Electrocardiogram and vectorcardiogram in Turner phenotype with normal chromosomes and pulmonary stenosis

Unusual combination of congenital heart lesions in a child with Noonan's syndrome

Congenital heart disease occurs in about 50% of patients with Noonan's syndrome. We report the unusual association of stenotic dysplastic pulmonary valve, peripheral pulmonary stenosis, right aortic arch, aberrant left subclavian artery, and complex aortic coarctation in a 9-year-old boy with Noonan's syndrome.

A comprehensive scoring system for evaluating Noonan syndrome

A multidisciplinary team assessed 23 patients with various manifestations of the Noonan syndrome, including pulmonary valve stenosis (with leaflet dysplasia), "typical" facial appearance (including hypertelorism, epicanthic folds, flat nasal bridge, and apparently low-set ears), short stature, and mental retardation. Seven patients had a family history of the syndrome. A comprehensive scoring system was devised on the basis of frequency and severity of manifestations and results of invasive and noninvasive tests in these patients and those reported in the literature. The scoring system was condensed into a score card for clinical use and validated by "blind" application to patients with isolated pulmonary valve stenosis or suspected Noonan syndrome. Use of a scoring system to diagnose a syndrome for which there is no specific diagnostic test facilitates accuracy and decreases observer bias. In the case of unusual congenital disorders it is particularly valuable for a pediatrician in general practice.

Asymmetric septal hypertrophy and propranolol treatment in a case of Ullrich-Noonan syndrome

A 4-year-old boy with the Ullrich-Noonan syndrome is described. Asymmetric septal hypertrophy was diagnosed by echocardiography and confirmed at cardiac catheterisation. The aortic subvalvar gradient was reduced from 56 mmHg to 10 mmHg with intravenous propranolol. Relatives of patients with the syndrome should be screened by echocardiography in the hope that the early detection of asymmetric septal hypertrophy and its treatment with propranolol may reduce the likelihood of sudden death.

Genetics of patent ductus arteriosus

A genetic study of 119 correlative cases of patent ductus arteriosus has been performed. The isolated cases showed female predominance, but there was a three times higher risk for the sibs of male cases, suggesting a multifactorial causative mechanism. Dermatoglyphs presented an excess of arches in male, and a tendency to distal axial triradius in female. There were 15 cases belonging to polymalformative syndromes, such as mongolism, Turner, Noonan, Holt-Oram, Lewis and rubella embryopathy.