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Lupo PJ, Archer NP, Harris RD, Marengo LK, Schraw JM, Hoyt AT, Tanksley S, Lee R, Drummond-Borg M, Freedenberg D, Shetty PB, Agopian AJ, Shumate C, Rasmussen SA, Langlois PH, Canfield MA. Newborn screening analytes and structural birth defects among 27,000 newborns. PLoS One 2024; 19:e0304238. [PMID: 38968308 PMCID: PMC11226011 DOI: 10.1371/journal.pone.0304238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/08/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Emerging evidence suggests newborn screening analytes may yield insights into the etiologies of birth defects, yet no effort has evaluated associations between a range of newborn screening analytes and birth defects. METHODS This population-based study pooled statewide data on birth defects, birth certificates, and newborn screening analytes from Texas occurring between January 1, 2007 and December 31, 2009. Associations between a panel of thirty-six newborn screening analytes, collected by the statewide Texas Newborn Screening Program, and the presence of a birth defect, defined as at least one of 39 birth defects diagnoses recorded by the Texas Birth Defects Registry, were assessed using regression analysis. FINDINGS Of the 27,643 births identified, 20,205 had at least one of the 39 birth defects of interest (cases) as identified by the Texas Birth Defects Registry, while 7,438 did not have a birth defect (controls). Among 1,404 analyte-birth defect associations evaluated, 377 were significant in replication analysis. Analytes most consistently associated with birth defects included the phenylalanine/tyrosine ratio (N = 29 birth defects), tyrosine (N = 28 birth defects), and thyroxine (N = 25 birth defects). Birth defects most frequently associated with a range of analytes included gastroschisis (N = 29 analytes), several cardiovascular defects (N = 26 analytes), and spina bifida (N = 23 analytes). CONCLUSIONS Several significant and novel associations were observed between newborn screening analytes and birth defects. While some findings could be consequences of the defects themselves or to the care provided to infants with these defects, these findings could help to elucidate mechanisms underlying the etiology of some birth defects.
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Affiliation(s)
- Philip J. Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
| | - Natalie P. Archer
- Birth Defects Epidemiology and Surveillance Branch, Environmental Epidemiology and Disease Registries Section, Texas Department of State and Health Services, Austin, Texas
| | - Rachel D. Harris
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
| | - Lisa K. Marengo
- Birth Defects Epidemiology and Surveillance Branch, Environmental Epidemiology and Disease Registries Section, Texas Department of State and Health Services, Austin, Texas
| | - Jeremy M. Schraw
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
| | - Adrienne T. Hoyt
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Susan Tanksley
- Laboratory Services Section, Texas Department of State Health Services, Austin, Texas
| | - Rachel Lee
- Laboratory Services Section, Texas Department of State Health Services, Austin, Texas
| | - Margaret Drummond-Borg
- Birth Defects Epidemiology and Surveillance Branch, Environmental Epidemiology and Disease Registries Section, Texas Department of State and Health Services, Austin, Texas
| | - Debra Freedenberg
- Birth Defects Epidemiology and Surveillance Branch, Environmental Epidemiology and Disease Registries Section, Texas Department of State and Health Services, Austin, Texas
| | - Priya B. Shetty
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston, Texas
| | - A. J. Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Charles Shumate
- Birth Defects Epidemiology and Surveillance Branch, Environmental Epidemiology and Disease Registries Section, Texas Department of State and Health Services, Austin, Texas
| | | | - Peter H. Langlois
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
| | - Mark A. Canfield
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin, Texas
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2
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Zubrzycki M, Schramm R, Costard-Jäckle A, Grohmann J, Gummert JF, Zubrzycka M. Cardiac Development and Factors Influencing the Development of Congenital Heart Defects (CHDs): Part I. Int J Mol Sci 2024; 25:7117. [PMID: 39000221 PMCID: PMC11241401 DOI: 10.3390/ijms25137117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
The traditional description of cardiac development involves progression from a cardiac crescent to a linear heart tube, which in the phase of transformation into a mature heart forms a cardiac loop and is divided with the septa into individual cavities. Cardiac morphogenesis involves numerous types of cells originating outside the initial cardiac crescent, including neural crest cells, cells of the second heart field origin, and epicardial progenitor cells. The development of the fetal heart and circulatory system is subject to regulatation by both genetic and environmental processes. The etiology for cases with congenital heart defects (CHDs) is largely unknown, but several genetic anomalies, some maternal illnesses, and prenatal exposures to specific therapeutic and non-therapeutic drugs are generally accepted as risk factors. New techniques for studying heart development have revealed many aspects of cardiac morphogenesis that are important in the development of CHDs, in particular transposition of the great arteries.
