, while in the LAI group, there were 95.0%, 89.7%, and 81.6%, respectively. Following the third-stage operation, overall survival rates at one and five years were 76.4% and 76.4%, respectively. Among patients in the RAI group, survival rates at one and five years post-third stage operation were 80.2% and 80.2%, respectively. Conclusions: Despite resource limitations, the survival outcomes of patients with atrial isomerism were found to be similar with those observed in high-income countries. Although an increased mortality rate was noted within the first year of life, focusing efforts on neonatal and infant care holds potential for improving overall outcomes.
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Affiliation(s)
- Tanawat Wicheannarat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakul Chanthong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thita Pacharapakornpong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ploy Thammasate
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kritvikrom Durongpisitkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Tocharoenchok
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekarat Nitiyarom
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thaworn Subtaweesin
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Vidiyala P, Pandey NN, Gupta SK, Sreelal TV, Verma M, Kumar S, Ramakrishnan S, Jagia P. Identification and Analysis of Atrial-Bronchial-Abdominal Disharmony in Patients with Isomeric Atrial Appendages. Pediatr Cardiol 2024:10.1007/s00246-024-03544-3. [PMID: 38888643 DOI: 10.1007/s00246-024-03544-3] [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: 05/01/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
Ideally, the morphology of atrial appendages should solely be used to identify and differentiate patients with isomeric right and left atrial appendages. However, in clinical practice, the segregation is often indirectly based on the arrangement of thoraco-abdominal structures. The correlation between thoraco-abdominal arrangement and atrial appendages, however, is imperfect. In this study, we sought to clarify the cardiovascular malformations in patients with isomeric atrial appendages with an emphasis on atrial-thoracic-abdominal disharmony. A retrospective review of all patients who underwent cardiac CT angiography between January 2014 and June 2023 and identified to have isomeric atrial appendages was performed. Of the 366 cases (median age: 2 years [interquartile range: 11 months-7 years]), 247 (67.5%) patients had isomeric right atrial appendages while 119 (32.5%) patients had isomeric left atrial appendages. In 316 (86.3%) patients, the thoraco-abdominal arrangement was as per atrial appendage morphology while the remaining 50 (13.6%) patients had disharmonious patterns. Compared to isomeric left atrial appendages, the disharmonious pattern was more frequent with isomeric right atrial appendages (5.9% vs. 17.4%; p 0.003). Irrespective of the type of isomerism, disharmony was mostly confined to the level of the abdomen. Not all patients with isomeric atrial appendages have a harmonious thoraco-abdominal arrangement. The atrial-bronchial-abdominal disharmony is more frequent with isomeric right atrial appendages and is mostly present at the level of the abdomen. A detailed sequential segmental analysis with an independent description of each organ system is, therefore, essential for the complete evaluation of patients with isomeric atrial appendages.
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Affiliation(s)
- Pujitha Vidiyala
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Thazhathu Veettil Sreelal
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
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Ortega-Zhindón DB, Pérez-Hernández N, Rodríguez-Pérez JM, García-Montes JA, Calderón-Colmenero J, Rivera-Buendía F, Cervantes-Salazar JL. Cardiac Laterality: Surgical Results of Right Atrial Isomerism. Diseases 2023; 11:170. [PMID: 37987281 PMCID: PMC10660862 DOI: 10.3390/diseases11040170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
Right atrial isomerism (RAI) is a complex entity with varying diagnostic and treatment outcomes due to its rarity. Treatment options range from palliative to corrective surgeries, resulting in heterogeneous outcomes. The aim of this study was to analyze the results obtained after cardiac surgery in patients with RAI. A retrospective study was conducted, including patients diagnosed with RAI who underwent cardiac surgery. Their follow-up was from 1 January 2010 to 31 March 2020. Demographic characteristics and perioperative conditions were described. Thirty-eight patients were included, the median age was 4 years (IQR 2-9.2) and 57.9% were men. The main diagnoses were atrioventricular canal (63.2%) and pulmonary stenosis (55.3%). The most common surgical procedures were modified Blalock-Taussig shunt (65.8%) and total cavopulmonary connection with an extracardiac conduit fenestrated without cardiopulmonary bypass (15.9%). We did not find any factors associated with negative outcomes in these patients. The overall survival was 86.8%, with a better outcome in those who did not require reintubation (log rank, p < 0.01). The survival of RAI was similar to other centers. Individuals with RAI should be evaluated rigorously to determine an adequate repair strategy, considering high morbidity and mortality.
