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Oehlman LB, Opotowsky AR, Weaver KN, Brown NM, Barnett CL, Miller EM, He H, Shikany AR. Current approach to genetic testing and genetic evaluation referrals for adults with congenital heart disease. Front Genet 2024; 15:1398887. [PMID: 38803543 PMCID: PMC11128592 DOI: 10.3389/fgene.2024.1398887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Congenital heart disease (CHD) is the most common congenital anomaly. Up to 33% have an identifiable genetic etiology. Improved medical and surgical management of CHD has translated into longer life expectancy and a rapidly growing population of adults living with CHD. The adult CHD (ACHD) population did not have access during childhood to the genetic technologies available today and therefore have not had a robust genetic evaluation that is currently recommended for infants with CHD. Given this potential benefit; the aims of this study were to determine how ACHD cardiologists offer genetics services to patients and identify the indications that influence decision-making for genetics care. Methods We performed a descriptive cross-sectional study of ACHD cardiologists. A study-developed questionnaire was distributed via emailed REDCap link. The recruitment email was sent to 104 potential respondents. The survey was open from 06/2022 to 01/2023. Results Thirty-five cardiologists participated in the study (response rate of 34%). Most cardiologists identified as white (77%) and male (66%). Cardiologists were more likely to refer patients to genetics (91%) than to order testing themselves (57%). Of the testing ordered, chromosomal testing (55%) was ordered more than gene sequencing (14%). Most cardiologists would refer a patient with a conotruncal lesion (interrupted aortic arch) over other indications for a genetics evaluation. There were more reported barriers to ordering genetic testing (66%) compared to referring to genetics for a genetics evaluation (23%). Cardiologists were more confident recognizing features suggestive of a genetic syndrome than ordering the correct test (p = 0.001). Regarding associations between clinical factors and current practices, more years in practice trended towards less referrals and testing. Evaluating a greater number of patients (p = 0.11) and greater confidence recognizing syndromic features (p = 0.12) and ordering the correct test (p = 0.09) were all associated with ordering more testing. Conclusion Testing for microdeletion syndromes is being offered and completed in the ACHD population, however testing for single-gene disorders associated with CHD is being under-utilized. Developing guidelines for genetic testing in adults with CHD could increase access to genetic services, impact medical management, reduce uncertainty regarding prognosis, and inform recurrence risk estimates.
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Affiliation(s)
- Laura B. Oehlman
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Alexander R. Opotowsky
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Kathryn N. Weaver
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nicole M. Brown
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Cara L. Barnett
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Erin M. Miller
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Hua He
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Amy R. Shikany
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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2
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Pidaparti M, Geddes GC, Durbin MD. Clinical Genetic and Genomic Testing in Congenital Heart Disease and Cardiomyopathy. J Clin Med 2024; 13:2544. [PMID: 38731073 PMCID: PMC11084871 DOI: 10.3390/jcm13092544] [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: 04/08/2024] [Revised: 04/20/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Congenital heart disease (CHD) and cardiomyopathies are the leading cause of morbidity and mortality worldwide. These conditions are often caused by genetic factors, and recent research has shown that genetic and genomic testing can provide valuable information for patient care. By identifying genetic causes, healthcare providers can screen for other related health conditions, offer early interventions, estimate prognosis, select appropriate treatments, and assess the risk for family members. Genetic and genomic testing is now the standard of care in patients with CHD and cardiomyopathy. However, rapid advances in technology and greater availability of testing options have led to changes in recommendations for the most appropriate testing method. Several recent studies have investigated the utility of genetic testing in this changing landscape. This review summarizes the literature surrounding the clinical utility of genetic evaluation in patients with CHD and cardiomyopathy.