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Affiliation(s)
- Marek Zubrzycki
- Department of Surgery for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany;
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Angelika Costard-Jäckle
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Jochen Grohmann
- Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany;
| | - Jan F. Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (R.S.); (A.C.-J.); (J.F.G.)
| | - Maria Zubrzycka
- Department of Clinical Physiology, Faculty of Medicine, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland
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3
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Guo J, Ling W, Dang T, Guo S, Ma H, Huang Q, Zeng L, Weng Z, Wu Q. Prenatal transposition of great arteries diagnosis and management: a Chinese single-center study. Front Cardiovasc Med 2024; 11:1341005. [PMID: 38510199 PMCID: PMC10951393 DOI: 10.3389/fcvm.2024.1341005] [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: 11/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Objective This study aimed to assess the diagnostic value of prenatal echocardiography for identifying transposition of the great arteries (TGA) during pregnancy and evaluating the associated outcomes. Methods We conducted a retrospective analysis of 121 prenatally diagnosed patients with TGA at our hospital between January 2012 and September 2022. This analysis included prenatal ultrasound, prenatal screening, clinical management and follow-up procedures. Results Among the 103 fetuses considered in the study, 90 (87.4%) were diagnosed with complete transposition of the great arteries (D-TGA), while 13 (12.6%) exhibited corrected transposition of the great arteries (CC-TGA). Diagnoses were distributed across the trimester, with 8 D-TGA and 2 CC-TGA patients identified in the first trimester, 68 D-TGA patients and 9 CC-TGA patients in the second trimester, and 14 D-TGA and 2 CC-TGA patients referred for diagnosis in the third trimester. Induction of labour was pursued for 76 D-TGA patients (84.4%) and 11 CC-TGA patients (84.6%), and 14 D-TGA patients (15.6%) and 2 CC-TGA patients (15.4%) continued pregnancy until delivery. Among the D-TGA patients, 9 fetuses (10.0%) underwent surgery, two of which were inadvertent fatality, while the remaining seven experienced positive outcomes. Additionally, seven TGA patients received palliative care, leading to four fatalities among D-TGA patients (5.2%), whereas 1 D-TGA patients and 2 CC-TGA patients survived. Conclusion This study underscores the feasibility of achieving an accurate prenatal diagnosis of TGA during early pregnancy. The utility of prenatal ultrasound in the development of personalized perinatal plans and the application of multidisciplinary treatment during delivery are conducive.
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Affiliation(s)
- Jie Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tingting Dang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiong Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liqin Zeng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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4
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Houyel L. Human Genetics of d-Transposition of Great Arteries. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1441:671-681. [PMID: 38884741 DOI: 10.1007/978-3-031-44087-8_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Although several genes underlying occurrence of transposition of the great arteries have been found in the mouse, human genetics of the most frequent cyanotic congenital heart defect diagnosed in neonates is still largely unknown. Development of the outflow tract is a complex process which involves the major genes of cardiac development, acting on myocardial cells from the anterior second heart field, and on mesenchymal cells from endocardial cushions. These genes, coding for transcription factors, interact with each other, and their differential expression conditions the severity of the phenotype. A precise description of the anatomic phenotypes is mandatory to achieve a better comprehension of the complex mechanisms responsible for transposition of the great arteries.
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Affiliation(s)
- Lucile Houyel
- Department of Congenital and Pediatric Cardiology, Necker-Enfants Malades Hospital-M3C, APHP, Paris, France.
- Université Paris Cité, Paris, France.
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5
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Gill E, Bamforth SD. Molecular Pathways and Animal Models of d-Transposition of the Great Arteries. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1441:683-696. [PMID: 38884742 DOI: 10.1007/978-3-031-44087-8_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
During normal cardiovascular development, the outflow tract becomes septated and rotates so that the separate aorta and pulmonary trunk are correctly aligned with the left and right ventricles, respectively. However, when this process goes wrong, the aorta and pulmonary trunk are incorrectly positioned, resulting in oxygenated blood being directly returned to the lungs, with deoxygenated blood being delivered to the systemic circulation. This is termed transposition of the great arteries (TGA). The precise etiology of TGA is not known, but the use of animal models has elucidated that genes involved in determination of the left- embryonic body axis play key roles. Other factors such as retinoic acid levels are also crucial. This chapter reviews the animal models presenting with TGA that have been generated by genetic manipulation or with exogenous agents.
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Affiliation(s)
- Eleanor Gill
- Newcastle University Biosciences Institute, Newcastle, UK
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6
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Oboli VN, Pizzolla A, Pattnaik P. A Diagnostic Dilemma: Transposition of the Great Arteries. Cureus 2023; 15:e38931. [PMID: 37188061 PMCID: PMC10176758 DOI: 10.7759/cureus.38931] [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] [Accepted: 05/12/2023] [Indexed: 05/17/2023] Open
Abstract
Transposition of the great arteries (TGA) remains one of the most common and severe underdiagnosed congenital cardiac anomalies in the prenatal period. Unfortunately, despite advances in prenatal ultrasound screening, the detection rate of major congenital heart defects (CHDs) remains low. We present the case of a preterm male infant delivered limp with generalized cyanosis and in respiratory distress at 36 weeks gestation with postnatal echocardiography (ECHO) depicting dextro-TGA (d-TGA). Maternal prenatal targeted fetal anomaly ultrasonography at 18 weeks gestation showed abnormal right ventricle and right ventricular outflow tract. Subsequent two-time repeat fetal ECHO showed ventricular septal defect. This case represents how challenging and unrecognized critical CHDs can be. Furthermore, it highlights the need for clinicians to have a high index of suspicion when newborns present with clinical manifestations of critical CHDs and manage it accordingly to avoid severe complications.
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Affiliation(s)
- Victor N Oboli
- Pediatrics, New York City Health + Hospitals/Lincoln, New York, USA
| | - Anthony Pizzolla
- Pediatrics, St. George's University School of Medicine, True Blue, GRD
| | - Priyam Pattnaik
- Neonatology, New York City Health + Hospitals/Lincoln, New York, USA
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7
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Lombardi R, Chen SN. A polygenic risk score after corrective surgery for transposition of the great arteries: Can genetics add value to clinical predictors of outcome? Int J Cardiol 2023; 373:55-56. [PMID: 36442671 DOI: 10.1016/j.ijcard.2022.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Raffaella Lombardi
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical Campus, USA; Department of Advanced Biomedical Sciences "Federico II" University of Naples, Naples, Italy.
| | - Suet Nee Chen
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical Campus, USA.
