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Miller JC, Velani RN, Miller WD, Thomas AS, Shaw FR, Kochilas L. Long-term Outcomes After Interrupted Aortic Arch Repair. Ann Thorac Surg 2024; 118:469-477. [PMID: 38360344 PMCID: PMC11269040 DOI: 10.1016/j.athoracsur.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Interrupted aortic arch (IAA) is associated with left ventricular outflow tract obstruction (LVOTO) and DiGeorge syndrome. High-risk infantile surgery is required to address IAA, with limited data available on long-term outcomes. We used the Pediatric Cardiac Care Consortium, a multicenter US-based registry for pediatric cardiac interventions, to assess long-term outcomes after IAA repair by patient characteristics and surgical approach. METHODS This is a retrospective cohort study of patients undergoing IAA repair between 1982 and 2003. Kaplan-Meier plots and Cox proportional hazards regression were used to examine associations with postdischarge deaths tracked by matching with the US National Death Index. RESULTS Of 390 patients meeting inclusion criteria, 309 (79.2%) survived to discharge. During a median follow-up of 23.6 years, 30-year survival reached 80.7% for patients surviving hospital discharge after initial IAA repair. Adjusted analysis revealed higher risk of death for type B vs type A (adjusted hazard ratio [aHR], 3.32; 95% CI, 1.48-7.44), staged repair (aHR, 2.50; 95% CI, 1.14-5.50), and LVOTO interventions during initial hospitalization (aHR, 4.12; 95% CI, 1.83-9.27) but not for LVOTO without need for interventions or presence of DiGeorge syndrome. There was a trend toward improved in-hospital and long-term survival over time during the study period. CONCLUSIONS Staged repair, type B IAA, and need for LVOTO intervention during initial hospitalization for repair are associated with high risk of death out to 30 years. Survival outcomes are improving, but further efforts need to minimize staged approach and risks associated with LVOTO relief procedures.
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Affiliation(s)
- J Cole Miller
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Romie N Velani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Wade D Miller
- University of South Carolina School of Medicine, Greenville, South Carolina
| | - Amanda S Thomas
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Fawwaz R Shaw
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Lazaros Kochilas
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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Mastromoro G, Calcagni G, Vignaroli W, Anaclerio S, Pugnaloni F, Rinelli G, Secinaro A, Bordonaro V, Putotto C, Unolt M, Digilio MC, Marino B, Versacci P. Crossed pulmonary arteries: An underestimated cardiovascular variant with a strong association with genetic syndromes-A report of 74 cases with systematic review of the literature. Am J Med Genet A 2022; 188:2351-2359. [PMID: 35491976 DOI: 10.1002/ajmg.a.62763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2022] [Accepted: 04/09/2022] [Indexed: 11/08/2022]
Abstract
Crossed pulmonary arteries (CPAs) represent an uncommon anatomic variant, usually associated with some specific syndromes and conotruncal defects. This finding has been described in 22q11.2 Deletion Syndrome (22q11.2DS). We evaluated the correlation between CPAs and genetic diseases, in order to better define the characteristics of this variant, considered a rare anatomic pattern. An in-depth analysis of CPAs genotype-phenotype correlations was performed via a literature review. We detected 74 CPAs patients through echocardiography. Of these 74 patients, 35.1% of patients showed additional intracardiac malformations, while 29.7% showed extracardiac vascular anomalies, of which 16.2% were associated with intracardiac defects and 13.5% were not. In all, 62.2% of patients were diagnosed with genetic diseases and 52.2% of them were 22q11.2DS patients. In conclusions, CPAs represent a cardiovascular variant, which is detectable in nonsyndromic individuals, but especially in various genetic syndromes and in particular in 22q11.2DS patients. Data on the real prevalence of this morphology is lacking in literature. Knowledge of this anatomic variant is useful to interpret the unusual course of the pulmonary branches and is helpful information before cardiovascular surgical correction. Moreover, due to the strong association of CPAs with some genetic syndromes, the identification of this anatomic pattern can indicate the utility of a genetic assessment of these patients.
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Affiliation(s)
- Gioia Mastromoro
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Walter Vignaroli
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Silvia Anaclerio
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Flaminia Pugnaloni
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Gabriele Rinelli
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Veronica Bordonaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Marta Unolt
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Maria Cristina Digilio
- Rare Diseases and Medical Genetics, Department of Pediatrics, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
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Pulmonary ductal coarctation and left pulmonary artery interruption; pathology and role of neural crest and second heart field during development. PLoS One 2020; 15:e0228478. [PMID: 32413023 PMCID: PMC7228067 DOI: 10.1371/journal.pone.0228478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/28/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives In congenital heart malformations with pulmonary stenosis to atresia an abnormal lateral ductus arteriosus to left pulmonary artery connection can lead to a localised narrowing (pulmonary ductal coarctation) or even interruption We investigated embryonic remodelling and pathogenesis of this area. Material and methods Normal development was studied in WntCre reporter mice (E10.0–12.5) for neural crest cells and Nkx2.5 immunostaining for second heart field cells. Data were compared to stage matched human embryos and a VEGF120/120 mutant mouse strain developing pulmonary atresia. Results Normal mouse and human embryos showed that the mid-pharyngeal endothelial plexus, connected side-ways to the 6th pharyngeal arch artery. The ventral segment formed the proximal pulmonary artery. The dorsal segment (future DA) was solely surrounded by neural crest cells. The ventral segment had a dual outer lining with neural crest and second heart field cells, while the distal pulmonary artery was covered by none of these cells. The asymmetric contribution of second heart field to the future pulmonary trunk on the left side of the aortic sac (so-called pulmonary push) was evident. The ventral segment became incorporated into the pulmonary trunk leading to a separate connection of the left and right pulmonary arteries. The VEGF120/120 embryos showed a stunted pulmonary push and a variety of vascular anomalies. Summary Side-way connection of the DA to the left pulmonary artery is a congenital anomaly. The primary problem is a stunted development of the pulmonary push leading to pulmonary stenosis/atresia and a subsequent lack of proper incorporation of the ventral segment into the aortic sac. Clinically, the aberrant smooth muscle tissue of the ductus arteriosus should be addressed to prohibit development of severe pulmonary ductal coarctation or even interruption of the left pulmonary artery.