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Affiliation(s)
- Mahati Pidaparti
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Gabrielle C. Geddes
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Matthew D. Durbin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Herman B Wells Center for Pediatric Research, 1044 W. Walnut, Indianapolis, IN 46202, USA
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3
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Ashiq S, Hyder SN, Ashiq K, Sabar MF. Role of Vascular Endothelial Growth Factor as a Potential Biomarker in Congenital Heart Defects: A Systematic Review. J Tehran Heart Cent 2023; 18:237-243. [PMID: 38680637 PMCID: PMC11053233 DOI: 10.18502/jthc.v18i4.14822] [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: 02/25/2023] [Accepted: 06/24/2023] [Indexed: 05/01/2024] Open
Abstract
Background Several studies have investigated the role of vascular endothelial growth factor (VEGF) variants, serum levels, and correlations with other extrinsic factors in congenital heart defects (CHDs); however, the findings need confirmation. The present systematic review evaluates the association between CHDs and genetic polymorphisms and serum expressions. Methods Relevant literature was searched through electronic databases using keywords and MeSH terms. VEGF activity was comparatively assessed between cyanotic and acyanotic CHDs, and the association between different polymorphisms and heart defects was evaluated. Results We ultimately evaluated 12 studies regarding the association between VEGF serum patterns and found that serum VEGF levels were upregulated or downregulated in correlation with hypoxia and hemoglobin levels and were significantly associated with cyanotic CHDs compared with acyanotic CHDs. Our results also showed a significant role for different single-nucleotide polymorphisms, including rs699947, rs2010963, and rs3025039. Conclusion The findings of the current study suggested a significant association between CHDs and VEGF genetic polymorphisms or varied serum levels. Nevertheless, more comprehensive studies may provide conclusive results and valuable insights into the pathogenesis of CHDs and relevant treatment strategies.
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Affiliation(s)
- Sana Ashiq
- Center for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Syed Najam Hyder
- Department of Pediatric Cardiology, University of Child Health Sciences, The Children’s Hospital, Lahore, Pakistan
| | - Kanwal Ashiq
- Faculty of Pharmaceutical Sciences, Superior University, Lahore, Pakistan
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4
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Meyers B, Lee VK, Dennis L, Wallace J, Schmithorst V, Votava-Smith JK, Rajagopalan V, Herrup E, Baust T, Tran NN, Hunter J, Licht DJ, Gaynor JW, Andropoulos DB, Panigrahy A, Ceschin R. Harmonization of Multi-Center Diffusion Tensor Tractography in Neonates with Congenital Heart Disease: Optimizing Post-Processing and Application of ComBat. NEUROIMAGE. REPORTS 2022; 2:100114. [PMID: 36258783 PMCID: PMC9575513 DOI: 10.1016/j.ynirp.2022.100114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advanced brain imaging of neonatal macrostructure and microstructure, which has prognosticating importance, is more frequently being incorporated into multi-center trials of neonatal neuroprotection. Multicenter neuroimaging studies, designed to overcome small sample sized clinical cohorts, are essential but lead to increased technical variability. Few harmonization techniques have been developed for neonatal brain microstructural (diffusion tensor) analysis. The work presented here aims to remedy two common problems that exist with the current state of the art approaches: 1) variance in scanner and protocol in data collection can limit the researcher's ability to harmonize data acquired under different conditions or using different clinical populations. 2) The general lack of objective guidelines for dealing with anatomically abnormal anatomy and pathology. Often, subjects are excluded due to subjective criteria, or due to pathology that could be informative to the final analysis, leading to the loss of reproducibility and statistical power. This proves to be a barrier in the analysis of large multi-center studies and is a particularly salient problem given the relative scarcity of neonatal imaging data. We provide an objective, data-driven, and semi-automated neonatal processing pipeline designed to harmonize compartmentalized variant data acquired under different parameters. This is done by first implementing a search space reduction step of extracting the along-tract diffusivity values along each tract of interest, rather than performing whole-brain harmonization. This is followed by a data-driven outlier detection step, with the purpose of removing unwanted noise and outliers from the final harmonization. We then use an empirical Bayes harmonization algorithm performed at the along-tract level, with the output being a lower dimensional space but still spatially informative. After applying our pipeline to this large multi-site dataset of neonates and infants with congenital heart disease (n= 398 subjects recruited across 4 centers, with a total of n=763 MRI pre-operative/post-operative time points), we show that infants with single ventricle cardiac physiology demonstrate greater white matter microstructural alterations compared to infants with bi-ventricular heart disease, supporting what has previously been shown in literature. Our method is an open-source pipeline for delineating white matter tracts in subject space but provides the necessary modular components for performing atlas space analysis. As such, we validate and introduce Diffusion Imaging of Neonates by Group Organization (DINGO), a high-level, semi-automated framework that can facilitate harmonization of subject-space tractography generated from diffusion tensor imaging acquired across varying scanners, institutions, and clinical populations. Datasets acquired using varying protocols or cohorts are compartmentalized into subsets, where a cohort-specific template is generated, allowing for the propagation of the tractography mask set with higher spatial specificity. Taken together, this pipeline can reduce multi-scanner technical variability which can confound important biological variability in relation to neonatal brain microstructure.
