Absent Aortic Valve in DiGeorge Syndrome

DiGeorge syndrome chromosome region deletion and duplication: Prenatal genotype-phenotype variability in fetal ultrasound and MRI

OBJECTIVE

The aim of the study was to assess genotype-phenotype correlation of prenatally diagnosed fetal DGS and dup22q11 syndrome by fetal molecular genetic analysis, fetal ultrasound, and/or MRI.

METHODS

In this retrospective consecutive case series, pregnant women were screened for fetal anomalies during a period of 10 years. Fetal genotype was assessed in 72 cases upon the occurrence of five prenatal fetal phenotypic features: cardiac anomalies, hypo/aplastic thymus, craniofacial malformations, urinary abnormalities, or IUGR; genotype-phenotype correlation was tested to potentially improve prenatal diagnosis of fetal DGS and dup22q11 syndrome.

RESULTS

Fetal genotypes of deletions or duplications in proximal clusters of LCR22s (A-B) were associated with fetal cardiac anomalies in combination with hypo/aplastic thymus and craniofacial malformations, suggesting a correlation with deleted HIRA. TOF associated with aplastic thymus in combination with renal defects indicated a relevant correlation with TBX1 deletion. Deletions in central LCR22s (B-D) with the loss of CRKL supposed a trend of genotype-phenotype correlation with fetal urinary abnormalities.

CONCLUSION

Genotype-phenotype correlation might improve prenatal diagnosis of fetal DGS and dup22q11 syndrome. Hence, prenatal screening and counseling is highly enhanced by a combination of fetal molecular genetic analysis, fetal ultrasound, and/or MRI. The implications of these findings remain to be explored.

Prenatal diagnosis of congenital absence of aortic valve associated with restrictive foramen ovale: Hemodynamic features and clinical outcome

We present the case of a fetus with absent aortic valve (AAV), mitral regurgitation (MR), and restrictive foramen ovale (FO) who survived in utero but died of severe hypoxia after birth. We reported previously two cases of "inverse circulatory shunt" in AAV with MR, that is, blood from the ascending aorta flowing into the left ventricle through aortic regurgitation, to the left atrium due to MR, to the right atrium through FO, to the right ventricle, then to the pulmonary arteries, and to the ascending aorta through the ductus. In the present case, restrictive FO prevented inverse circulatory shunt, but resulted in postnatal death.