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Mastromoro G, Calcagni G, Versacci P, Putotto C, Chinali M, Lambiase C, Unolt M, Pelliccione E, Anaclerio S, Caprio C, Cioffi S, Bilio M, Baban A, Drago F, Digilio MC, Marino B, Baldini A. Left pulmonary artery in 22q11.2 deletion syndrome. Echocardiographic evaluation in patients without cardiac defects and role of Tbx1 in mice. PLoS One 2019; 14:e0211170. [PMID: 30933971 PMCID: PMC6443172 DOI: 10.1371/journal.pone.0211170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction and hypothesis Patients with 22q11 deletion syndrome (22q11.2DS) present, in about 75% of cases, typical patterns of cardiac defects, with a particular involvement on the ventricular outflow tract and great arteries. However, in this genetic condition the dimensions of the pulmonary arteries (PAs) never were specifically evaluated. We measured both PAs diameter in patients with 22q11.2DS without cardiac defects, comparing these data to a normal control group. Moreover, we measured the PAs diameter in Tbx1 mutant mice. Finally, a cell fate mapping in Tbx1 mutants was used to study the expression of this gene in the morphogenesis of PAs. Methods We evaluated 58 patients with 22q11.2DS without cardiac defects. The control group consisted of 54 healthy subjects, matched for age and sex. All cases underwent a complete transthoracic echocardiography. Moreover, we crossed Tbx1+/- mice and harvested fetuses. We examined the cardiovascular phenotype of 8 wild type (WT), 37 heterozygous (Tbx1+/-) and 6 null fetuses (Tbx1-/-). Finally, we crossed Tbx1Cre/+mice with R26RmT-mG Cre reporter mice to study Tbx1 expression in the pulmonary arteries. Results The echocardiographic study showed that the mean of the LPA/RPA ratio in 22q11.2DS was smaller (0.80 ± 0.12) than in controls (0.97 ± 0.08; p < 0.0001). Mouse studies resulted in similar data as the size of LPA and RPA was not significantly different in WT embryos, but in Tbx1+/- and Tbx1-/- embryos the LPA was significantly smaller than the RPA in both mutants (P = 0.0016 and 0.0043, respectively). We found that Tbx1 is expressed near the origin of the PAs and in their adventitia. Conclusions Children with 22q11.2DS without cardiac defects show smaller LPA compared with healthy subjects. Mouse studies suggest that this anomaly is due to haploinsufficiency of Tbx1. These data may be useful in the clinical management of children with 22q11.2DS and should guide further experimental studies as to the mechanisms underlying PAs development.
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Affiliation(s)
- Gioia Mastromoro
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Marcello Chinali
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | | | - Marta Unolt
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Elena Pelliccione
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Silvia Anaclerio
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Cinzia Caprio
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, CNR, Naples, Italy
| | - Sara Cioffi
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, CNR, Naples, Italy
| | - Marchesa Bilio
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, CNR, Naples, Italy
| | - Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Maria Cristina Digilio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
- * E-mail: (AB); (BM)
| | - Antonio Baldini
- Institute of Genetics and Biophysics “Adriano Buzzati Traverso”, CNR, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- * E-mail: (AB); (BM)
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Yuksel MA, Oztunc F, Imamoglu M, Tuten A, Temel Yuksel I, Madazli R. Prenatal diagnosis of a bilateral arterial duct associated with trisomy 18. J OBSTET GYNAECOL 2015; 35:750-1. [DOI: 10.3109/01443615.2015.1005585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ammar-Khodja F, Abdellali M. Exclusion of chromosomal abnormalities and microdeletions 22q11 and 10p13 in algerian patients with isolated conotruncal malformation. CYTOL GENET+ 2015. [DOI: 10.3103/s0095452715010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Variety of prenatally diagnosed congenital heart disease in 22q11.2 deletion syndrome. Obstet Gynecol Sci 2014; 57:11-6. [PMID: 24596813 PMCID: PMC3924741 DOI: 10.5468/ogs.2014.57.1.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/30/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the spectrum of prenatally diagnosed congenital heart disease in a Korean population with 22q11.2 deletion syndrome, and to provide guidelines for screening 22q11.2 deletion prenatally. Methods This retrospective study evaluated 1,137 consecutive fetuses that had prenatal genetic testing for 22q11.2 deletion because of suspected congenital heart disease between September 2002 and December 2012, at Asan Medical Center, Seoul, Korea. Results Main cardiovascular diseases in the 53 fetuses with confirmed 22q11.2 deletions were tetralogy of Fallot (n = 24, 45%), interrupted aortic arch (n = 10, 19%), ventricular septal defect (n = 5, 9%), double outlet right ventricle (n = 4, 8%), and coarctation of the aorta (n = 4, 8%). Other cardiac defects were rarely associated with 22q11.2 deletion. One fetus had persistent truncus arteriosus, one had aortic stenosis, and one had hypoplastic right heart syndrome. Two fetuses had normal intracardiac anatomy with an isolated right aortic arch, and one had an isolated bilateral superior vena cava. Conclusion A variety of congenital heart diseases were seen during the prenatal period. Conotruncal cardiac defects except transposition of great arteries were strongly associated with 22q11.2 deletion. When such anomalies are diagnosed by fetal echocardiography, genetic testing for 22q11.2 deletion should be offered. Even if less frequent deletion-related cardiac defects are detected, other related anomalies, such as thymic hypoplasia or aplasia, should be evaluated to rule out a 22q11.2 deletion.
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El-Ella SS, El Gendy F, Tawfik MA, El Sobky E, Khattab A, El-mekkawy M. Chromosome 22 microdeletion in children with syndromic congenital heart disease by fluorescent in situ hybridization (FISH). EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2012. [DOI: 10.1016/j.ejmhg.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Momma K. Cardiovascular anomalies associated with chromosome 22q11.2 deletion syndrome. Am J Cardiol 2010; 105:1617-24. [PMID: 20494672 DOI: 10.1016/j.amjcard.2010.01.333] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 11/30/2022]
Abstract
Cardiovascular anomalies are present in 80% of neonates with 22q11.2 deletion syndrome. Three genes in chromosome 22q11.2 (TBX1, CRKL, and ERK2) have been identified whose haploinsufficiency causes dysfunction of the neural crest cell and anterior heart field and anomalies of 22q11.2 deletion syndrome. The most common diseases are conotruncal anomalies, which include tetralogy of Fallot (TF), TF with pulmonary atresia, truncus arteriosus, and interrupted aortic arch. A high prevalence of the deletion is noted in patients with TF with absent pulmonary valve, TF associated with pulmonary atresia and major aortopulmonary collateral arteries, truncus arteriosus, and type B interruption of aortic arch. Right aortic arch, aberrant subclavian artery, cervical origin of the subclavian artery, crossing pulmonary arteries, and major aortopulmonary collateral arteries are frequently associated with cardiovascular anomalies associated with 22q11.2 deletion syndrome. Virtually every type of congenital heart defect has been described early in the context of a 22q11.2 deletion. In conclusion, conotruncal anomaly associated with aortic arch and ductus arteriosus anomalies should increase the suspicion of 22q11.2 deletion.
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Affiliation(s)
- Kazuo Momma
- Section of Pediatric Cardiology, Heart Center, Tokyo Women's Medical University, Tokyo, Japan.