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Affiliation(s)
- Benjamin Meyers
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Vincent K. Lee
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lauren Dennis
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julia Wallace
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Vanessa Schmithorst
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jodie K. Votava-Smith
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Vidya Rajagopalan
- Department of Radiology, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California Los Angeles, CA
| | - Elizabeth Herrup
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Tracy Baust
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nhu N. Tran
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Los Angeles and Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Jill Hunter
- Department of Radiology, Texas Children’s Hospital, Houston, TX
| | - Daniel J. Licht
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J. William Gaynor
- Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rafael Ceschin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA
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5
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Clinical, demographic and genetic features of patients with congenital heart disease : A single center experience. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1120570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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6
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Wang M, Tian Y, Yu P, Li N, Deng Y, Li L, Kang H, Chen D, Wang H, Liu Z, Liang J. Association between congenital heart defects and maternal manganese and iron concentrations: a case-control study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:26950-26959. [PMID: 34865185 PMCID: PMC8989826 DOI: 10.1007/s11356-021-17054-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/11/2021] [Indexed: 05/10/2023]
Abstract
To investigate the correlation between maternal manganese and iron concentrations and the risk of CHD among their infant. A multi-center hospital-based case control study was conducted in China. There were 322 cases and 333 controls have been selected from pregnant women who received prenatal examinations. Correlations between CHDs and maternal manganese and iron concentrations were estimated by conditional logistic regression. Moreover, the interaction between manganese and iron on CHDs was analyzed. Compared with the controls, mothers whose hair manganese concentration was 3.01 μg/g or more were more likely to have a child with CHD than those with a lower concentration. The adjusted OR was 2.68 (95%CI = 1.44-4.99). The results suggested that mothers whose iron content was 52.95 μg/g or more had a significantly higher risk of having a child with CHD (aOR = 2.87, 95%CI = 1.54-5.37). No interaction between maternal manganese and iron concentrations was observed in the multiplicative or additive model. The concurrently existing high concentration of manganese and iron may bring higher risk of CHD (OR = 7.02). Women with excessive manganese concentrations have a significantly increased risk of having offspring with CHDs. The high maternal iron status also correlates with CHDs. The concurrently existing high concentration of manganese and iron may bring higher risk of CHD.
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Affiliation(s)
- Meixian Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Tian
- Liupanshui Maternal and Child Health Care Hospital, Liupanshui Children's Hospital, Liupanshui, Guizhou, China
| | - Ping Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Nana Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying Deng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lu Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hong Kang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dapeng Chen
- Chenghua District Maternal and Child Health Hospital of Chengdu, Chengdu, Sichuan, China
| | - Hui Wang
- Mianyang Maternal and Child Health Care Hospital, Mianyang, Sichuan, China
| | - Zhen Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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7
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Salzer-Sheelo L, Polak U, Barg A, Kahana S, Yacobson S, Agmon-Fishman I, Klein C, Matar R, Rurman-Shahar N, Sagi-Dain L, Basel-Salmon L, Maya I, Sukenik-Halevy R. Prenatal and postnatal chromosomal microarray analysis in 885 cases of various congenital heart defects. Arch Gynecol Obstet 2022; 306:1007-1013. [PMID: 35083553 DOI: 10.1007/s00404-021-06366-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to evaluate the prevalence of clinically significant (pathogenic and likely pathogenic) variants detected by chromosomal microarray (CMA) tests performed for prenatally and postnatally detected congenital heart defects. METHODS A retrospective evaluation of CMA analyses over a period of four years in a single tertiary medical center was performed. Detection rate of clinically significant variants was calculated in the whole cohort, prenatal vs. postnatal cases, and isolated vs. non-isolated CHD. This rate was compared to previously published control cohorts, and to a theoretical detection rate of noninvasive prenatal testing (NIPS; 5 chromosomes). RESULTS Of the 885 cases of CHD, 111 (12.5%) clinically significant variants were detected, with no significant difference between the 498 prenatal and the 387 postnatal cases (10.8% vs. 14.7%, p = 0.08). In both groups, the detection rate was significantly higher for non-isolated vs. isolated CHD (76/339 = 22.4% vs. 35/546 = 6.4%, respectively, p < 0.05). The detection rate was higher than the background risk in both groups, including cases of postnatal isolated CHD. 44% of abnormal findings in the prenatal setting would be detectable by NIPS. CONCLUSION CMA should be performed for both prenatally and postnatally detected CHD, including postnatal cases of isolated CHD, while NIPS can be considered in specific scenarios.