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Affiliation(s)
- Diego B. Ortega-Zhindón
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Nonanzit Pérez-Hernández
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.P.-H.); (J.M.R.-P.)
| | - José Manuel Rodríguez-Pérez
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.P.-H.); (J.M.R.-P.)
| | - José A. García-Montes
- Department of Interventional Cardiology in Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Juan Calderón-Colmenero
- Department of Pediatric Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Frida Rivera-Buendía
- Department of Clinical Research, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Jorge L. Cervantes-Salazar
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
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Wu Q, Guo S, Huang B, Ling W, Peng L, Ma H, Chen F, Lyu G, Liu M, Qiu X, Weng Z. Characterization of ultrasound and postnatal pathology in fetuses with heterotaxy syndrome. Front Cardiovasc Med 2023; 10:1195191. [PMID: 37485264 PMCID: PMC10359725 DOI: 10.3389/fcvm.2023.1195191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Background To explore the diagnostic clues and abnormality spectrum of heterotaxy syndrome by prenatal ultrasonography and postnatal verification. Methods The prenatal ultrasonic data of 88 heterotaxy syndrome fetuses were analyzed retrospectively as left isomerism (LI) and right isomerism (RI). Prenatal ultrasound compared with the anatomical casting of the fetal body after labor induction, and the confirmatory postnatal diagnosis after delivery. Results Fetal LI showed typical malformations of gastric vesicles on different sides from the heart, absence of hepatic segment of the inferior vena cava (IVC), abdominal aorta (AO) parallel with the azygos vein (AV), bilateral left bronchus, bilateral left atrial appendages, and polysplenia; intracardiac malformations of AV septal defects (AVSD), single atrium (SA), left ventricular outflow tract obstruction (LVOTO), and double-outlet right ventricle (DORV); and cardiac conduction abnormalities of sinus bradycardia and AV blockage. Fetal RI reported typical malformations of gastric vesicles on different sides from the heart, juxtaposition of the IVC with AO, anomalous pulmonary venous connection (APVC), asplenia, and bilateral right atrial appendages; intracardiac malformations of AVSD, SA, single ventricle, pulmonary atresia and stenosis, and DORV. The postnatal verification revealed 3 malformations misdiagnoses and 4 malformations missed diagnoses in LI fetuses and 10 misdiagnoses and 8 missed diagnoses in RI fetuses. Conclusions The proposed five-step prenatal ultrasonography has an important diagnostic value for the identification and classification of heterotaxy syndrome. The different sides of gastric vesicles and cardiac apex are important diagnostic clues for heterotaxy syndrome, featuring disconnected or hypoplastic IVC, typical complex cardiac malformation, and atrioventricular block in fetal LI, and shown APVC, juxtaposition of IVC and AO, and intracardiac malformations such as AVSD, DORV, and LVOTO in fetal RI.
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Affiliation(s)
- Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Biying Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Longzhuang Peng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Guorong Lyu
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
| | - Min Liu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiuqing Qiu
- Department of Obstetrics & Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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7
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Suo MJ, Chen WC, Xu ZQ, Tian GX, Li T, Li P, Sheng W, Huang GY, Ma XJ. X-linked BCOR variants identified in Chinese Han patients with congenital heart disease. J Gene Med 2023; 25:e3461. [PMID: 36314054 DOI: 10.1002/jgm.3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) frequently manifests as a complex phenotype and approximately one-third of cases may be caused by genetic factors. BCOR, an X-linked gene encoding the corepressor of BCL6, has been demonstrated to be closely involved in human heart development. However, whether BCOR variants represent the genetic etiology underlying CHD needs further investigation. METHODS We performed whole exome sequencing on CHD nuclear families and identified a candidate gene, BCOR, by robust bioinformatic analysis and medical literature searches. Targeted DNA sequencing of the candidate gene was conducted and then the association between variants and the risk of developing CHD was analyzed. The effects of BCOR mutations on gene expression, localization, protein interaction, and signaling pathways were evaluated in vitro. RESULTS We identified a BCOR hemizygous missense variant (c.1448C>T, p.Pro483Leu) in a male proband presented with CHD/heterotaxy. Sanger sequencing confirmed that this variant was inherited from his asymptomatic mother. Interestingly, through literature searches, we observed another novel BCOR hemizygous missense variant (c.1619G>A, p.Arg540Gln) in a CHD patient with heterotaxy, supporting the pathogenic evidence of BCOR variants. Functional experiments conducted in vitro revealed that the variant p.Pro483Leu altered the subcellular localization of BCOR protein, disrupted its interaction with BCL6, and significantly promoted cell proliferation, whereas the variant p.Arg540Gln displayed no obvious effects. Nevertheless, transcriptional analysis revealed that down-regulation of BCOR substantially enhanced the activities of mitogen-activated protein and phosphoinositide 3-kinase-AKT signaling pathways, which are closely attributed to heart development. Targeted sequencing of 932 sporadic CHD patients enriched nine variants of BCOR predicted as likely rare and damaging and a septal defect was present in 81.8% (9/11) of them, including the two probands, which was consistent with the possible phenotype caused by BCOR defects. CONCLUSIONS The findings of the present study indicate that variants in BCOR may predispose individuals to CHD in the Chinese Han population.