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10
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Hashmi SF, Hanif M, Maroo S, Pollock JCS. Double aortic arch with dominant left arch and right ligamentum arteriosum. CONGENIT HEART DIS 2009; 4:474-7. [PMID: 19925543 DOI: 10.1111/j.1747-0803.2009.00286.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This case report describes a rare example of double aortic arch with a dominant left aortic arch, patent minor right aortic arch, left descending aorta, and right ligamentum arteriosum causing tracheobronchial compression in a twin baby girl with DiGeorge syndrome. She also had large right subclavian artery arising from right-sided diverticulum of Kommerell, aplastic thymus, T cell lymphopenia with normal immunoglobulin, hypocalcemia, and hypomagnesemia. The diverticulum of Kommerell was resected and minor right aortic arch, right ligamentum arteriosum, and right subclavian artery were divided through right posterolateral thoracotomy. Aortopexy was performed under bronchoscopic guidance to relieve the airway compression. We strongly suggest a right-sided approach in this type of vascular arrangement for easy access and better outcome.
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Affiliation(s)
- Syed Faisal Hashmi
- Departments of Pediatric Cardiothoracic Surgery, Royal Hospital for Sick Children, Glasgow, UK.
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Lofland GK. Reprint of One-Stage Repair and Unifocalization for Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries in Early Infancy. PROGRESS IN PEDIATRIC CARDIOLOGY 2009. [DOI: 10.1016/j.ppedcard.2009.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lofland GK. An overview of pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries. PROGRESS IN PEDIATRIC CARDIOLOGY 2009. [DOI: 10.1016/j.ppedcard.2009.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Carotti A, Digilio MC, Piacentini G, Saffirio C, Di Donato RM, Marino B. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. ACTA ACUST UNITED AC 2008; 14:35-42. [PMID: 18636635 DOI: 10.1002/ddrr.6] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Specific types and subtypes of cardiac defects have been described in children with 22q11.2 deletion syndrome as well as in other genetic syndromes. The conotruncal heart defects occurring in patients with 22q11.2 deletion syndrome include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus, interrupted aortic arch, isolated anomalies of the aortic arch, and ventricular septal defect. These conotruncal heart defects are frequently associated in this syndrome with additional cardiovascular anomalies of the aortic arch, pulmonary arteries, infundibular septum, and semilunar valves complicating cardiac anatomy and surgical treatment. In this review we describe the surgical anatomy, the operative treatment, and the prognostic results of the cardiac defects associated with 22q11.2 deletion syndrome. According to the current literature, in patients with tetralogy of Fallot with/without pulmonary atresia and truncus arteriosus, in spite of the complex cardiac anatomy, the presence of 22q11.2 deletion syndrome does not worsen the surgical prognosis. On the contrary in children with pulmonary atresia with ventricular septal defect and probably in those with interrupted aortic arch the association with 22q11.2 deletion syndrome is probably a risk factor for the operative treatment. The complex cardiovascular anatomy in association with depressed immunological status, pulmonary vascular reactivity, neonatal hypocalcemia, bronchomalacia and broncospasm, laryngeal web, and tendency to airway bleeding must be considered at the time of diagnosis and surgical procedure. Specific diagnostic, surgical, and perioperative protocols should be applied in order to provide appropriate treatment and to reduce surgical mortality and morbidity.
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Affiliation(s)
- Adriano Carotti
- Pediatric Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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15
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Nakanishi T. Atsuyoshi Takao. Cardiol Young 2007; 17:461-9. [PMID: 17910779 DOI: 10.1017/s1047951107001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Toshio Nakanishi
- Pediatric Cardiology, Heart Institute, Tokyo Women's Medical University, Tokyo, Japan.
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Patel CR, Smith GL, Lane JR, Robinson HB. Prenatal echocardiographic diagnosis of a right aortic arch and bilateral arterial duct with isolation of the left subclavian artery from the left pulmonary artery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1107-10. [PMID: 17646375 DOI: 10.7863/jum.2007.26.8.1107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Chandrakant R Patel
- MBThe Heart Center, Children's Hospital Medical Center of Akron, 2 Perkins Sq, Akron, OH 44308-1062, USA.
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Pierpont ME, Basson CT, Benson DW, Gelb BD, Giglia TM, Goldmuntz E, McGee G, Sable CA, Srivastava D, Webb CL. Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 2007; 115:3015-38. [PMID: 17519398 DOI: 10.1161/circulationaha.106.183056] [Citation(s) in RCA: 554] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The intent of this review is to provide the clinician with a summary of what is currently known about the contribution of genetics to the origin of congenital heart disease. Techniques are discussed to evaluate children with heart disease for genetic alterations. Many of these techniques are now available on a clinical basis. Information on the genetic and clinical evaluation of children with cardiac disease is presented, and several tables have been constructed to aid the clinician in the assessment of children with different types of heart disease. Genetic algorithms for cardiac defects have been constructed and are available in an appendix. It is anticipated that this summary will update a wide range of medical personnel, including pediatric cardiologists and pediatricians, adult cardiologists, internists, obstetricians, nurses, and thoracic surgeons, about the genetic aspects of congenital heart disease and will encourage an interdisciplinary approach to the child and adult with congenital heart disease.
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Piacentini G, Digilio MC, Sarkozy A, Placidi S, Dallapiccola B, Marino B. Genetics of congenital heart diseases in syndromic and non-syndromic patients: new advances and clinical implications. J Cardiovasc Med (Hagerstown) 2007; 8:7-11. [PMID: 17255809 DOI: 10.2459/01.jcm.0000247428.51828.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital heart defects (CHDs) are the most common birth defects in humans and over the last 20 years significant progress has been made in the understanding of the molecular and genetic determinants of an increasing number of CHDs. Fundamental to this progress has been the contribution of five fields of research: the epidemiological results of the Baltimore-Washington Infant Study (BWIS); the pathogenetic classification introduced by Clark; the Human Genome Project; genotype-phenotype correlation and familial recurrence studies; and transgenic animals. The recently advanced cytogenetic techniques can now detect subtle rearrangements in chromosomes, which may be overlooked by standard methods and, more recently, molecular instruments such as linkage analysis and positional cloning are being used to identify genes causing Mendelian monogenic syndromes with CHDs, such as Holt-Oram, Ellis-van Creveld and Noonan/LEOPARD syndromes. Finally, useful information is yet available with regard to genes causing isolated CHDs in individuals who do not have a genetic syndrome (an example is the mutation of NKX2.5 and GATA4 genes causing atrial septal defect). The future perspectives for the genetics of CHDs will involve three fields of interest: diagnosis; therapy; and prognosis.