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Affiliation(s)
- Liat Salzer-Sheelo
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Uri Polak
- Pediatric Cardiac Critical Care Unit, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.,Pediatric Cardiology, Hadassah University Medical Center, Ein Kerem, Jerusalem, Israel.,The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | | | - Sarit Kahana
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Shiri Yacobson
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Ifaat Agmon-Fishman
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Cochava Klein
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Reut Matar
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Noa Rurman-Shahar
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated To the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lina Basel-Salmon
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel.,Pediatric Genetics Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Idit Maya
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Sukenik-Halevy
- The Raphael Recanati Genetic Institute, Rabin Medical Center, 49100, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Nagata H, Yamamura K, Matsuoka R, Kato K, Ohga S. Transition in cardiology 2: Maternal and fetal congenital heart disease. Pediatr Int 2022; 64:e15098. [PMID: 35507001 DOI: 10.1111/ped.15098] [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: 04/28/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
The number of women with congenital heart disease (CHD) reaching reproductive age has been increasing. Many women with CHDs are desirous of pregnancy, but they face issues regarding preconception, antepartum, and postpartum management. On the other hand, the fetal diagnosis of CHD has improved with advances in the technique and equipment for fetal echocardiography. Recently, experiences with fetal intervention have been reported in patients with severe CHD, such as critical aortic stenosis. Nevertheless, some types of CHD are challenge to diagnose prenatally, resulting in adverse outcomes. Medical care is part of the transitional care for women and fetuses with CHD during the perinatal period. Pre-conceptional and prenatal counseling play an important role in transitional care. Sex and reproductive education need to be performed as early as possible. We herein review the current status, important issues to be resolved, and the future of maternal and fetal CHD to relevant caregivers.
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Affiliation(s)
- Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryohei Matsuoka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Miletic A, Stojanovic JR, Parezanovic V, Rsovac S, Drakulic D, Soldatovic I, Mijovic M, Bosankic B, Petrovic H, Borlja N, Milivojevic M, Marjanovic A, Brankovic M, Cuturilo G. Genetic evaluation of newborns with critical congenital heart defects admitted to the intensive care unit. Eur J Pediatr 2021; 180:3219-3227. [PMID: 33963417 DOI: 10.1007/s00431-021-04097-w] [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] [Received: 03/18/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Rapid and efficient diagnostics is crucial for newborns with congenital heart defects (CHD) in intensive care unit (ICU) but is often challenging. Given that genetic factors play a role in 20-30% cases of CHD, it is likely that genetic tests could improve both its speed and efficiency. We aimed to analyze the utility of rapid and cost-effective multiplex ligation dependent probe amplification analysis (MLPA) for chromosomal analysis in newborns with critical CHD. One hundred consecutive newborns admitted with critical CHD to the ICU were included in the study. Those with normal MLPA findings were further tested by chromosomal microarray and clinical exome sequencing. Overall, pathogenic/likely pathogenic variants were determined in ten (10%) newborns by MLPA, three (3%) by chromosomal microarray, and three (3%) by clinical exome sequencing. The most common variant detected was deletion of 22q11.2 region.Conclusion: MLPA is fast and cost-effective analysis that could be used as the first-tier test in newborns with critical CHD admitted to the ICU. What is Known: • MLPA is an established method for chromosome analysis in patients with CHD, but detection rate in newborns with critical CHD is unknown. What is New: • Study suggests that detection rate of casual variants using MLPA in newborns with critical CHD is 10%.