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Affiliation(s)
- Mei-Jiao Suo
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei-Cheng Chen
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Zi-Qing Xu
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Gui-Xiang Tian
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Ting Li
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Ping Li
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei Sheng
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Guo-Ying Huang
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiao-Jing Ma
- Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
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8
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Yi T, Sun H, Fu Y, Hao X, Sun L, Zhang Y, Han J, Gu X, Liu X, Guo Y, Wang X, Zhou X, Zhang S, Yang Q, Fan J, He Y. Genetic and Clinical Features of Heterotaxy in a Prenatal Cohort. Front Genet 2022; 13:818241. [PMID: 35518361 PMCID: PMC9061952 DOI: 10.3389/fgene.2022.818241] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Some genetic causes of heterotaxy have been identified in a small number of heterotaxy familial cases or animal models. However, knowledge on the genetic causes of heterotaxy in the fetal population remains scarce. Here, we aimed to investigate the clinical characteristics and genetic spectrum of a fetal cohort with heterotaxy. Methods: We retrospectively investigated all fetuses with a prenatal diagnosis of heterotaxy at a single center between October 2015 and November 2020. These cases were studied using the genetic testing data acquired from a combination of copy number variation sequencing (CNV-seq) and whole-exome sequencing (WES), and their clinical phenotypes were also reviewed. Result: A total of 72 fetuses diagnosed with heterotaxy and complete clinical and genetic results were enrolled in our research. Of the 72 fetuses, 18 (25%) and 54 (75%) had left and right isomerism, respectively. Consistent with the results of a previous study, intracardiac anomalies were more severe in patients with right atrial isomerism than in those with left atrial isomerism (LAI) and mainly manifested as atrial situs inversus, bilateral right atrial appendages, abnormal pulmonary venous connection, single ventricles or single atria, and pulmonary stenosis or atresia. In 18 fetuses diagnosed with LAI, the main intracardiac anomalies were bilateral left atrial appendages. Of the 72 fetuses that underwent CNV-seq and WES, 11 (15.3%) had positive genetic results, eight had definitive pathogenic variants, and three had likely pathogenic variants. The diagnostic genetic variant rate identified using WES was 11.1% (8/72), in which primary ciliary dyskinesia (PCD)-associated gene mutations (CCDC40, CCDC114, DNAH5, DNAH11, and ARMC4) accounted for the vast majority (n = 5). Other diagnostic genetic variants, such as KMT2D and FOXC1, have been rarely reported in heterotaxy cases, although they have been verified to play roles in congenital heart disease. Conclusion: Thus, diagnostic genetic variants contributed to a substantial fraction in the etiology of fetal heterotaxy. PCD mutations accounted for approximately 6.9% of heterotaxy cases in our fetal cohort. WES was identified as an effective tool to detect genetic causes prenatally in heterotaxy patients.
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Affiliation(s)
- Tong Yi
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Lab for Cardiovascular PrecisionMedicine, Beijing, China.,Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Hairui Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yuwei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Xiaoyan Hao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Guo
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Siyao Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Fan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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9
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Butel-Simoes GI, Jones P, Wood EM, Spelman D, Woolley IJ, Ojaimi S. Congenital asplenia study: clinical and laboratory characterisation of adults with congenital asplenia. Ann Hematol 2022; 101:1421-1434. [PMID: 35451619 DOI: 10.1007/s00277-022-04765-3] [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: 09/13/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Congenital asplenia is a rare disorder commonly associated with other visceral and cardiac congenital anomalies. Isolated congenital asplenia is even less common than syndromic forms. The risk of severe bacterial infections associated with asplenia is the most concerning clinical implication and carries a significant mortality risk. Prophylactic measures against the clinical syndrome known as overwhelming postsplenectomy infections (OPSI) include vaccination, prophylactic and emergency antibiotics and health education including fever management and travel advice. This case series describes fourteen adults with congenital asplenia and polysplenia syndrome, most of whom were diagnosed incidentally as adults, and outlines the nature of their diagnosis, clinical phenotype, family history and key pathology findings.
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Affiliation(s)
| | - Penelope Jones
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Department of Haematology, Monash Health, Victoria, Australia
| | - Denis Spelman
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
| | - Ian J Woolley
- Monash Infectious Diseases, Monash Health, Victoria, Australia
- Spleen Australia, Alfred Health, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Victoria, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Victoria, Australia
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Victoria, Australia
- Immunology Laboratory, Monash Pathology, Monash Health, Victoria, Australia
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10
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Seidl-Mlczoch E, Kasprian G, Kitzmueller E, Zimpfer D, Steiner I, Jowett V, Stuempflen M, Wielandner A, Ulm B, Michel-Behnke I. Discordant Post-natal Patterns in Fetuses With Heterotaxy Syndrome: A Retrospective Single-Centre Series on Outcome After Fetal Diagnosis. Front Pediatr 2022; 10:908505. [PMID: 35911827 PMCID: PMC9329514 DOI: 10.3389/fped.2022.908505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Cardiac and extra-cardiac anomalies in 46 pre-natally diagnosed cases of heterotaxy were compared to post-natal anatomical patterns in order to reveal discordant findings. Second, the outcome of these fetuses was evaluated. METHODS Fetuses with heterotaxy, diagnosed in a tertiary referral centre, were analysed retrospectively. Based on the foetal abdominal situs view, right atrial isomerism (RAI) and left atrial isomerism (LAI) were defined as foetal sub-types. Post-natally, discordant anatomical patterns for broncho-pulmonary branching, atrial appendage morphology, and splenic status were further clarified with CT scans. In summary, the spectrum of pre-natally and post-natally detected cardiac and extra-cardiac anomalies is systematically reviewed. Necessary surgical interventions and mid-long-term outcomes were compared between the two sub-types in surviving infants. RESULTS