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Affiliation(s)
- Gerardo Piacentini
- Pediatric Cardiology, Department of Pediatrics, La Sapienza University, Rome, Italy
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Lofland GK. One-Stage Repair and Unifocalization for Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries in Early Infancy. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.optechstcvs.2007.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tannous HJ, Moulick AN, Jonas RA. Interrupted Aortic Arch and Aortic Atresia With Circle of Willis-Dependent Coronary Perfusion. Ann Thorac Surg 2006; 82:e11-3. [PMID: 16863727 DOI: 10.1016/j.athoracsur.2006.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 04/27/2006] [Accepted: 05/11/2006] [Indexed: 11/19/2022]
Abstract
We present a case of type B interrupted aortic arch and aortic atresia. This combination is usually incompatible with life. However, the presence of an aberrant right subclavian artery and enough blood flow through the circle of Willis allowed perfusion of the coronary arteries through retrograde carotid and aortic blood flow. A two-ventricular repair was successfully undertaken.
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Affiliation(s)
- Henry J Tannous
- Children's National Medical Center, Washington, District of Columbia, USA.
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Park IS, Ko JK, Kim YH, Yoo HW, Seo EJ, Choi JY, Gil HY, Kim SJ. Cardiovascular anomalies in patients with chromosome 22q11.2 deletion: a Korean multicenter study. Int J Cardiol 2006; 114:230-5. [PMID: 16824627 DOI: 10.1016/j.ijcard.2005.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 11/10/2005] [Accepted: 12/05/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The 22q11.2 deletion syndrome is reported with increasing frequency worldwide, and its clinical manifestations, including cardiovascular anomalies, appear to be more diverse than previously reported. The aim of this study was to determine the incidence and the pattern of cardiovascular anomalies in Korean patients with 22q11 deletion. METHODS This study involved six Korean institutions. We reviewed the clinical records of patients and confirmed the presence of 22q11.2 deletion by fluorescent in situ hybridization (FISH). RESULTS A total of 222 patients were examined and 190 (85.6%) patients had the cardiovascular abnormalities: 63.2% tetralogy of Fallot (TOF), 20.5% isolated ventricular septal defects (VSDs), 5.3% interrupted aortic arch type B (IAA B), 3.6% double outlet right ventricle (DORV), 3.6% atrial septal defects (ASDs) and 1.7% truncus arteriosus (TA). Of 168 patients with VSD, 69.6% had the perimembranous type, 11.9% the total conal defect type, 6.5% the subarterial type, 4.2% the muscular type and 1.2% the mixed type. A right aortic arch was observed in 50% of patients, and an aberrant subclavian artery was significantly more common with a right (30.9%) than a left (18.3%) aortic arch (p<0.05). CONCLUSIONS A wide variety of cardiovascular anomalies were present in Korean patients with the 22q11.2 deletion.
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Momma K. Cardiovascular anomalies associated with chromosome 22q11.2 deletion. Int J Cardiol 2006; 114:147-9. [PMID: 16730817 DOI: 10.1016/j.ijcard.2006.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 02/16/2006] [Indexed: 11/20/2022]
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Restivo A, Sarkozy A, Digilio MC, Dallapiccola B, Marino B. 22q11 deletion syndrome: a review of some developmental biology aspects of the cardiovascular system. J Cardiovasc Med (Hagerstown) 2006; 7:77-85. [PMID: 16645366 DOI: 10.2459/01.jcm.0000203848.90267.3e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The morphology and molecular genetics of the 22q11 deletion syndrome cardiovascular anomalies are reviewed. Special emphasis is given to TBX1, recently identified and considered to be the potential key gene for this clinical syndrome. The TBX1 downstream molecular pathways modulating the normal development of the pharyngeal apparatus are also discussed, and emphasis is given to the possible, equally fundamental role of downstream molecular pathway disruption in causing the clinical 22q11 deletion phenotype features.
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Affiliation(s)
- Angelo Restivo
- Department of Paediatrics, University of Rome La Sapienza, Italy
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Arnold JS, Werling U, Braunstein EM, Liao J, Nowotschin S, Edelmann W, Hebert JM, Morrow BE. Inactivation of Tbx1 in the pharyngeal endoderm results in 22q11DS malformations. Development 2006; 133:977-87. [PMID: 16452092 DOI: 10.1242/dev.02264] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The 22q11 deletion (22q11DS; velo-cardio-facial syndrome/DiGeorge syndrome) is characterized by defects in the derivatives of the pharyngeal apparatus. Mouse genetic studies have identified Tbx1, a member of the T-box family of transcription factors, as being responsible for the physical malformations of the syndrome. Mice heterozygous for a null mutation in Tbx1 have mild anomalies, whereas homozygous Tbx1 mutants die at birth with severe defects in the derivatives of the pharyngeal apparatus, including cleft palate, thymus gland aplasia and cardiac outflow tract malformations. Tbx1 is expressed in the splanchnic mesenchyme, the pharyngeal endoderm (PE) and in the core mesoderm of the pharyngeal apparatus. Tissue interactions between the epithelia and mesenchyme of the arches are required for development of the pharyngeal apparatus; the precise role of Tbx1 in each tissue is not known. To assess the role of Tbx1 in the PE, a conditional allele of Tbx1 was generated using the Cre/loxP system. Foxg1-Cre was used to drive PE-specific ablation of Tbx1. Conditional null mutants survived embryogenesis, but died in the neonatal period with malformations identical to the defects observed in Tbx1 homozygous null mutants. The abnormalities appear to be secondary to failed outgrowth of the pharyngeal pouches. These results show that Tbx1 in the PE is required for the patterning and development of the pharyngeal apparatus, thereby disrupting the formation of its derivative structures.
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Affiliation(s)
- Jelena S Arnold
- Department of Molecular Genetics, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Sun AM, Alhabshan F, Branson H, Freedom RM, Yoo SJ. MRI diagnosis of isolated origin of the left subclavian artery from the left pulmonary artery. Pediatr Radiol 2005; 35:1259-62. [PMID: 16096825 DOI: 10.1007/s00247-005-1569-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 07/13/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
Right aortic arch with isolation of the left subclavian artery is a rare disorder. In this entity, the left subclavian artery has its origin from the pulmonary artery via the ductus arteriosus. We report an infant with an unbalanced atrioventricular septal defect, right aortic arch, bilateral ductus arteriosi and an isolated left subclavian artery. This infant also had chromosome 22q11 deletion. The origin and course of the isolated subclavian artery were well-demonstrated using contrast-enhanced 3-D magnetic resonance angiography. This non-invasive diagnostic modality can accurately reveal detailed mediastinal vascular anatomy in a young infant and allows diagnosis of aberrant vascular connections.