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8
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De Ita M, Gaytán-Cervantes J, Cisneros B, Araujo MA, Huicochea-Montiel JC, Cárdenas-Conejo A, Lazo-Cárdenas CC, Ramírez-Portillo CI, Feria-Kaiser C, Peregrino-Bejarano L, Yáñez-Gutiérrez L, González-Torres C, Rosas-Vargas H. Clustering of Genetic Anomalies of Cilia Outer Dynein Arm and Central Apparatus in Patients with Transposition of the Great Arteries. Genes (Basel) 2022; 13:genes13091662. [PMID: 36140829 PMCID: PMC9498580 DOI: 10.3390/genes13091662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Transposition of the great arteries (TGA) is a congenital heart defect with a complex pathogenesis that has not been fully elucidated. In this study, we performed whole-exome sequencing (WES) in isolated TGA-diagnosed patients and analyzed genes of motile and non-motile cilia ciliogenesis and ciliary trafficking, as well as genes previously associated with this heart malformation. Deleterious missense and splicing variants of genes DNAH9, DNAH11, and ODAD4 of cilia outer dynein arm and central apparatus, HYDIN, were found in our TGA patients. Remarkable, there is a clustering of deleterious genetic variants in cilia genes, suggesting it could be an oligogenic disease. Our data evidence the genetic diversity and etiological complexity of TGA and point out that population allele determination and genetic aggregation studies are required to improve genetic counseling.
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Affiliation(s)
- Marlon De Ita
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
- Dpto de Genética y Biología Molecular, CINVESTAV Zacatenco IPN, Ciudad de México 07360, Mexico
| | - Javier Gaytán-Cervantes
- Laboratorio de Secuenciación, División de Desarrollo de la Investigación, IMSS, Ciudad de México 06720, Mexico
| | - Bulmaro Cisneros
- Dpto de Genética y Biología Molecular, CINVESTAV Zacatenco IPN, Ciudad de México 07360, Mexico
| | - María Antonieta Araujo
- Departamento clínico de Genética Médica, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | - Juan Carlos Huicochea-Montiel
- Departamento clínico de Genética Médica, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | - Alan Cárdenas-Conejo
- Departamento clínico de Genética Médica, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | - Charles César Lazo-Cárdenas
- Departamento clínico de Cardiología, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | - César Iván Ramírez-Portillo
- Departamento clínico de Cardiología, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | - Carina Feria-Kaiser
- Unidad de Cuidados Intensivos Neonatales, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
| | | | - Lucelli Yáñez-Gutiérrez
- Clínica de Cardiopatías Congénitas, UMAE Hospital de Cardiología, CMN Siglo XXI, Ciudad de México 06720, Mexico
| | - Carolina González-Torres
- Laboratorio de Secuenciación, División de Desarrollo de la Investigación, IMSS, Ciudad de México 06720, Mexico
- Correspondence: (C.G.-T.); (H.R.-V.)
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México 06720, Mexico
- Correspondence: (C.G.-T.); (H.R.-V.)
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9
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Tortigue M, Nield LE, Karakachoff M, McLeod CJ, Belli E, Babu-Narayan SV, Prigent S, Boet A, Conway M, Elder RW, Ladouceur M, Khairy P, Kowalik E, Kalfa DM, Barron DJ, Mussa S, Hiippala A, Temple J, Abadir S, Le Gloan L, Lachaud M, Sanatani S, Thambo JB, Gronier CG, Amedro P, Vaksmann G, Charbonneau A, Koutbi L, Ovaert C, Houeijeh A, Combes N, Maury P, Duthoit G, Hiel B, Erickson CC, Bonnet C, Van Hare GF, Dina C, Karsenty C, Fournier E, Le Bloa M, Pass RH, Liberman L, Happonen JM, Perry JC, Romefort B, Benbrik N, Hauet Q, Fraisse A, Gatzoulis MA, Abrams DJ, Dubin AM, Ho SY, Redon R, Bacha EA, Schott JJ, Baruteau AE. Familial Recurrence Patterns in Congenitally Corrected Transposition of the Great Arteries: An International Study. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003464. [PMID: 35549293 DOI: 10.1161/circgen.121.003464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease of unknown cause. We aimed to better understand familial recurrence patterns. METHODS An international, multicentre, retrospective cohort study was conducted in 29 tertiary hospitals in 6 countries between 1990 and 2018, entailing investigation of 1043 unrelated ccTGA probands. RESULTS Laterality defects and atrioventricular block at diagnosis were observed in 29.9% and 9.3%, respectively. ccTGA was associated with primary ciliary dyskinesia in 11 patients. Parental consanguinity was noted in 3.4% cases. A congenital heart defect was diagnosed in 81 relatives from 69 families, 58% of them being first-degree relatives, including 28 siblings. The most prevalent defects in relatives were dextro-transposition of the great arteries (28.4%), laterality defects (13.6%), and ccTGA (11.1%); 36 new familial clusters were described, including 8 pedigrees with concordant familial aggregation of ccTGA, 19 pedigrees with familial co-segregation of ccTGA and dextro-transposition of the great arteries, and 9 familial co-segregation of ccTGA and laterality defects. In one family co-segregation of ccTGA, dextro-transposition of the great arteries and heterotaxy syndrome in 3 distinct relatives was found. In another family, twins both displayed ccTGA and primary ciliary dyskinesia. CONCLUSIONS ccTGA is not always a sporadic congenital heart defect. Familial clusters as well as evidence of an association between ccTGA, dextro-transposition of the great arteries, laterality defects and in some cases primary ciliary dyskinesia, strongly suggest a common pathogenetic pathway involving laterality genes in the pathophysiology of ccTGA.