A total of 46 fetuses with heterotaxy were included; LAI was diagnosed in 29 (63%) fetuses and RAI was diagnosed in 17 (37%) fetuses. Extra-cardiac anomalies were noted in 35% of fetuses. Seven out of the 29 fetuses (24%) with LAI had atrio-ventricular block (AVB) and four of these cases presented with hydrops. Twenty nine out of the 46 participating fetuses (63%) were live births, with 62% in the LAI group and 65% in the RAI group. Five fetuses were lost to follow-up. At the age of 1 year, the overall survival of live births [estimate (95% CI)] was 67% (48; 92%) in patients with LAI and 55% (32; 94%) in patients with RAI. At the age of 5 years, the estimates were 67% (48; 92%) in the LAI group and 46% (24-87%) in the RAI group. The median survival (first quartile; third quartile) was 11.1 (0.1; 14) years for patients with LAI and 1.3 (0.09; NA) years for patients with RAI. Of 17 children who had undergone cardiac surgery, five (29%) children achieved a bi-ventricular repair and 12 (70%) children achieved a uni-ventricular palliation. Three were primarily palliated, but converted to bi-ventricular thereafter. Foetal subtype definition of heterotaxy based on the abdominal situs and post-natal thoracic imaging studies showed a discordant pattern of broncho-pulmonary branching and atrial appendage anatomy in 40% of our live-born children. CONCLUSION Heterotaxy is a rare and complex condition with significant morbidity and mortality related to severe cardiac and extra-cardiac associations. Accurate pre-natal diagnosis can help identify the fetuses at risk and allow for timely intervention in a multi-disciplinary setting. Further studies are warranted to shed light on the exact sub-type definition in fetuses with heterotaxy and the presence of discordant post-natal patterns.
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Affiliation(s)
- Elisabeth Seidl-Mlczoch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Erwin Kitzmueller
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Irene Steiner
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Victoria Jowett
- Department of Fetal Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marlene Stuempflen
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Alice Wielandner
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
| | - Barbara Ulm
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Ina Michel-Behnke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Pediatric Heart Center, Medical University of Vienna, Vienna, Austria
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11
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Seidl‐Mlczoch E, Kasprian G, Ba‐ssalamah A, Stuempflen M, Kitzmueller E, Muin DA, Zimpfer D, Prayer D, Michel‐behnke I, Ulm B. Characterization of phenotypic spectrum of fetal heterotaxy syndrome by combining ultrasound and magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:837-845. [PMID: 34097330 PMCID: PMC9299896 DOI: 10.1002/uog.23705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Heterotaxy or isomerism of the atrial appendages is a congenital disorder with variable presentation, associated with both cardiac and non-cardiac anomalies, which may have a serious impact on fetal outcome. The aim of this exploratory study was to assess the value of fetal magnetic resonance imaging (MRI), as a complementary tool to ultrasound, for describing the morphological spectrum encountered in heterotaxy. METHODS This retrospective study included 27 fetuses that underwent fetal MRI following prenatal suspicion of heterotaxy on ultrasound from 1998 to 2019 in a tertiary referral center. Heterotaxy was classified as left atrial isomerism (LAI) or right atrial isomerism (RAI) based on fetal echocardiography (FE) examination. In addition to routine prenatal ultrasound, fetal MRI was offered routinely to enhance the diagnosis of non-cardiac anomalies, which might have been missed on ultrasound. Prenatal findings on ultrasound, FE and MRI were reviewed systematically and compared with those of postnatal imaging and autopsy reports. RESULTS Twenty-seven fetuses with heterotaxy and cardiovascular pathology, of which 19 (70%) had LAI and eight (30%) had RAI, were included. Seven (7/19 (37%)) fetuses with LAI had normal intracardiac anatomy, whereas all fetuses with RAI had a cardiac malformation. All 27 fetuses had non-cardiac anomalies on fetal MRI, including situs and splenic anomalies. In 12/19 (63%) fetuses with LAI, a specific abnormal configuration of the liver was observed on MRI. In three fetuses, fetal MRI revealed signs of total anomalous pulmonary venous connection obstruction. An abnormal bronchial tree pattern was suspected on prenatal MRI in 6/19 (32%) fetuses with LAI and 3/8 (38%) fetuses with RAI. CONCLUSIONS Visualization on MRI of non-cardiac anomalies in fetuses with suspected heterotaxy is feasible and can assist the complex diagnosis of this condition, despite its limitations. This modality potentially enables differentiation of less severe cases from more complex ones, which may have a poorer prognosis. Fetal MRI can assist in prenatal counseling and planning postnatal management. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Seidl‐Mlczoch
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - G. Kasprian
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - A. Ba‐ssalamah
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - M. Stuempflen
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - E. Kitzmueller
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - D. A. Muin
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal MedicineMedical University of Vienna, ViennaAustria
| | - D. Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center ViennaMedical University of Vienna, ViennaAustria
| | - D. Prayer
- Department of Biomedical Imaging and Image‐guided Therapy, Division of Neuroradiology and Musculoskeletal RadiologyMedical University of Vienna, ViennaAustria
| | - I. Michel‐behnke
- Pediatric Heart Center, Department of Pediatrics and Adolescent Medicine, Division of Pediatric CardiologyMedical University of ViennaViennaAustria
| | - B. Ulm
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal MedicineMedical University of Vienna, ViennaAustria
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12
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Shahrouki P, Lee EW, Ruehm S. Polysplenia syndrome and sickle cell trait: extensive deep venous thrombosis from venous stasis and hypercoagulability. Clin Imaging 2021; 82:127-131. [PMID: 34813990 DOI: 10.1016/j.clinimag.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Deep venous thrombosis is a hitherto under-recognized complication occurring in patients with polysplenia syndrome, despite the high prevalence of venous anomalies such as interrupted inferior vena cava (IVC) with azygos/hemiazygos continuation. Here we report the first case of concurrent polysplenia (as evidenced by interrupted IVC with azygos/hemiazygos continuation, multiple left-sided spleens, bowel malrotation with inverted mesenteric veins, preduodenal portal vein, and pancreatic hypoplasia/partial agenesis of the dorsal pancreas) and sickle cell trait, complicated by extensive deep venous thrombosis refractory to medical and interventional radiologic management.