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MESH Headings
- Abnormalities, Multiple
- Aortic Arch Syndromes/diagnosis
- Aortic Arch Syndromes/surgery
- Cardiac Surgical Procedures
- Chromosome Deletion
- Chromosomes, Human, Pair 22
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/surgery
- Female
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/surgery
- Humans
- Imaging, Three-Dimensional
- Infant, Newborn
- Magnetic Resonance Angiography/methods
- Pulmonary Artery/abnormalities
- Pulmonary Artery/surgery
- Subclavian Artery/abnormalities
- Subclavian Artery/surgery
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Affiliation(s)
- Ai-Min Sun
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., M5G 1X8, Toronto, ON, Canada
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26
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Digilio MC, Marino B, Capolino R, Angioni A, Sarkozy A, Roberti MC, Conti E, de Zorzi A, Dallapiccola B. Familial recurrence of nonsyndromic congenital heart defects in first degree relatives of patients with deletion 22q11.2. Am J Med Genet A 2005; 134A:158-64. [PMID: 15669097 DOI: 10.1002/ajmg.a.30587] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The majority of nonsyndromic congenital heart defects (CHDs) are considered to follow a multifactorial model of inheritance. Multiple family members affected by CHD can occasionally be detected, and the involvement of several genetic loci interacting with environmental factors is suspected to be implicated. The DiGeorge/velo-cardio-facial syndrome related to microdeletion 22q11.2 (del22) is a genetic condition associated with CHD in most of the cases. We report here on five pedigrees of patients with del22, showing occurrence of nonsyndromic CHD in a first-degree relative of the proband case. Familial aggregation of syndromic and nonsyndromic CHD as observed in our series is to be considered as an unusual pattern of recurrence. The interaction between several different genes and environmental factors, a familial susceptibility predisposing to a specific cardiac malformation, or chance association can all be hypothesized searching an explanation for these particular observations.
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Antshel KM, Kates WR, Roizen N, Fremont W, Shprintzen RJ. 22q11.2 deletion syndrome: genetics, neuroanatomy and cognitive/behavioral features keywords. Child Neuropsychol 2005; 11:5-19. [PMID: 15823980 DOI: 10.1080/09297040590911185] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper presents a conceptual review of the genetic underpinnings of 22q11.2 Deletion Syndrome. The neuroanatomical, neuropsychological, behavioral, and psychiatric phenotype associated with 22q11.2 Deletion Syndrome is also explored, including variables that are thought to affect symptom expression. The history of the deletion syndrome is described, and future directions for continued research are discussed.
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Affiliation(s)
- Kevin M Antshel
- Department of Psychiatry and Behavioral Sciences, SUNY-Upstate Medical University, Syracuse, NY 13210, USA.
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28
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Yatsenko SA, Yatsenko AN, Szigeti K, Craigen WJ, Stankiewicz P, Cheung SW, Lupski JR. Interstitial deletion of 10p and atrial septal defect in DiGeorge 2 syndrome. Clin Genet 2004; 66:128-36. [PMID: 15253763 DOI: 10.1111/j.1399-0004.2004.00290.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present molecular genetic investigations of a 4-year-old boy with craniofacial dysmorphism and developmental delay. Trivial mitral and tricuspid regurgitation without gross structural abnormality was diagnosed by echocardiography. High-resolution chromosome analysis revealed an interstitial deletion, del(10)(p12.1p12.32). To characterize the deletion size and breakpoints, we performed fluorescence in situ hybridization analysis using 27 BAC clones. Our data demonstrate an approximately 5.5 Mb deletion del(10)(p12.1p12.31). Surprisingly, the BAC clone RP11-56H7 that contains NEBL, an apparent downstream gene of the cardiogenic transcription factor HAND2 previously shown to be deleted in the patients with DiGeorge 2 syndrome and 10p13 deletion, was deleted in our patient with 10p12.1-p12.31 deletion. In addition, we provide clinical data and results of molecular analysis for a patient with multiple congenital anomalies including Ebstein's anomaly, kidney malformations, and 10p13-p14 deletion. We also reviewed 19 patients with congenital heart defects and deletions involving 10p and propose that atrial septal defect (ASD) is a common cardiac anomaly associated with DiGeorge 2 syndrome. Based on genotype-phenotype analysis of published patients and those reported herein, we propose an approximately 1.0 Mb critical region between loci D10S547 and D10S2176 in 10p14 to be associated with ASD. Considering that septal defects are the most frequent congenital heart anomaly, we suggest that further investigations in the 10p critical region are important to identify gene(s) responsible for this common birth defect.
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Affiliation(s)
- S A Yatsenko
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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29
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Lofland GK. Pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7:85-94. [PMID: 15283357 DOI: 10.1053/j.pcsu.2004.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Pulmonary atresia with ventricular septal defect and major aorta pulmonary collaterals arteries is a rare and complex congenital cardiac defect. There is considerable variability in the anatomy, morphology, and geometry of the native pulmonary arteries and the collateral vessels. While the ultimate goal of therapy is a biventricular correction with complete unifocalization, establishment of right ventricular to pulmonary arterial continuity, and closure of all intracardiac defects, achieving this endpoint can be frustrating and difficult. A carefully considered approach for each individual patient is required. Patients with appropriate anatomy may undergo a definitive single-stage unifocalization and biventricular correction in early infancy. Patients with less favorable anatomy will require a more eclectic approach. While our knowledge of the genetics of this defect is rudimentary, further advances in genetic understanding and technology hold tremendous promise for the development of future therapies.
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Affiliation(s)
- Gary K Lofland
- Section of Cardiac Surgery, Ward Family Center for Congenital Heart Disease, Children's Mercy Hospitals & Clinics, University of Missouri, Kansas City, MO 64108, USA
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30
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Abstract
Survival of patients with persistent truncus arteriosus, otherwise known as truncus arteriosus communis, has increased over the past several years with advances in congenital heart surgery and postoperative management. Despite the fact that ongoing debate regarding timing for surgical intervention, timing and indication for truncal valve replacement, and the ideal materials to use for the right ventricle to pulmonary artery conduit, perseverance on the part of cardiac surgeons, cardiologists, and the rest of the medical team caring for these patients has resulted in longer and improved quality of life. Early, accurate diagnosis, initial stabilization, and medical management in the perinatal period, and surgical intervention are most important in preventing or decreasing long-term morbidity and mortality.
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Affiliation(s)
- Barbara Ferdman
- Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, Division of Pediatric Cardiology, 1465 S. Grand Boulevard, St. Louis, MO 63104, USA.