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Affiliation(s)
- Aleksandra Miletic
- Department of Clinical Genetics, University Children's Hospital, Belgrade, Serbia
| | | | - Vojislav Parezanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, University Children's Hospital, Belgrade, Serbia
| | - Snezana Rsovac
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital, Belgrade, Serbia
| | - Danijela Drakulic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Mijovic
- Department of Clinical Genetics, University Children's Hospital, Belgrade, Serbia
| | - Brankica Bosankic
- Department of Clinical Genetics, University Children's Hospital, Belgrade, Serbia
| | - Hristina Petrovic
- Department of Clinical Genetics, University Children's Hospital, Belgrade, Serbia
| | | | - Milena Milivojevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Ana Marjanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Goran Cuturilo
- Department of Clinical Genetics, University Children's Hospital, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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10
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Balasubramanian R, Vuppalapati S, Avanthika C, Jhaveri S, Peddi NC, Ahmed S, Reddy A, Kaur J. Epidemiology, Genetics and Epigenetics of Congenital Heart Diseases in Twins. Cureus 2021; 13:e17253. [PMID: 34540478 PMCID: PMC8448266 DOI: 10.7759/cureus.17253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
Congenital heart defects (CHDs) refer to abnormalities in the heart function that arise at the fetal stages. It is the most common birth defect that affects 0.8% of all liveborn infants. There is an increase in the incidence of congenital heart disease in monochorionic twin gestation. A six-fold increase in CHDs exists among monochorionic twins especially in association with twin-twin transfusion syndrome (TTTS) compared to dichorionic twin pregnancy. In this review article, we discussed the epidemiology, the role of genetics like protein-coding genes, epigenetics, placenta, hemodynamics and environmental factors in the etiology of CHD in twins. We conducted a literature search in PubMed indexed journals using the medical terms "twin pregnancy" and "congenital heart defect" to provide an overview of the uptrend in CHD in twin pregnancies, primarily due to assisted reproductive technologies (ARTs) and multiple other factors. Both the heart and placenta are vascular and share a common development window; therefore, CHD can develop secondary to placental pathologies. Among environmental factors, the strongest association of maternal smoking with CHD has been seen. We studied the causative factors to suggest improvement in echocardiographic skills in case of abnormal findings in twin gestations to decrease the CHD-associated morbidity and mortality, as early diagnosis allows doctors to precisely determine the risk of CHD. Systemic ultrasound scanning with five transverse views is very effective in diagnosing fetal CHD in twin pregnancy. In the case of genetics, prenatal counseling allows the expectant to understand the full ramifications of possible events after the pregnancy. The pathological basis of malformations specific to conjoined twinning and twin reversed arterial perfusion sequence is addressed. Also, there is evidence that folate supplementation may be protective against CHD but more research is needed to clarify the mechanisms. We concluded from the literature that monochorionic twins are at high risk of CHD. Chorionicity seems to play a more vital role than zygosity. Even the type of heart defect in monochorial twin pregnancies was unique from single, dizygotic, or dichorionic twin pregnancies. We also emphasize improving echocardiographic skills of technicians in referring ART dichorionic twin fetuses with suspicious findings to fetal cardiologists and performing postnatal scans in the case of TTTS. To understand the role of the placenta, making use of newer technologies and examining the placenta both during pregnancy and beyond delivery will play a vital role in understanding the etiology. Even identifying early signals impacting the heart and placental vasculature and correcting them using advanced technology could downtrend the incidence in coming years. Increased maternal age as well as multiple pregnancies increasing the risk of CHD has also been implicated. For more clarity on the role of genetics, the cost of DNA sequencing needs to decrease. This will enable whole-genome sequencing in the future thus helping to discover the gene responsible for CHD ultimately proving beneficial for future generations. For environmental factors, we have to rely on observational studies to assess the risk to the unborn child. There is difficulty in studying natural factors due to the unreliability of exposure to contaminants like pesticides and air pollution.