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Affiliation(s)
- Puja Shahrouki
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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13
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Baban A, Lodato V, Parlapiano G, Drago F. Genetics in Congenital Heart Diseases: Unraveling the Link Between Cardiac Morphogenesis, Heart Muscle Disease, and Electrical Disorders. Heart Fail Clin 2021; 18:139-153. [PMID: 34776075 DOI: 10.1016/j.hfc.2021.07.016] [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] [Indexed: 12/14/2022]
Abstract
The genetic background of congenital heart diseases (CHDs) is extremely complex, heterogenous, and still majorly to be determined. CHDs can be sporadic or familial. In this article we discuss in detail the phenotypic spectrum of selected genes including MYH7, GATA4, NKX2-5, TBX5, and TBX20. Our goal is to offer the clinician a general overview of the clinical spectrum of the analyzed topics that are traditionally known as causative for CHDs but we underline in this review the possible progressive functional (cardiomyopathy) and electric aspects (arrhythmias) caused by the genetic background.
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Affiliation(s)
- Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Lodato
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Giovanni Parlapiano
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children Hospital and Research Institute, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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14
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Ortega-Zhindón DB, Flores-Sarria IP, Minakata-Quiróga MA, Angulo-Cruzado ST, Romero-Montalvo LA, Cervantes-Salazar JL. [Isomorfismo cardiaco: Una perspectiva multidisciplinaria]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:470-479. [PMID: 34491249 PMCID: PMC8641457 DOI: 10.24875/acm.20000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/17/2021] [Indexed: 12/03/2022] Open
Abstract
Atrial isomerism describes complex anatomical findings with defects in the determination of lateralization; being a rare situation, with a prevalence of 1 in every 10.000 to 20.000 live births, with an incidence of up to 4% of all cardiac malformations. The diagnosis can be made in the neonatal age; however, clinical presentation is nonspecific. Depending on the spectrum of malformations, complex and invasive diagnostic tools may be required. Treatment is varied and can range from palliative surgery in view of univentricular physiology to total correction surgery for biventricular repair.
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Affiliation(s)
| | | | | | | | - Luis A. Romero-Montalvo
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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15
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Ortega-Zhindón DB, Calderón-Colmenero J, García-Montes JA, Sandoval JP, Minakata-Quiroga MA, Cervantes-Salazar JL. Cardiac surgery in patients with atrial isomerism: Long-term results and outcomes. J Card Surg 2021; 36:4476-4484. [PMID: 34494321 DOI: 10.1111/jocs.15982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of the study was to identify, determine, and analyze the clinical and surgical outcomes of patients with atrial isomerism (AI) undergoing cardiac surgery. METHODS A retrospective study was carried out. Patients with diagnosis of AI undergoing cardiac surgery at the National Institute of Cardiology Ignacio Chávez, from January 1, 2010 and March 31, 2020 were included; demographic characteristics and perioperative conditions of the patients were considered. RESULTS Sixty-five patients were included, with an average age of 6.4 ± 4.9 years, 50.8% males. Thirty-eight (58.5%) had right atrial isomerism (RAI) and 27 (41.5%) had left atrial isomerism (LAI); univentricular physiology (78.5%) predominated. Atrioventricular septal defect (AVSD) in RAI and septal defects in LAI were identified as the main associated defects. The most common surgical procedures performed were modified Blalock-Taussig shunt (MBTS) (27.6%), MBTS with total anomalous pulmonary venous connection (TAPVC) repair (15.3%) and total cavopulmonary connection (TCPC) with an extracardiac conduit fenestrated (10.8%); 100% RAI required a univentricular approach, while in LAI it was 48.1%. Overall survival was 92.3%, with 100% survival in LAI with biventricular physiology and 86.8% in RAI with univentricular physiology. CONCLUSIONS The survival of our institution is similar to that of other referral centers, where patients with LAI had a better evolution than RAI; in addition, the univentricular approach was required in all with RAI. Patients with AI must undergo a rigorous evaluation to determine an adequate repair strategy, considering univentricular RAI with a high possibility of morbidity and mortality.