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Affiliation(s)
- Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Lynne E Nield
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | | | | | - Emre Belli
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Sonya V Babu-Narayan
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Solène Prigent
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Angèle Boet
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Miriam Conway
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Robert W Elder
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT (R.W.E.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Diseases, M3C Hôpital Européen Georges Pompidou, Paris, France (M.L.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland (E.K.)
| | - David M Kalfa
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - David J Barron
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | - Shafi Mussa
- Department of Congenital Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom (S.M.)
| | - Anita Hiippala
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - Joel Temple
- Department of Pediatrics, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE (J.T.)
| | - Sylvia Abadir
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
- Division of Cardiology, CHU Mère-Enfant Sainte-Justine, University of Montreal, Quebec, Canada (S.A.)
| | - Laurianne Le Gloan
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Department of Cardiology, CHU Nantes, Nantes, France (L.L.G.)
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada (S.S.)
| | | | - Céline Grunenwald Gronier
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Pascal Amedro
- Department of Cardiology, CHU Bordeaux, France (J.-B.T., P.A.)
- PhyMedExp, CNRS, INSERM, University of Montpellier, France (P.A.)
| | - Guy Vaksmann
- Department of Pediatric Cardiology, Hôpital Privé de La Louvière, Lille, France (G.V.)
| | - Anne Charbonneau
- Department of Pediatric and Congenital Cardiology, American Memorial Hospital, CHU Reims, France (A.C.)
| | - Linda Koutbi
- Department of Cardiology (L.K.), La Timone Hospital, CHU Marseille, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology (C.O.), La Timone Hospital, CHU Marseille, France
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, France (C.O.)
| | - Ali Houeijeh
- Department of Pediatric Cardiology, CHRU Lille, France (A.H.)
| | - Nicolas Combes
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
- Department of Cardiology, Pasteur Clinic, Toulouse, France (N.C.)
| | | | - Guillaume Duthoit
- Department of Cardiology, Groupe Hospitalier Pitié Salpétrière, Sorbonne Université, Paris, France (G.D.)
| | - Bérengère Hiel
- Department of Pediatric Cardiology, CHU Amiens, France (B.H.)
| | - Christopher C Erickson
- UDivision of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE (C.C.E.)
| | | | - George F Van Hare
- Division of Pediatric Cardiology, St Louis Children's Hospital, Washington University School of Medicine (G.F.V.H.)
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
| | - Clément Karsenty
- Department of Pediatric and Congenital Cardiology, Children's Hospital (C.K.), CHU Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR 1048, Université de Toulouse, France (C.K.)
| | - Emmanuelle Fournier
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Switzerland (M.L.B.)
| | - Robert H Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, NY (R.H.P.)
| | - Leonardo Liberman
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Juha-Matti Happonen
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - James C Perry
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego (J.C.P.)
| | - Bénédicte Romefort
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Nadir Benbrik
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Quentin Hauet
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Michael A Gatzoulis
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Stanford University, Palo Alto, CA (A.M.D.)
| | - Siew Yen Ho
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Emile A Bacha
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
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10
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Słodki M. Dextro-transposition of great vessels: difficult to detect prenatally, one of the most dangerous and one of the best prognosed. Transl Pediatr 2022; 11:783-788. [PMID: 35800282 PMCID: PMC9253946 DOI: 10.21037/tp-22-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maciej Słodki
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland.,Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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11
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Abdelwahid E, de Carvalho KAT. Editorial: MicroRNAs in Heart Regeneration: Regulatory Mechanisms and Therapeutic Applications. Front Cardiovasc Med 2022; 9:863332. [PMID: 35295258 PMCID: PMC8920091 DOI: 10.3389/fcvm.2022.863332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eltyeb Abdelwahid
- Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Eltyeb Abdelwahid
| | - Katherine Athayde Teixeira de Carvalho
- Advanced Therapy and Cellular Biotechnology in Regenerative Medicine Department, The Pelé Pequeno Príncipe Research Institute, Child and Adolescent Health Research and Pequeno Príncipe Faculties, Curitiba, Brazil
- Katherine Athayde Teixeira de Carvalho
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12
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Whole genome sequencing in transposition of the great arteries and associations with clinically relevant heart, brain and laterality genes. Am Heart J 2022; 244:1-13. [PMID: 34670123 DOI: 10.1016/j.ahj.2021.10.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The most common cyanotic congenital heart disease (CHD) requiring management as a neonate is transposition of great arteries (TGA). Clinically, up to 50% of TGA patients develop some form of neurodevelopmental disability (NDD), thought to have a significant genetic component. A "ciliopathy" and links with laterality disorders have been proposed. This first report of whole genome sequencing in TGA, sought to identify clinically relevant variants contributing to heart, brain and laterality defects. METHODS Initial whole genome sequencing analyses on 100 TGA patients focussed on established disease genes related to CHD (n = 107), NDD (n = 659) and heterotaxy (n = 74). Single variant as well as copy number variant analyses were conducted. Variant pathogenicity was assessed using the American College of Medical Genetics and Genomics-Association for Molecular Pathology guidelines. RESULTS Fifty-five putatively damaging variants were identified in established disease genes associated with CHD, NDD and heterotaxy; however, no clinically relevant variants could be attributed to disease. Notably, case-control analyses identified significantly more predicted-damaging, silent and total variants in TGA cases than healthy controls in established CHD genes (P < .001), NDD genes (P < .001) as well as across the three gene panels (P < .001). CONCLUSION We present compelling evidence that the majority of TGA is not caused by monogenic rare variants and is most likely oligogenic and/or polygenic in nature, highlighting the complex genetic architecture and multifactorial influences on this CHD sub-type and its long-term sequelae. Assessment of variant burden in key heart, brain and/or laterality genes may be required to unravel the genetic contributions to TGA and related disabilities.
