The Heritable Basis of Congenital Heart Disease: Past, Present, and Future

Statistical models of the genetic etiology of congenital heart disease

Congenital heart disease (CHD) is a collection of anatomically and clinically heterogeneous structure anomalies of heart at birth. Finding genetic causes of CHD can not only shed light on developmental biology of heart, but also provide basis for improving clinical care and interventions. The optimal study design and analytical approaches to identify genetic causes depend on the underlying genetic architecture. A few well-known syndromes with CHD as core conditions, such as Noonan and CHARGE, have known monogenic causes. The genetic causes of most of CHD patients, however, are unknown and likely to be complex. In this review, we highlight recent studies that assume a complex genetic architecture of CHD with two main approaches. One is genomic sequencing studies aiming for identifying rare or de novo risk variants with large genetic effect. The other is genome-wide association studies optimized for common variants with moderate genetic effect.

CHDbase: A comprehensive knowledgebase for congenital heart disease-related genes and clinical manifestations

Congenital heart disease (CHD) is one of themost common causes of major birth defects, with a prevalence of 1%. Although an increasing number of studies reported the etiology of CHD, the findings scattered throughout the literature are difficult to retrieve and utilize in research and clinical practice. We therefore developed CHDbase, an evidence-based knowledgebase of CHD-related genes and clinical manifestations manually curated from 1114 publications, linking 1124susceptibility genes and 3591 variations to more than 300 CHD types and related syndromes. Metadata such as the information of each publication and the selected population and samples, the strategy of studies, and the major findings of studies were integrated with each item of the research record. We also integrated functional annotations through parsing ∼50 databases/tools to facilitate the interpretation of these genes and variations in disease pathogenicity. We further prioritized the significance of these CHD-related genes with a gene interaction network approach and extracted a core CHD sub-network with 163 genes. The clear genetic landscape of CHD enables the phenotype classification based on the shared genetic origin. Overall, CHDbase provides a comprehensive and freely available resource to study CHD susceptibility, supporting a wide range of users in the scientific and medical communities. CHDbase is accessible at http://chddb.fwgenetics.org.

Diagnostic value of echocardiography in fetal cardiac malformation and clinical classification

Diagnostic value of echocardiography in fetal cardiac malformation and clinical classification was investigated. In total, 206 high-risk parturients, who received a screening of prenatal fetal cardiac malformation in Jinan Maternity and Child Care Hospital from January 2015 to June 2017, were retrospectively analyzed, among those parturients, the results of labor induction or newborns of 141 parturients were diagnosed as cardiac malformation, the fetuses of 65 parturients were diagnosed as non-cardiac malformation, the detection of fetal cardiac malformation of all the parturients was carried out by two-dimensional ultrasound and four-dimensional ultrasound during gestation period, presence or absence of congenital cardiac malformation of the fetuses and clinical classification were estimated. The sensitivity of two-dimensional ultrasound diagnosis combined with four-dimensional ultrasound diagnosis was significantly higher than that of two-dimensional ultrasound diagnosis and four-dimensional ultrasound diagnosis (P<0.05). In addition, the sensitivity of four-dimensional ultrasound diagnosis was significantly higher than that of two-dimensional ultrasound diagnosis (P<0.05). The specificity and positive predictive value of four-dimensional ultrasound diagnosis were significantly higher than those of two-dimensional ultrasound diagnosis and two-dimensional ultrasound diagnosis combined with four-dimensional ultrasound diagnosis (P<0.05). The diagnostic coincidence rates of four-dimensional ultrasound diagnosis and two-dimensional ultrasound diagnosis combined with four-dimensional ultrasound diagnosis were significantly higher than that of two-dimensional ultrasound diagnosis (P<0.05). The negative predictive values of the combined ultrasound diagnosis and four-dimensional ultrasound diagnosis were significantly higher than that of two-dimensional ultrasound diagnosis (P<0.05). The diagnostic efficiency of two-dimensional ultrasound combined with four-dimensional ultrasound was good in the diagnosis of fetal cardiac malformation in prenatal period of pregnant women, it could improve detection rate of fetal cardiac malformation and is worthy of being generalized in clinic.