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Affiliation(s)
- Diego B Ortega-Zhindón
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Juan Calderón-Colmenero
- Department of Pediatric Cardiology, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - José A García-Montes
- Department of Interventional Cardiology in Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Juan P Sandoval
- Department of Interventional Cardiology in Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - María A Minakata-Quiroga
- Department of Cardiac Anesthesia, National Institute of Cardiology Ignacio Chávez, Mexico City, México
| | - Jorge L Cervantes-Salazar
- Department of Pediatric Cardiac Surgery and Congenital Heart Disease, National Institute of Cardiology Ignacio Chávez, Mexico City, México
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16
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The multisystem nature of isomerism: left isomerism complicated by Abernethy malformation and portopulmonary hypertension. Cardiol Young 2021; 31:532-540. [PMID: 33731242 DOI: 10.1017/s1047951121000809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Isomerism, also referred to as "heterotaxy" is a complex set of anatomic and functional perturbations. One of the most obvious manifestations of isomerism is the disturbance of organ arrangement, such that the thoracic organs are no longer asymmetric on the left and right. We report the case of a 14-year-old female in whom exercise-induced dyspnea led to a late diagnosis of left isomerism complicated by Abernethy malformation and portopulmonary hypertension. A comprehensive evaluation revealed two anatomic left lungs and hyparterial bronchi, bilateral left atria, an interrupted inferior caval vein with azygos continuation, multiple spleens, sinus node dysfunction, hepatic hypertrophy with focal nodular hyperplasia, and absence of the portal vein. Pulmonary vasodilator therapy was initiated resulting in clinical improvement. This case exhibits unique features including a late diagnosis of isomerism with Abernethy malformation and portopulmonary hypertension. The patient's presentation, medical workup, and future treatment emphasise the importance of multidisciplinary care in children with complex multisystem disease. We review the multiple cardiac and extracardiac manifestations of isomerism.
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17
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Esmat HA, Naseri MW, Shirzai A. Heterotaxy polysplenia syndrome in an adult female with complete endocardial cushion defect. Radiol Case Rep 2021; 16:1080-1084. [PMID: 33717387 PMCID: PMC7921178 DOI: 10.1016/j.radcr.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/30/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body. It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome. The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Mohammad Wali Naseri
- Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Asadullah Shirzai
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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18
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Wu MH, Wang JK, Chiu SN, Tseng WC, Lu CW, Lin HC, Lin MT, Chen CA. Twin atrioventricular nodes, arrhythmias, and survival in pediatric and adult patients with heterotaxy syndrome. Heart Rhythm 2020; 18:605-612. [PMID: 33321198 DOI: 10.1016/j.hrthm.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heterotaxy syndrome is likely to involve arrhythmias from associated conduction system abnormalities, which are distinct in different subtypes of isomerism and may change further after interventions and remodeling. OBJECTIVE The purpose of this study was to understand the risk of arrhythmias and its relation to isomerism subtypes. METHODS Patients diagnosed between 1980 and 2019 as having heterotaxy syndrome were enrolled and grouped as right atrial isomerism (RAI), left atrial isomerism (LAI), or indeterminate isomerism. RESULTS Of the 366 patients enrolled, 326 (89.1%) had RAI, 35 (9.6%) LAI, and 5 (1.4%) indeterminate isomerism; 71 (19.4%) patients were adults. Arrhythmias occurred in 37.2% of patients (109 supraventricular tachycardia [SVT], 8 atrial fibrillation/flutter, 12 ventricular tachycardia, and 14 paced bradycardia). Freedom from arrhythmias by the age of 1, 5, 10, 20, and 40 years was 0.849, 0.680, 0.550, 0.413, and 0.053, respectively. Twin atrioventricular nodes were identified in 51.5% of patients with RAI, 8.7% of patients with LAI, and 40.0% of patients with indeterminate isomerism and were the key predictors of SVT. Indeterminate isomerism was also a risk factor for SVT. Other forms of tachycardia appeared relatively late. Sinus bradycardia with junctional rhythm was common in LAI (48.7%) and less in indeterminate isomerism (20.0%), with none occurring in RAI. Only in patients with RAI who showed the poorest survival, ventricular tachycardia worsened the long-term survival. CONCLUSION RAI was the predominant subtype of heterotaxy in this cohort. Collectively, the median RAI/LAI ratio was 0.731 and 5.450 in Western and East Asian studies, respectively. Arrhythmias, tachycardia, or paced bradycardia were common, but the spectrum was distinct among subtypes.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Sheunn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, Yuan-Lin Branch, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsin-Chia Lin
- Department of Pediatrics, Yuan-Lin Branch, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
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19
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Doello K, Conde V, Perez MC, Mendoza I, Mesas C, Prados J. Unusual long survival in a case of heterotaxy and polysplenia. Surg Radiol Anat 2020; 43:607-611. [PMID: 32995936 DOI: 10.1007/s00276-020-02586-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Heterotaxy syndrome with polysplenia is an extremely rare congenital disorder caused by a disruption in the embryonic development that results in an abnormal arrangement of the abdominal and thoracic organs. We present the case of a 59-year-old female patient with invasive ductal carcinoma of the right breast (luminal A type) and CT findings of heterotaxy syndrome with polysplenia. The most remarkable anomalies identified were a left inferior vena cava draining into the hemiazygos vein, absent inferior vena cava at the thoracic level, and hepatic veins directly draining into the right atrium. Moreover, an atrial septal defect was identified, explaining the pulmonary hypertension of unknown cause previously detected in the patient. The relevance of this case lies in the unusual anatomical abnormalities found and the large patient survival, having in to account the great rate of heterotaxy syndrome mortality in the first years of life.