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13
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Cashman TJ, Trivedi CM. Human 3p14.3: A Regulatory Region in Transposition of the Great Arteries. Circ Res 2022; 130:181-183. [PMID: 35050689 PMCID: PMC8852236 DOI: 10.1161/circresaha.121.320624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Timothy J Cashman
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA 01605 USA,Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605 USA
| | - Chinmay M. Trivedi
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA 01605 USA,Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605 USA,Department of Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 01605 USA,Correspondence to: Chinmay M. Trivedi, MD, PhD, The Albert Sherman Center, AS7-1047, 368 Plantation St, Worcester, MA 01605
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14
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Trisomy 21, transposition of the great arteries and abnormal myelopoiesis. Cardiol Young 2022; 32:142-143. [PMID: 35034684 DOI: 10.1017/s1047951121002444] [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] [Indexed: 11/07/2022]
Abstract
Down syndrome is a well-recognised genetic condition associated with several comorbidities. Although CHD is common in Down syndrome, transposition of the great arteries is exceptionally rare. We describe a neonate with Down syndrome who presented with transient abnormal myelopoiesis and transposition of the great arteries. Down syndrome may accelerate pulmonary hypertension in transposition of the great arteries and is associated with poor outcomes.
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15
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Ontoria-Oviedo I, Földes G, Tejedor S, Panadero J, Kitani T, Vázquez A, Wu JC, Harding SE, Sepúlveda P. Modeling Transposition of the Great Arteries with Patient-Specific Induced Pluripotent Stem Cells. Int J Mol Sci 2021; 22:ijms222413270. [PMID: 34948064 PMCID: PMC8705900 DOI: 10.3390/ijms222413270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022] Open
Abstract
The dextro-transposition of the great arteries (d-TGA) is one of the most common congenital heart diseases. To identify biological processes that could be related to the development of d-TGA, we established induced pluripotent stem cell (iPSC) lines from two patients with d-TGA and from two healthy subjects (as controls) and differentiated them into endothelial cells (iPSC-ECs). iPSC-EC transcriptome profiling and bioinformatics analysis revealed differences in the expression level of genes involved in circulatory system and animal organ development. iPSC-ECs from patients with d-TGA showed impaired ability to develop tubular structures in an in vitro capillary-like tube formation assay, and interactome studies revealed downregulation of biological processes related to Notch signaling, circulatory system development and angiogenesis, pointing to alterations in vascular structure development. Our study provides an iPSC-based cellular model to investigate the etiology of d-TGA.
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Affiliation(s)
- Imelda Ontoria-Oviedo
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (S.T.); (A.V.)
- Correspondence: (I.O.-O.); (P.S.); Tel.: +34-96-1246632 (I.O.-O.); +34-96-1246635 (P.S.)
| | - Gabor Földes
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK; (G.F.); (S.E.H.)
- Heart and Vascular Center, Semmelweis University, H1122 Budapest, Hungary
| | - Sandra Tejedor
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (S.T.); (A.V.)
| | - Joaquín Panadero
- IGENOMIX S.L., Edificios Europark, Parque Tecnológico, 46980 Paterna, Spain;
| | - Tomoya Kitani
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.K.); (J.C.W.)
| | - Alejandro Vázquez
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (S.T.); (A.V.)
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; (T.K.); (J.C.W.)
| | - Sian E. Harding
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK; (G.F.); (S.E.H.)
| | - Pilar Sepúlveda
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain; (S.T.); (A.V.)
- Correspondence: (I.O.-O.); (P.S.); Tel.: +34-96-1246632 (I.O.-O.); +34-96-1246635 (P.S.)
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16
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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17
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Omer SO, Alhabshan FM, Jijeh AMZ, Caimbon NC, Enriquez CC, Männer J, Yelbuz TM. Is Transposition of the Great Arteries Associated With Shortening of the Intrapericardial Portions of the Great Arterial Trunks? An Echocardiographic Analysis on Newborn Infants With Simple Transposition of the Great Arteries to Explore an Animal Model-Based Hypothesis on Human Beings. J Am Heart Assoc 2021; 10:e019334. [PMID: 34278802 PMCID: PMC8475693 DOI: 10.1161/jaha.120.019334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.