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31
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Derbent M, Yilmaz Z, Baltaci V, Saygili A, Varan B, Tokel K. Chromosome 22q11.2 deletion and phenotypic features in 30 patients with conotruncal heart defects. Am J Med Genet A 2003; 116A:129-35. [PMID: 12494430 DOI: 10.1002/ajmg.a.10832] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This report describes the dysmorphic features and frequency of 22q11.2 deletion (del22q11) in 30 Turkish patients with conotruncal heart defects (CTHDs). Fluorescence in situ hybridization (FISH) analysis revealed deletions in the 22q11.2 region in nine (30%) individuals. The CTHDs in this group were tetralogy of Fallot (four cases), double-outlet right ventricle (DORV) (two cases), transposition of great arteries (two cases), and ventricular septal defect (VSD) associated with other CTHDs (one case). The frequency of del22q11 in the study group was relatively high because many of the patients with dysmorphic findings also had cardiac anomalies involving the pulmonary artery, ductus arteriosus, or the aortic arch and its main branches. Twenty of the 30 patients exhibited several dysmorphic findings. Two of the nine patients with del22q11 exhibited no apparent dysmorphic features other than sacral dimple. Interestingly, one of the patients with del22q11 had a phenotypic appearance similar to that seen in oculo-auriculo-vertebral spectrum (OAVS). This individual had left microtia, atresia of the external meatus, mandibular asymmetry, and peripheral facial nerve paralysis. His mental development was normal and there were no abnormalities on ophthalmological examination. The CTHDs in this patient were situs inversus dextrocardia, DORV, pulmonary stenosis, and VSD. Radiographs of this patient showed platybasia, complete fusion of C2-C3, and posterior fusion of the T1-T2 vertebrae. This particular case indicates that the phenotypic features of del22q11 and OAVS may overlap.
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Affiliation(s)
- Murat Derbent
- Department of Pediatrics, Baskent University Faculty of Medicine, Ankara, Turkey.
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Shi Y, Hsieh K, Wu J, Lee C, Tsai C, Yu M, Chang J, Tsai F. Genetic analysis of chromosome 22q11.2 markers in congenital heart disease. J Clin Lab Anal 2003; 17:28-35. [PMID: 12526020 PMCID: PMC6807742 DOI: 10.1002/jcla.10062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Congenital heart disease (CHD) is a common cardiac defect found in infants and children. Despite advances in diagnosis and treatment, our understanding of the causative mechanism and etiology of CHD is limited. To determine the genetic etiology of CHD, we selected 11 consecutive short tandem-repeat polymorphic (STRP) markers located in the interval of the 22q11.2 region to perform genotype analysis on a large number of CHD patients (>120) and their normal relatives (>220). The results show that as regards the distribution of allelic size and frequency of these STRP markers, there were no significant differences between the CHD patients and the normal volunteers. This indicates that there is no linkage disequilibrium with these markers in CHD. In the level of heterozygosity for each marker in nonsyndromic CHD and conotruncal heart defect (CTD), there were no significant differences between the two populations. In syndromic CHD, the level of heterozygosity for D22S1648 was significantly lower than that observed in the unaffected population (chi(2) = 11.25; P = 0.001). This suggests that there may be a deletion at the D22S1648 locus, and the low heterozygosity of D22S1648 indicates that this marker can be used as a genetic marker for detecting microdeletions in 22q11.2. With the use of fluorescence in situ hybridization (FISH) and real-time quantitative polymerase chain reaction (PCR) performed on syndromic patients, we confirmed the molecular results.
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Affiliation(s)
- Yi‐Ru Shi
- Department of Medical Research, China Medical College Hospital, Taichung, Taiwan
| | - Kai‐Sheng Hsieh
- Department of Pediatrics, Veterans General Hospital, Haohsiung, Taiwan
| | - Jer‐Yuarn Wu
- Department of Medical Research, China Medical College Hospital, Taichung, Taiwan
- Medical Genetics, China Medical College Hospital, Taichung, Taiwan
| | - Cheng‐Chun Lee
- Department of Medical Research, China Medical College Hospital, Taichung, Taiwan
- Neurology, China Medical College Hospital, Taichung, Taiwan
| | - Chang‐Hai Tsai
- Department of Medical Research, China Medical College Hospital, Taichung, Taiwan
- Pediatrics, China Medical College Hospital, Taichung, Taiwan
| | - Ming‐Tseng Yu
- Medical Genetics, China Medical College Hospital, Taichung, Taiwan
| | | | - Fuu‐Jen Tsai
- Department of Medical Research, China Medical College Hospital, Taichung, Taiwan
- Pediatrics, China Medical College Hospital, Taichung, Taiwan
- Medical Genetics, China Medical College Hospital, Taichung, Taiwan
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Eapen RS, Eidem BW. Echocardiographic assessment of velocardiofacial syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Marino B, Digilio M, Toscano A. Common arterial trunk, DiGeorge syndrome and microdeletion 22q11. PROGRESS IN PEDIATRIC CARDIOLOGY 2002. [DOI: 10.1016/s1058-9813(02)00004-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rauch R, Rauch A, Koch A, Kumpf M, Dufke A, Singer H, Hofbeck M. Cervical origin of the subclavian artery as a specific marker for monosomy 22q11. Am J Cardiol 2002; 89:481-4. [PMID: 11835939 DOI: 10.1016/s0002-9149(01)02279-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ralf Rauch
- Department of Cardiology, University Children's Hospital, Tuebingen, Germany.
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Toscano A, Anaclerio S, Digilio MC, Giannotti A, Fariello G, Dallapiccola B, Marino B. Ventricular septal defect and deletion of chromosome 22q11: anatomical types and aortic arch anomalies. Eur J Pediatr 2002; 161:116-7. [PMID: 11954747 DOI: 10.1007/s00431-001-0877-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vittorini S, Sacchelli M, Iascone MR, Collavoli A, Storti S, Giusti A, Andreani G, Botto N, Biagini A, Clerico A. Molecular characterization of chromosome 22 deletions by short tandem repeat polymorphism (STRP) in patients with conotruncal heart defects. Clin Chem Lab Med 2001; 39:1249-58. [PMID: 11798086 DOI: 10.1515/cclm.2001.201] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The haploinsufficiency of chromosome 22q11.2 can cause both DiGeorge and velocardiofacial syndromes, both of which are characterized by conotruncal heart defects as well as a wide range of other extracardiac anomalies. Several studies have demonstrated that approximately 10-20% of patients with conotruncal heart defects have a 22q11.2 deletion. In clinical laboratories, the deletion is usually detected by fluorescent in situ hybridization (FISH). We set up a polymerase chain reaction-based non-radioactive method for molecular analysis of the 22q11.2 region in conotruncal cardiac patients with conotruncal defects. Sixty-four children with conotruncal defects and their parents were genotyped by polymerase chain reaction, using fifteen polymorphic markers. We identified nine deletions (confirmed by FISH): eight were "de novo" and one familial, maternally inherited. Six deletions were of paternal and three of maternal origin. There were seven deletions of 3 Mb and the other two were of 1.5 Mb. This method is a cost-effective means of characterizing the 22q11.2 region and it can be applied for a rapid screening of 22q11.2 deletion in patients at risk. In agreement with previously published data, we found no correlation between the sizes and the parental origin of deletions and cardiac or extra-cardiac phenotypes.