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Affiliation(s)
| | - Sravya Vuppalapati
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
| | | | - Sharan Jhaveri
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Nikhil Chowdary Peddi
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
| | - Sana Ahmed
- Internal Medicine, Smt. Kashibai Navale Medical College, Pune, IND
| | - Apeksha Reddy
- Pediatrics, People's Education Society Institute of Medical Sciences and Research, Kuppam, IND
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11
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Findley TO, Crain AK, Mahajan S, Deniwar A, Davis J, Solis Zavala AS, Corno AF, Rodriguez-Buritica D. Congenital heart defects and copy number variants associated with neurodevelopmental impairment. Am J Med Genet A 2021; 188:13-23. [PMID: 34472185 DOI: 10.1002/ajmg.a.62484] [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: 02/22/2021] [Revised: 06/02/2021] [Accepted: 08/05/2021] [Indexed: 01/21/2023]
Abstract
A genetic etiology is identifiable in 20%-30% of patients with congenital heart defects (CHD). Chromosomal microarray analysis (CMA) can detect copy number variants (CNV) associated with CHD. In previous studies, the diagnostic yield of postnatal CMA testing ranged from 4% to 28% in CHD patients. However, incidental pathogenic CNV and variants of unknown significance are often discovered without any known association with CHD. The study objective was to describe the rate of pathogenic CNV associated with neurodevelopmental impairment (NDI) and compare clinical findings in CHD neonates with genetic results. A single-center retrospective review was performed on all consecutive newborns with CHD admitted to a tertiary neonatal intensive care unit from January 2013 to March 2019 (n = 525). CHD phenotypes were classified as per the National Birth Defect Prevention Study. CMA detected pathogenic CNV in 21.3% (61/287) of neonates, and karyotype or fluorescence in situ hybridization detected aneuploidies in an additional 11% of the overall cohort (58/525). Atrioventricular septal defects and conotruncal defects showed the highest diagnostic yield by CMA (28.6% and 27.2%, respectively). Among neonates with pathogenic CNV on CMA, 78.7% (48/61) were associated with NDI. Neonates with pathogenic CNV were smaller in length at birth compared to those with benign CNV or variants of unknown significance (p = 0.005) and were more likely to be discharged with an enteral feeding tube (p = 0.027). CMA can discover genetic variants associated with NDI and are common in neonates with CHD. Genetic testing in the neonatal period can heighten awareness of genetic risk for NDI.
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Affiliation(s)
- Tina O Findley
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alyssa K Crain
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Smridhi Mahajan
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ahmed Deniwar
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, USA.,Children's Heart Institute, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jessica Davis
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ana S Solis Zavala
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Antonio F Corno
- Children's Heart Institute, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David Rodriguez-Buritica
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, USA
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12
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Morales-Demori R, Montañes E, Erkonen G, Chance M, Anders M, Denfield S. Epidemiology of Pediatric Heart Failure in the USA-a 15-Year Multi-Institutional Study. Pediatr Cardiol 2021; 42:1297-1307. [PMID: 33871685 DOI: 10.1007/s00246-021-02611-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
The epidemiology of pediatric heart failure (HF) has been characterized for congenital heart disease (CHD) and cardiomyopathies (CM), but the impact of CM associated with CHD has not been studied. This study aims to describe the characteristics and outcomes of inpatient pediatric HF patients with CHD, CM, and CHD with CM (CHD + CM) across the USA. We included all HF patients with CM diagnoses with and without CHD using ICD 9/10 codes ≤ 19 years old from January 2004 to September 2019 using the Pediatric Health Information System database. We identified 67,349 unique patients ≤ 19 years old with HF, of which 87% had CHD, 7% had CHD + CM, and 6% had CM. Pediatric HF admissions increased significantly from 2004 to 2018 with an associated increase in extracorporeal circulatory support (ECLS) use. Heart transplantation (HTX) increased only in the CHD and CHD + CM groups. CHD patients required less ECLS with and without HTX; however, they had significantly higher inpatient mortality after those procedures than the other groups (p < 0.001). CM patients were older (median 115 months) and had the lowest inpatient mortality after HTX with and without ECLS (p < 0.05). CHD + CM showed the highest overall inpatient mortality (15%), and cumulative hospital billed charges (median US$ 541,374), all p < 0.001. Pediatric HF admissions have increased from 2004 to 2018. ECLS use and HTX have expanded in this population, with an associated decrease in inpatient mortality in the CHD and CM groups. CHD + CM patients are a growing population with the highest inpatient mortality.