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Affiliation(s)
- Kevin Doello
- Medical Oncology Service, Virgen de las Nieves Hospital, 18014, Granada, Spain.,Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain
| | - Veronica Conde
- Medical Oncology Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Maria C Perez
- Radiological Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Inmaculada Mendoza
- Radiological Service, Virgen de las Nieves Hospital, 18014, Granada, Spain
| | - Cristina Mesas
- Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain.,Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071, Granada, Spain.,Instituto Biosanitario de Granada (Ibs. GRANADA), 18014, Granada, Spain
| | - José Prados
- Institute of Biopathologyand Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain. .,Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071, Granada, Spain. .,Instituto Biosanitario de Granada (Ibs. GRANADA), 18014, Granada, Spain.
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20
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Bansal N, Ghosh R, Sankhyan LK, Chatterjee S, Chatterjee S, Bose S. Left isomerism with bilateral superior vena cava, interrupted inferior vena cava and tetralogy of Fallot. Ann Pediatr Cardiol 2020; 13:364-367. [PMID: 33311931 PMCID: PMC7727908 DOI: 10.4103/apc.apc_117_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 11/05/2022] Open
Abstract
The association of left isomerism with tetralogy of Fallot (TOF) is rare and reported as scattered case reports. Complex congenital cardiac and noncardiac malformations are known to be associated with left isomerism, but right-sided obstructive lesions are rare. We present our experience with a case of left isomerism with bilateral superior vena cava, interrupted inferior vena cava, and TOF managed by atrial septation and intracardiac repair.
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Affiliation(s)
- Nikhil Bansal
- Department of Cardiothoracic Surgery, The Mission Hospital, Durgapur, West Bengal, India
| | - Rajarshi Ghosh
- Department of Cardiothoracic Surgery, The Mission Hospital, Durgapur, West Bengal, India
| | | | - Sujoy Chatterjee
- Department of Cardiothoracic Surgery, The Mission Hospital, Durgapur, West Bengal, India
| | - Srirup Chatterjee
- Department of Cardiothoracic Surgery, The Mission Hospital, Durgapur, West Bengal, India
| | - Satyajit Bose
- Department of Cardiothoracic Surgery, The Mission Hospital, Durgapur, West Bengal, India
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21
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Banka P, Adar A, Schaetzle B, Sleeper LA, Emani S, Geva T. Changes in Prognosis of Heterotaxy Syndrome Over Time. Pediatrics 2020; 146:peds.2019-3345. [PMID: 32647064 DOI: 10.1542/peds.2019-3345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Long-term outcomes in heterotaxy syndrome (HS) are poorly described. Some reports suggest improved survival in the recent era, whereas others do not. We sought to describe long-term outcomes and assess whether outcomes have changed over time. METHODS Patients with HS born between 1985 and 2014 who had cardiac care (except initial palliation) at our institution were divided into 4 birth eras and survival over time was compared. Independent risk factors for mortality were identified by using Cox proportional hazards regression. In patients who underwent surgery, association between surgical pathway (univentricular versus biventricular repair) and mortality after adjusting for baseline confounders was evaluated. A risk stratification model was created by using classification and regression analysis. RESULTS Among 264 patients, 118 (44.7%) had asplenia and 146 (55.3%) had polysplenia syndrome. Overall mortality was 40.2% (n = 106), with median follow-up of 10.2 years (longest 31.5 years). In multivariable analysis, pulmonary vein stenosis, coarctation, univentricular circulation, asplenia phenotype, and at least mild atrioventricular valve regurgitation at presentation were associated with mortality, whereas birth era was not. Among patients who underwent surgery, univentricular repair remained associated with mortality after adjustment. In classification and regression analysis, patients with biventricular circulation (especially those with polysplenia) had lower mortality than those with univentricular circulation. CONCLUSIONS In this large retrospective study of HS, outcomes remain poor and have not improved since the early 1990s. We identified risks factors associated with earlier mortality and found that those with univentricular circulation and totally anomalous pulmonary venous connection had the worst prognosis. Survival was higher in those with biventricular circulation.