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Affiliation(s)
- S Vittorini
- Laboratorio di Biologia Molecolare, IFC-CNR, Ospedale G. Pasquinucci, Massa, Italy.
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40
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Strauss AW. The molecular basis of congenital cardiac disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 1:179-188. [PMID: 11486220 DOI: 10.1016/s1092-9126(98)70021-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Today, congenital cardiovascular disease is virtually always amenable to corrective or palliative surgical interventions. However, the mechanisms causing developmental anomalies of the heart and vessels have remained obscure until recently. This review presents genetic defects causing the pediatric vasculopathies; Marfan's syndrome, inherited supravalvar aortic stenosis, and Williams' syndrome. A synopsis of known mutations causing human cardiomyopathies in nuclear genes encoding contractile proteins, cardiomyocyte structural proteins, and mitochondrial proteins essential for cardiac energy production is provided. The molecular genetic evidence implicating single gene mutations in the pathogenesis of conotruncal anomalies (the 22q11 monosomy or "cardiac defects, abnormal facies, thymic hypoplasia, cleft palate, and hypocalcemia with deletions on chromosome 22" [CATCH-22] syndrome), heterotaxy syndromes, trisomies and atrioventricular canal defects, and secundum atrial septal defects is presented. The consequences of these genetic causes for diagnostic evaluation and perioperative care are emphasized. Single gene defects are a common cause of congenital cardiac disease. Copyright 1998 by W.B. Saunders Company
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Affiliation(s)
- Arnold W. Strauss
- Department of Pediatrics, St Louis Children's Hospital, St Louis, MO
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Momma K, Takao A, Matsuoka R, Imai Y, Muto A, Osawa M, Takayama M. Tetralogy of Fallot associated with chromosome 22q11.2 deletion in adolescents and young adults. Genet Med 2001; 3:56-60. [PMID: 11339379 DOI: 10.1097/00125817-200101000-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To clarify the clinical profiles of adolescents and young adults with tetralogy and 22q11.2 deletion, which has recently been identified as a cause of tetralogy of Fallot in about 15% of patients. METHODS Thirty-four patients with 22q11.2 deletion and tetralogy of Fallot, with or without pulmonary atresia, including 15 males and 19 females, with their age ranging from 16 to 35 years (mean = 25) were studied. Main outcome measurements include chromosome deletion identified by fluorescence in situ hybridization (FISH) of peripheral blood lymphocytes, medical states assessed with New York Heart Association classification, social activity assessed with Warnes index, IQ assessed by Wechsler test. RESULTS Eighteen of 20 patients with tetralogy and pulmonary stenosis had cardiac repair, and their cardiac conditions were good except one. Of 14 patients with tetralogy with pulmonary atresia, 7 had Rastelli type cardiac repair and were doing well, although 4 of them needed re-operation for conduit stenosis. No cardiac repair was done in the other 7 patients with tetralogy, pulmonary atresia and major collateral arteries because their peripheral pulmonary arteries were too small. In 28 of the 34 patients (82%), overall social activity was limited because of extracardiac diseases, including deafness, club feet, mental retardation, and schizophrenia. The IQ in 17 patients was 59 +/- 13 (mean +/- SD): range 41 to 79. In two patients, repeated IQ study showed a decrease. Four patients developed schizophrenia. CONCLUSION Tetralogy with 22q11 deletion can be repaired surgically except in those patients with pulmonary atresia, major collateral arteries, and small peripheral pulmonary arteries. However, most of the adult patients show an inability to function in social life in contrast to most patients with tetralogy but without the deletion, who have a normal social life. Extracardiac diseases, including deafness, club feet, mental retardation, and schizophrenia were major handicaps limiting full social activities in postoperative adolescents and young adults with 22q11.2 deletion and tetralogy.
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Affiliation(s)
- K Momma
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Japan
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42
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Marino B, Digilio MC, Toscano A, Anaclerio S, Giannotti A, Feltri C, de Ioris MA, Angioni A, Dallapiccola B. Anatomic patterns of conotruncal defects associated with deletion 22q11. Genet Med 2001; 3:45-8. [PMID: 11339377 DOI: 10.1097/00125817-200101000-00010] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Patients with cardiovascular malformations (CVMs) and deletion 22q11 from our series were studied in order to (1) analyze the association with dysmorphic features and noncardiac anomalies, (2) identify specific cardiac patterns and the distinctive association with additional CVMs. METHODS From 1993 to 2000, 931 patients with CVM (95 with a clinical diagnosis of DiGeorge/velocardiofacial syndrome (DG/VCFS), 208 with different genetic syndromes, 628 without dysmorphic features) underwent accurate cardiac assessment, clinical and phenotypical examination, and screening for deletion 22q11 by fluorescence in situ hybridization (FISH). RESULTS Deletion 22q11 was detected in 88 of the total patients, and in 87 of the 95 patients with a clinical diagnosis of DG/VCFS. Only one patient among the 628 without dysmorphic features had deletion 22q11. Conotruncal heart defects were the most common CVMs, often presenting in association with additional anomalies in four areas of the cardiovascular system: (1) the aortic arch can be right sided, cervical, double, and the subclavian artery can be aberrant, (2) the pulmonary arteries can present discontinuity, diffuse hypoplasia, discrete stenosis, defect of arborization and major aortopulmonary collateral arteries (MAPCA), (3) the infundibular septum can be malaligned, hypoplastic, or absent, (4) the semilunar valves can be bicuspid, severely dysplastic, insufficient, or stenotic. CONCLUSION In subjects with deletion 22q11 CVM is virtually always associated with one or more noncardiac anomalies. Deletion 22q11 is exceptionally rare in children with nonsyndromic CVMs. Specific patterns of CVMs are observed in patients with deletion 22q11, including (1) anomalies of the aortic arch, (2) anomalies of the pulmonary arteries and of the pulmonary blood supply, (3) defects of the infundibular septum, (4) malformations of the semilunar valves. These additional CVMs may influence the surgical treatment of these patients.