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Affiliation(s)
- Raysa Morales-Demori
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA.
| | - Elena Montañes
- Department of Pediatrics, Division of Cardiology, Hospital 12 de Octubre, Madrid, Spain
| | - Gwen Erkonen
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA
| | - Michael Chance
- Quality Outcomes & Analytics Specialist, Texas Children's Hospital, Houston, TX, USA
| | - Marc Anders
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA
| | - Susan Denfield
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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13
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A new era of genetic testing in congenital heart disease: A review. Trends Cardiovasc Med 2021; 32:311-319. [PMID: 33964404 DOI: 10.1016/j.tcm.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/07/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022]
Abstract
Genetic and genomic testing in pediatric CHD is becoming increasingly routine, and can have important psychosocial, clinical and reproductive implications. In this paper we highlight important challenges and considerations when providing genetics consults and testing in pediatric CHD and illustrate the role of a dedicated CHD genetics clinic. Key lessons include that a) a genetic diagnosis can have clinical utility that justifies testing early in life, b) adequate genetic counselling is crucial to ensure families are supported, understand the range of possible results, and are prepared for new or unexpected health information, and c) further integration of the clinical genetics and cardiology workflows will be required to effectively manage the burgeoning information arising from genetic testing. Our experience demonstrates that a dedicated CHD genetics clinic is a valuable addition to a multidisciplinary team providing care to children with CHD.
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14
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Kim RW. Is There Any Clinical Utility to Genetic Testing for Patients With Congenital Heart Disease? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:26-29. [PMID: 34116779 DOI: 10.1053/j.pcsu.2021.04.002] [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: 02/25/2021] [Revised: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 11/11/2022]
Abstract
Genetic diagnosis is becoming increasingly sophisticated, with the ability to identify even fine differences in patients with a wide variety of congenital heart lesions. Although we have an incomplete understanding of the clinical consequences of most genetic findings, some categories of mutations can have important implications for disease recurrence and prognosis. Consideration of the biology underlying a genetic deficiency, when known, can be useful in the clinical management of some patients.
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Affiliation(s)
- Richard W Kim
- Pediatric and Congenital Cardiac Surgery, Guerin Congenital Heart Program, Smidt Heart Institute, Cedars- Sinai Medical Center, Los Angeles, California.
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15
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Yalçin SS, Dönmez Y, Aypar E, Yalçin S. Element profiles in blood and teeth samples of children with congenital heart diseases in comparison with healthy ones. J Trace Elem Med Biol 2021; 63:126662. [PMID: 33126039 DOI: 10.1016/j.jtemb.2020.126662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/29/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Some elements were claimed to play a role in the pathogenesis of congenital heart defects (CHD) and influence the general well-being and health of these children. OBJECTIVES We aimed to assess the levels of some elements simultaneously in the blood and teeth samples of children with cyanotic and acyanotic CHD compared with healthy children. METHODS A total of 39 children with CHD (11 with cyanotic and 28 with acyanotic CHD) and 42 age- and sex-adjusted controls were enrolled. Levels of 13 elements, including magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, cadmium, lead, mercury, and molybdenum, were assessed using inductively coupled plasma mass spectrometry. RESULTS Children with cyanotic and acyanotic CHD had significantly lower teeth calcium and calcium/phosphorus ratio as compared to the controls after adjusting for confounders. The mean blood iron level was found to be significantly higher in the cyanotic CHD group compared to the other groups. In addition, children with acyanotic CHD had significantly higher teeth copper levels, higher blood molybdenum and lower blood magnesium levels compared to the healthy control group. Blood cadmium and mercury levels were found to be significantly elevated in both the cyanotic and acyanotic CHD groups compared to the healthy control group. There were no differences in toxic metal levels of teeth in cases with CHD. CONCLUSION Monitoring adequate and balanced gestational micronutrient intake might support not only maternal health but also fetal cardiac development and infant well-being. Supplementation of magnesium should be evaluated in patients having CHD.
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Affiliation(s)
- Sıddıka Songül Yalçin
- Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Yasemin Dönmez
- Unit of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Aypar
- Unit of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Suzan Yalçin
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey
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16
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Abstract
PURPOSE OF REVIEW This article reviews the current understanding and limitations in knowledge of the effect genetics and genetic diagnoses have on perioperative and postoperative surgical outcomes in patients with congenital heart disease (CHD). RECENT FINDINGS Presence of a known genetic diagnosis seems to effect multiple significant outcome metrics in CHD surgery including length of stay, need for extracorporeal membrane oxygenation, mortality, bleeding, and heart failure. Data regarding the effects of genetics in CHD is complicated by lack of standard genetic assessment resulting in inaccurate risk stratification of patients when analyzing data. Only 30% of variation in CHD surgical outcomes are explained by currently measured variables, with 2.5% being attributed to diagnosed genetic disorders, it is thought a significant amount of the remaining outcome variation is because of unmeasured genetic factors. SUMMARY Genetic diagnoses clearly have a significant effect on surgical outcomes in patients with CHD. Our current understanding is limited by lack of consistent genetic evaluation and assessment as well as evolving knowledge and discovery regarding the genetics of CHD. Standardizing genetic assessment of patients with CHD will allow for the best risk stratification and ultimate understanding of these effects.