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Affiliation(s)
- Seham O. Omer
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Fahad M. Alhabshan
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Abdulraouf M. Z. Jijeh
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Natalia C. Caimbon
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Carmelita C. Enriquez
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
| | - Jörg Männer
- Institute for Anatomy and EmbryologyUMGGeorg‐August‐University of GöttingenGöttingenGermany
| | - Talat Mesud Yelbuz
- Department of Cardiac SciencesKing Abdulaziz Cardiac CenterMinistry of National Guard Health AffairsRiyadhSaudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhSaudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhSaudi Arabia
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18
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Diz OM, Toro R, Cesar S, Gomez O, Sarquella-Brugada G, Campuzano O. Personalized Genetic Diagnosis of Congenital Heart Defects in Newborns. J Pers Med 2021; 11:562. [PMID: 34208491 PMCID: PMC8235407 DOI: 10.3390/jpm11060562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/26/2022] Open
Abstract
Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach.
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Affiliation(s)
- Olga María Diz
- UGC Laboratorios, Hospital Universitario Puerta del Mar, 11009 Cadiz, Spain;
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
| | - Rocio Toro
- Medicine Department, School of Medicine, Cádiz University, 11519 Cadiz, Spain;
| | - Sergi Cesar
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
| | - Olga Gomez
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain;
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Oscar Campuzano
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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19
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Guida V, Sparascio FP, Bernardini L, Pancheri F, Melis D, Cocciadiferro D, Pagnoni M, Puzzo M, Goldoni M, Barone C, Hozhabri H, Putotto C, Giuffrida MG, Briuglia S, Palumbo O, Bianca S, Stanzial F, Benedicenti F, Kariminejad A, Forzano F, Baghernajad Salehi L, Mattina T, Brancati F, Castori M, Carella M, Fadda MT, Iannetti G, Dallapiccola B, Digilio MC, Marino B, Tartaglia M, De Luca A. Copy number variation analysis implicates novel pathways in patients with oculo-auriculo-vertebral-spectrum and congenital heart defects. Clin Genet 2021; 100:268-279. [PMID: 33988253 DOI: 10.1111/cge.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022]
Abstract
Oculo-auriculo-vertebral spectrum (OAVS) is a developmental disorder of craniofacial morphogenesis. Its etiology is unclear, but assumed to be complex and heterogeneous, with contribution of both genetic and environmental factors. We assessed the occurrence of copy number variants (CNVs) in a cohort of 19 unrelated OAVS individuals with congenital heart defect. Chromosomal microarray analysis identified pathogenic CNVs in 2/19 (10.5%) individuals, and CNVs classified as variants of uncertain significance in 7/19 (36.9%) individuals. Remarkably, two subjects had small intragenic CNVs involving DACH1 and DACH2, two paralogs coding for key components of the PAX-SIX-EYA-DACH network, a transcriptional regulatory pathway controlling developmental processes relevant to OAVS and causally associated with syndromes characterized by craniofacial involvement. Moreover, a third patient showed a large duplication encompassing DMBX1/OTX3, encoding a transcriptional repressor of OTX2, another transcription factor functionally connected to the DACH-EYA-PAX network. Among the other relevant CNVs, a deletion encompassing HSD17B6, a gene connected with the retinoic acid signaling pathway, whose dysregulation has been implicated in craniofacial malformations, was also identified. Our findings suggest that CNVs affecting gene dosage likely contribute to the genetic heterogeneity of OAVS, and implicate the PAX-SIX-EYA-DACH network as novel pathway involved in the etiology of this developmental trait.
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Affiliation(s)
- Valentina Guida
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesca Piceci Sparascio
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Laura Bernardini
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Pancheri
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Naples, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Dario Cocciadiferro
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mario Pagnoni
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Marianna Puzzo
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marina Goldoni
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Barone
- Medical Genetics, Referral Center for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Hossein Hozhabri
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Grazia Giuffrida
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Silvana Briuglia
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Messina, Italy
| | - Orazio Palumbo
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sebastiano Bianca
- Medical Genetics, Referral Center for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Franco Stanzial
- Genetic Counseling Service, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | - Francesco Benedicenti
- Genetic Counseling Service, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | | | - Francesca Forzano
- Clinical Genetics Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Teresa Mattina
- Unit of Medical Genetics, University of Catania, Catania, Italy
| | - Francesco Brancati
- Department of Life, Health and Environmental Sciences, Unit of Medical Genetics University of L'Aquila, L'Aquila, Italy
| | - Marco Castori
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimo Carella
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Teresa Fadda
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Giorgio Iannetti
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Bruno Dallapiccola
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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20
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Alfarhan A, Alquayt M, Alshalhoub M, Alnahdi MA, Masuadi E, Alhabshan F. Risk factors for transposition of the great arteries in Saudi population. Saudi Med J 2021; 41:1054-1062. [PMID: 33026045 PMCID: PMC7841512 DOI: 10.15537/smj.2020.10.25418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives: To assess potential risk factors and their effect on the development of transposition of the great arteries (TGA). Methods: A retrospective case-control study of all patients diagnosed with TGA between 1999 to 2016 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Age and gender-matched controls were selected. Risk factors, including consanguinity, gestational diabetes, family history of congenital heart disease, parental age, and maternal parity, were collected. Regression modeling was used to analyze the effects of risk factors on the development of TGA. Results: A total of 206 patients with transposition of the great arteries were enrolled in the study. Transposition of the great arteries cases were divided into simple and complex TGA. Selected healthy controls were 446. In the studied cases, consanguinity was found in 95 (46%) of cases, gestational diabetes was diagnosed in 36 (17.5%) mothers, and 35 (17%) had a confirmed family history of congenital heart disease. When risk factors of the cases were compared to the controls, consanguinity, gestational diabetes, maternal age, and parity were found to significantly increase the incidence of TGA. Conclusion: Our study revealed significant risk factors for the development of transposition of great arteries including first degree consanguineous marriages, gestational diabetes, family history of congenital cardiac anomalies, and increasing maternal age and parity. These factors increased the risk by at least 2 folds.