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MESH Headings
- Abnormalities, Multiple/genetics
- Adolescent
- Aorta, Thoracic/abnormalities
- Child
- Child, Preschool
- Chromosome Deletion
- Chromosomes, Human, Pair 22
- DiGeorge Syndrome/diagnosis
- DiGeorge Syndrome/genetics
- Female
- Genotype
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Infant
- Infant, Newborn
- Male
- Phenotype
- Pulmonary Atresia/diagnosis
- Pulmonary Atresia/genetics
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/genetics
- Truncus Arteriosus/abnormalities
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Affiliation(s)
- B Marino
- Department of Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy
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Hokanson JS, Pierpont E, Hirsch B, Moller JH. 22q11.2 microdeletions in adults with familial tetralogy of Fallot. Genet Med 2001; 3:61-4. [PMID: 11339381 DOI: 10.1097/00125817-200101000-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the incidence of 22q11.2 microdeletions in the adult survivors of correction of tetralogy of Fallot who have familial congenital heart disease. METHODS Patients who had survived a correction of tetralogy of Fallot between 1954 and 1974 and had affected family members were identified during a study of these long-term survivors. Fluorescence in situ hybridization analysis was performed using both the N 25 (Oncor) and TUPLE1(VYSIS) probes, mapped to 22q11.2. RESULTS One of 18 (5.6%) patients had a microdeletion within 22q11.2, including both N25 and TUPLE1. CONCLUSION 22q11.2 microdeletions involving TUPLE1 and/or N25 are present in a minority of adults with familial tetralogy of Fallot.
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Affiliation(s)
- J S Hokanson
- Children's Hospital of Illinois and University of Illinois College of Medicine at Peoria, USA
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McElhinney DB, Hanley FL, Stanger P. Familial absent pulmonary valve syndrome without deletions of chromosome 22q11. Cardiol Young 2000; 10:618-20. [PMID: 11117395 DOI: 10.1017/s1047951100008908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deletions of chromosome 22q11 are common in patients with tetralogy of Fallot, and in those with absent pulmonary valve syndrome. In this report, we describe a pair of siblings with absent pulmonary valve syndrome, neither of whom had deletions of chromosome 22q11. The finding of familial absent pulmonary valve syndrome without deletion of 22q11 in our patients suggests an alternative genetic basis for this rare condition.
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Affiliation(s)
- D B McElhinney
- Division of Cardiothoracic Surgery, University of California, San Francisco, USA
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45
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Lofland GK. The management of pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries by definitive single stage repair in early infancy. Eur J Cardiothorac Surg 2000; 18:480-6. [PMID: 11024388 DOI: 10.1016/s1010-7940(00)00547-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The management of infants and children with pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries (PA/VSD/MAPCA) has proven to be challenging. Therapeutic approaches have included staged unifocalization, shunting, coiling of collateral vessels, and heart/lung transplantation. Results have been variable and frustrating. Hoping to take advantage of growth potential in pulmonary segments supplied by MAPCA, a more radical approach was adopted in March of 1997. This consists of single stage complete unifocalization with closure of the ventricular septal defect and establishment of right ventricular to pulmonary arterial continuity with a cryopreserved pulmonary allograft (Rastelli type correction) through a midline sternal incision. METHODS During an 18-month period, eleven consecutive infants with PA/VSD/MAPCA underwent complete surgical correction. The ages ranged from 5 days to 5 months. Weights ranged from 2.2 to 5.6 kg. Through a standard median sternotomy incision, the pericardium and both pleural spaces were opened. Normothermic cardiopulmonary bypass was instituted. Section of all collaterals was accomplished without hypoxemia, and all collaterals were ligated at their origin from the aorta. They were then brought through posterior mediastinum to construct a pulmonary artery confluence. The ventricular septal defect was closed, and continuity was established between the right ventricle and the newly created pulmonary artery confluence with cryopreserved allografts. RESULTS Ten of 11 patients survived operation, with postoperative courses that were uncomplicated. Length of stay ranged from 7-16 days, with a median length of stay of 11 days. One perioperative death occurred in a patient with preoperative co-morbidities of necrotizing enterocolitis, with no functioning gastrointestinal tract, intraventricular hemorrhage, and ventilator dependency since birth. At angiography, this patient has no demonstrable central pulmonary arteries and multiple diminutive aorta pulmonary collaterals. Autopsy revealed no demonstrable pulmonary arteries within the pulmonary parenchyma. All patients have been followed closely, and have grown normally. Two patients undergone repeat cardiac catheterization because of the echocardiographic demonstration of right ventricle pressures that had exceeded 50% of systemic. Both patients were treated with balloon angioplasty and one of these patients has had stenting of stenotic pulmonary arterial segments. No other patients have required additional hospitalization. Right ventricular pressures have remained less than fifty percent of systemic by echocardiographic assessment in all other patients. CONCLUSIONS We feel that a single stage correction of pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries can be accomplished in early infancy with acceptable morbidity and mortality. The initiation of normothermic cardio-pulmonary bypass greatly facilitates dissection of collaterals and prevents hypoxemia. Interventional cardiology with balloon angioplasty and stenting of abnormal pulmonary arterial segments is both an important essential adjunct in the management of these patients. We remain optimistic that a single stage approach to this complex lesion coupled with cardiac catheterization, balloon angioplasty, and stenting, will provide long-term results superior to staged approaches.
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Affiliation(s)
- G K Lofland
- The Children's Mercy Hospital, University of Missouri Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
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Alizad A, Seward JB. Echocardiographic features of genetic diseases: part 7. Complex genetic disorders. J Am Soc Echocardiogr 2000; 13:707-14. [PMID: 10887360 DOI: 10.1067/mje.2000.102341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Alizad
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Abstract
Two patients with chromosome 22q11 deletion and cortical dysgenesis (gyral abnormalities) are reported in this study. One had unilateral clubfoot in addition to multiple features suggestive of the Di George syndrome (DGS), and the other presented with leg asymmetry and seizures, with subsequent recognition of the velo-cardio-facial syndrome (VCFS). In each patient, gyral abnormalities were identified in the hemisphere contralateral to the limb abnormality. A wide range of central nervous system abnormalities have been reported in DGS and VCFS, including three prior reports of gyral abnormalities (lissencephaly, microgyria). The 2 patients reported herein strengthen the association between the 22q11 deletion spectrum and cortical dysgenesis, but the underlying pathogenetic mechanism (primary neural migration vs. vascular disruption) remains unclear.
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Affiliation(s)
- L M Bird
- Children's Hospital and Health Center, Department of Pediatrics, University of California, San Diego 92123, USA.
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Marino B, Digilio MC, Persiani M, Di Donato R, Toscano A, Giannotti A, Dallapiccola B. Deletion 22q11 in patients with interrupted aortic arch. Am J Cardiol 1999; 84:360-1, A9. [PMID: 10496456 DOI: 10.1016/s0002-9149(99)00297-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In our series of 27 children with various types of interruption of the aortic arch (IAA), deletion 22q11 is prevalent in patients with simple IAA type B, and is absent in patients with IAA type A and in those with associated additional major cardiac defects. Anomalies of the infundibular septum should be considered a characteristic aspect of children with IAA and deletion 22q11.
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Affiliation(s)
- B Marino
- Department of Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy
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Momma K. Right aortic arch with coarctation proximal to the right subclavian artery and Kommerell's diverticulum. Cardiol Young 1998; 8:413-4. [PMID: 9731662 DOI: 10.1017/s1047951100006983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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