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17
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Platt J. A Person-Centered Approach to Cardiovascular Genetic Testing. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036624. [PMID: 31570390 DOI: 10.1101/cshperspect.a036624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular genetic counselors provide guidance to people facing the reality or prospect of inherited cardiovascular conditions. Key activities in this role include discussing clinical cardiac screening for at-risk family members and offering genetic testing. Psychological factors often influence whether patients choose to have genetic testing and how they understand and communicate the results to at-risk relatives, so psychological counseling increases the impact of genetic education and medical recommendations. This work reviews the literature on the factors that influence patient decisions about cardiovascular genetic testing and the psychological impact of results on people who opt to test. It also models use of a psychological framework to apply themes from the literature to routine cardiovascular genetic counseling practice. Modifications of the framework are provided to show how it can be adapted to serve the needs of both new and experienced genetic counselors.
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Affiliation(s)
- Julia Platt
- Stanford Center for Inherited Cardiovascular Disease, Falk Cardiovascular Research Center, Stanford, California 94305, USA
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18
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Jerves T, Beaton A, Kruszka P. The genetic workup for structural congenital heart disease. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 184:178-186. [PMID: 31833661 DOI: 10.1002/ajmg.c.31759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022]
Abstract
Congenital heart disease (CHD) is the most prevalent birth defect and is the result of multiple etiologies including genetic and environmental causes. This article reviews the genetic workup for structural CHD in the clinical setting, beginning with CHD epidemiology and etiology and then moving to genetic testing, clinical evaluation, and genetic counseling. An algorithm is presented as a guide to genetic test selection, and available tests are explained with their respective advantages and limitations. Finally, future advances are discussed. As this review focuses on structural heart disease, isolated cardiomyopathies, inherited primary arrhythmia syndromes and aortopathies are not discussed.
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Affiliation(s)
- Teodoro Jerves
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrea Beaton
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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19
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Geddes GC, Syverson E, Earing MG. Three year experience of a clinical cardiovascular genetics program for infants with congenital heart disease. CONGENIT HEART DIS 2019; 14:832-837. [PMID: 31222963 PMCID: PMC6851694 DOI: 10.1111/chd.12817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/17/2019] [Accepted: 06/02/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the first 3 years of experience of having an inpatient "cardiogenetics" program which involves medical geneticist assessment of infants with major congenital heart disease (CHD) requiring surgical intervention in the first year of life. PATIENTS Patients less than a year of age admitted to Children's Hospital of Wisconsin's Herma Heart Institute for surgical intervention for CHD seen by the cardiogenetics program. Patients with major trisomies (13, 18, and 21) were excluded. OUTCOME MEASURES Utilization and yield of genetic testing, and diagnostic rate were assessed as outcome measures and compared to a baseline time period and a genetic testing protocol time period. RESULTS There were 201 infants with CHD evaluated by the cardiogenetics program over 3 years. A total of patients 46 patients of the 196 who underwent genetic testing had multiple tests completed. This is a significant decrease from the baseline (247/329, P < .0001) and from the genetic testing protocol (29/81, P < .0387) time periods. The diagnostic rate was 33% which is significantly increased compared to the baseline rate of 15% (80/524, P < .0001) and trends toward a significant increase during the testing protocol rate (25/113, P = .0520). The number of dual diagnosis increased to 9 of 201 compared to the baseline (2/524) and the genetic testing protocol (1/113) time periods. The rate of incidental diagnoses altering care increased to 6 of 201 from the baseline (1/524) and the genetic testing protocol (1/113) time periods. CONCLUSION An inpatient cardiogenetics program significantly increases the diagnostic rate, the detection of complex phenotypes with dual diagnoses, the identification of incidental genetic diagnoses associated with changes in care, and significantly decreases the likelihood of multiple tests being completed on an individual patient. Increased medical geneticist involvement in programs that care for infants with CHD should be encouraged to improve patient care and genetic testing utilization.
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Affiliation(s)
- Gabrielle C Geddes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Erin Syverson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael G Earing
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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