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Affiliation(s)
- Abdulrahman Alfarhan
- Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail.
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21
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Al Nasef M, Alghamdi MH, Bello Valls ML, Zahrani AM, AlAkfash A, Ardah HI, Diranneya OM, Alhabshan F. Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00039-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy.
Methods
We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients.
Results
We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001).
Conclusions
The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.
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22
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Ashton DJ, Greenberg SB. Post Repair Transposition of the Great Arteries: What You Need to Know. Semin Roentgenol 2020; 55:312-319. [PMID: 32859347 DOI: 10.1053/j.ro.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel J Ashton
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR.
| | - S Bruce Greenberg
- Department of Radiology and Department of Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR
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23
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De Ita M, Cisneros B, Rosas-Vargas H. Genetics of Transposition of Great Arteries: Between Laterality Abnormality and Outflow Tract Defect. J Cardiovasc Transl Res 2020; 14:390-399. [PMID: 32734553 DOI: 10.1007/s12265-020-10064-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Abstract
Transposition of great arteries (TGA) is a complex congenital heart disease whose etiology is still unknown. This defect has been associated, at least in part, with genetic abnormalities involved in laterality establishment and heart outflow tract development, which suggest a genetic heterogeneity. In animal models, the evidence of association with certain genes is strong but, surprisingly, genetic anomalies of its human orthologues are found only in a low proportion of patients and in nonaffected subjects, so that the underlying causes remain as an unexplored field. Evidence related to TGA suggests different pathogenic mechanisms involved between patients with normal organ disposition and isomerism. This article reviews the most important genetic abnormalities related to TGA and contextualizes them into the mechanism of embryonic development, comparing them between humans and mice, to comprehend the evidence that could be relevant for genetic counseling. Graphical abstract.
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Affiliation(s)
- Marlon De Ita
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico.,2o Piso Hospital de Pediatría, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Genética Humana, Instituto Mexicano del Seguro Social IMSS, Av. Cuauhtémoc 330, Col Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico
| | - Bulmaro Cisneros
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- 2o Piso Hospital de Pediatría, UMAE Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Genética Humana, Instituto Mexicano del Seguro Social IMSS, Av. Cuauhtémoc 330, Col Doctores, Delegación Cuauhtémoc, 06720, Mexico City, Mexico.
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24
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Johnson AL, Schneider JE, Mohun TJ, Williams T, Bhattacharya S, Henderson DJ, Phillips HM, Bamforth SD. Early Embryonic Expression of AP-2α Is Critical for Cardiovascular Development. J Cardiovasc Dev Dis 2020; 7:jcdd7030027. [PMID: 32717817 PMCID: PMC7570199 DOI: 10.3390/jcdd7030027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Congenital cardiovascular malformation is a common birth defect incorporating abnormalities of the outflow tract and aortic arch arteries, and mice deficient in the transcription factor AP-2α (Tcfap2a) present with complex defects affecting these structures. AP-2α is expressed in the pharyngeal surface ectoderm and neural crest at mid-embryogenesis in the mouse, but the precise tissue compartment in which AP-2α is required for cardiovascular development has not been identified. In this study we describe the fully penetrant AP-2α deficient cardiovascular phenotype on a C57Bl/6J genetic background and show that this is associated with increased apoptosis in the pharyngeal ectoderm. Neural crest cell migration into the pharyngeal arches was not affected. Cre-expressing transgenic mice were used in conjunction with an AP-2α conditional allele to examine the effect of deleting AP-2α from the pharyngeal surface ectoderm and the neural crest, either individually or in combination, as well as the second heart field. This, surprisingly, was unable to fully recapitulate the global AP-2α deficient cardiovascular phenotype. The outflow tract and arch artery phenotype was, however, recapitulated through early embryonic Cre-mediated recombination. These findings indicate that AP-2α has a complex influence on cardiovascular development either being required very early in embryogenesis and/or having a redundant function in many tissue layers.
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Affiliation(s)
- Amy-Leigh Johnson
- Newcastle University Biosciences Institute, Centre for Life, Newcastle NE1 3BZ, UK; (A.-L.J.); (D.J.H.); (H.M.P.)
| | | | | | - Trevor Williams
- Department of Craniofacial Biology, University of Colorado Anshutz Medical Campus, Aurora, CO 80045, USA;
| | - Shoumo Bhattacharya
- Department of Cardiovascular Medicine, University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK;
| | - Deborah J. Henderson
- Newcastle University Biosciences Institute, Centre for Life, Newcastle NE1 3BZ, UK; (A.-L.J.); (D.J.H.); (H.M.P.)
| | - Helen M. Phillips
- Newcastle University Biosciences Institute, Centre for Life, Newcastle NE1 3BZ, UK; (A.-L.J.); (D.J.H.); (H.M.P.)
| | - Simon D. Bamforth
- Newcastle University Biosciences Institute, Centre for Life, Newcastle NE1 3BZ, UK; (A.-L.J.); (D.J.H.); (H.M.P.)