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Affiliation(s)
- Puja Banka
- Departments of Cardiology and.,Departments of Pediatrics and
| | | | | | - Lynn A Sleeper
- Departments of Cardiology and.,Departments of Pediatrics and
| | - Sitaram Emani
- Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; and.,Surgery, Medical School, Harvard University, Boston, Massachusetts
| | - Tal Geva
- Departments of Cardiology and .,Departments of Pediatrics and
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22
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23
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Abstract
Heterotaxy is a generalized term for patients who have an abnormality of laterality that cannot be described as situs inversus. Infants with heterotaxy can have significant anatomic and medical complexity and require personalized, specialized care, including comprehensive anatomic assessment. Common and rare anatomic findings are reviewed by system to help guide a thorough phenotypic evaluation. General care guidelines and considerations unique to this patient population are included. Future directions for this unique patient population, particularly in light of improved neonatal survival, are discussed.
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Affiliation(s)
- Gabrielle C Geddes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA.
| | - Sai-Suma Samudrala
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G Earing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Institute, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS#716, Milwaukee, WI 53226, USA; Section of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Isomerism of the atrial appendages: morphology and terminology. Cardiovasc Pathol 2020; 47:107205. [PMID: 32179252 DOI: 10.1016/j.carpath.2020.107205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our aim is to identify the pathognomonic anatomical markers and the best terminology to describe the cardiac malformations associated with absent or multiple spleens, which are known as asplenia or polysplenia syndromes or isomerism. MATERIALS AND METHODS We have reviewed 65 hearts with isomerism of atrial appendages of the Anatomical Collections of Congenital Heart Disease, Institute of Pathological Anatomy of the University of Padua consisting of 1800 specimens. All the hearts were classified according to sequential segmental classification. RESULTS The incidence of isomerism was 3.6%. Of the total, 45 hearts with isomerism of right atrial appendages showed bilateral trilobed lungs, short bronchi, and absent spleen. The atrioventricular junction was univentricular in 49% of cases with a common atrioventricular valve in 91%. Pulmonary atresia and double outlet right ventricle were present in 40% and 47% of cases, respectively. Total anomalous pulmonary venous drainage and absent coronary sinus were always present. In 20 hearts with isomerism of left atrial appendages, bilateral bilobed lungs with long bilateral bronchi and multiple spleens were always found. The biventricular atrioventricular connection was present in 65% with a common valve in 30% of the hearts. The ventriculoarterial connection was concordant in 45% of cases, and aortic atresia and pulmonary atresia were both noted in 15% of each. An anomalous symmetric pulmonary venous drainage was observed in 65% of the hearts and interruption of inferior vena cava was found in 75% of cases. CONCLUSIONS We believe that the appropriate terminology is based on the symmetrical morphology of the atrial appendages. The absence of the coronary sinus and the total anomalous pulmonary venous drainage are the markers of isomerism of the right atrial appendages. Symmetric pulmonary venous drainage and interruption of inferior vena cava are the markers of isomerism of left atrial appendages. In recent years, thanks to the improvement of clinical diagnosis and of surgical techniques these patients have the possibility to survive to adult age.
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25
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Ugas Charcape CF, Alpaca Rodriguez LR, Matos Rojas IA, Lazarte Rantes CI, Valdez Quintana M, Katekaru Tokeshi DA, Epelman M. Characterisation of computed tomography angiography findings in paediatric patients with heterotaxy. Pediatr Radiol 2019; 49:1142-1151. [PMID: 31165901 DOI: 10.1007/s00247-019-04434-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heterotaxy refers to the abnormal arrangement of organs across the left-right axis and is typically associated with complex cardiovascular malformations. OBJECTIVE To characterise the range of cardiac and extracardiac CT angiography findings in children with heterotaxy using the latest nomenclature consensus and to compare the different types of isomerism. MATERIALS AND METHODS We retrospectively analysed the data of 64 consecutive paediatric patients referred to our tertiary paediatric cardiovascular centre who underwent CT angiography for the evaluation of known or suspected heterotaxy within a 52-month period. RESULTS Right atrial isomerism was identified in 44 (69%) children, while left atrial isomerism was identified in 18 (28%) children. Atrial appendage anatomy and situs could not be determined in 2 children (3%). Associated heart defects included complete atrioventricular canal (CAVC) in 51 (80%) children, total anomalous pulmonary venous return in 43 (67%) and pulmonary atresia in 23 (36%). The bronchial branching pattern corresponded to atrial appendage morphology in all children except in the two in whom atrial appendage morphology could not be defined. In children with right atrial isomerism, the most common associated abnormalities were CAVC (n=41, 93%) and asplenia (n=34, 77%), while in those with left atrial isomerism, the most common associated abnormalities were polysplenia (n=17, 94%) and an interrupted inferior vena cava with azygos continuation (n=15, 83%). CONCLUSION CT angiography provides useful cardiovascular and extracardiac data on heterotaxy, which frequently involves a pattern of side-related findings but has great anatomical variability.
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Affiliation(s)
- Carlos F Ugas Charcape
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru.
| | - Larry R Alpaca Rodriguez
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Irma A Matos Rojas
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Claudia I Lazarte Rantes
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Melissa Valdez Quintana
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Doris A Katekaru Tokeshi
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | - Monica Epelman
- Department of Medical Imaging/Radiology Nemours Children's Health System/Nemours Children's Hospital, University of Central Florida, College of Medicine, Orlando, FL, USA
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