- Correspondence: ; Tel.: +44-191-241-8764
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25
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Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of transposition of the great arteries: an updated review. Ultrasonography 2020; 39:331-339. [PMID: 32660209 PMCID: PMC7515665 DOI: 10.14366/usg.20055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
Simple transposition of the great arteries (TGA) is a cyanotic heart disease that accounts for 5% to 7% of all congenital heart diseases. It is commonly underdiagnosed in utero, with prenatal detection rates of less than 50%. Simple TGA is characterized by ventriculoarterial discordance, atrioventricular concordance, and a parallel relationship of TGA. The prenatal diagnosis of TGA influences postnatal outcomes and therefore requires planned delivery and perinatal management. For these reasons, it is important to identify the key ultrasound markers of TGA to improve the prenatal diagnosis and consequently provide perinatal assistance. The presence of two vessels instead of three in the three-vessel tracheal view, a parallel course of TGA, and identification of the origin of each of TGA are the key markers for diagnosing TGA. In addition to the classical ultrasound signs, other two-dimensional ultrasound markers such as an abnormal right convexity of the aorta, an I-shaped aorta, and the "boomerang sign" may also be used to diagnose TGA in the prenatal period. When accessible, an automatic approach using four-dimensional technologies such as spatio-temporal image correlation and sonographically-based volume computer-aided analysis may improve the prenatal diagnosis of TGA. This study aimed to review the ultrasound markers that can be used in the antenatal diagnosis of TGA, with a focus on the tools used by ultrasonographers, the obstetric and fetal medicine team, and perinatal cardiologists to improve the diagnosis of this condition.
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Affiliation(s)
- Nathalie Jeanne Bravo-Valenzuela
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.,Department of Pediatrics, Pediatric Cardiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alberto Borges Peixoto
- Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil.,Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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26
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Mengmeng X, Yuejuan X, Sun C, Yanan L, Fen L, Kun S. Novel mutations of the SRF gene in Chinese sporadic conotruncal heart defect patients. BMC MEDICAL GENETICS 2020; 21:95. [PMID: 32380971 PMCID: PMC7203814 DOI: 10.1186/s12881-020-01032-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/22/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Conotruncal heart defects (CTDs) are a group of congenital heart malformations that cause anomalies of cardiac outflow tracts. In the past few decades, many genes related to CTDs have been reported. Serum response factor (SRF) is a ubiquitous nuclear protein that acts as transcription factor, and SRF was found to be a critical factor in heart development and to be strongly expressed in the myocardium of the developing mouse and chicken hearts. The targeted inactivation of SRF during heart development leads to embryonic lethality and myocardial defects in mice. METHODS To illustrate the relationship between SRF and human heart defects, we screened SRF mutations in 527 CTD patients, a cross sectional study. DNA was extracted from peripheral leukocyte cells for target sequencing. The mutations of SRF were detected and validated by Sanger sequencing. The affection of the mutations on wild-type protein was analyzed by in silico softwares. Western blot and real time PCR were used to analyze the changes of the expression of the mutant mRNA and protein. In addition, we carried out dual luciferase reporter assay to explore the transcriptional activity of the mutant SRF. RESULTS Among the target sequencing results of 527 patients, two novel mutations (Mut1: c.821A > G p.G274D, the adenine(A) was mutated to guanine(G) at position 821 of the SRF gene coding sequences (CDS), lead to the Glycine(G) mutated to Asparticacid(D) at position 274 of the SRF protein amino acid sequences; Mut2: c.880G > T p.G294C, the guanine(G) was mutated to thymine (T) at position 880 of the SRF CDS, lead to the Glycine(G) mutated to Cysteine (C) at position 294 of the SRF protein amino acid sequences.) of SRF (NM_003131.4) were identified. Western blotting and real-time PCR showed that there were no obvious differences between the protein expression and mRNA transcription of mutants and wild-type SRF. A dual luciferase reporter assay showed that both SRF mutants (G274D and G294C) impaired SRF transcriptional activity at the SRF promoter and atrial natriuretic factor (ANF) promoter (p < 0.05), additionally, the mutants displayed reduced synergism with GATA4. CONCLUSION These results suggest that SRF-p.G274D and SRF-p.G294C may have potential pathogenic effects.
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Affiliation(s)
- Xu Mengmeng
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang road, Shanghai, 200092, China
| | - Xu Yuejuan
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang road, Shanghai, 200092, China.
| | - Chen Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang road, Shanghai, 200092, China
| | - Lu Yanan
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang road, Shanghai, 200092, China
| | - Li Fen
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, No. 1678, Dongfang Road, Shanghai, 200127, China
| | - Sun Kun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang road, Shanghai, 200092, China.
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27
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Liu X, Chen W, Li W, Priest JR, Fu Y, Pang K, Ma B, Han B, Liu X, Hu S, Zhou Z. Exome-Based Case-Control Analysis Highlights the Pathogenic Role of Ciliary Genes in Transposition of the Great Arteries. Circ Res 2020; 126:811-821. [PMID: 32078439 DOI: 10.1161/circresaha.119.315821] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Transposition of the great arteries (TGA) is one of the most severe types of congenital heart diseases. Understanding the clinical characteristics and pathogenesis of TGA is, therefore, urgently needed for patient management of this severe disease. However, the clinical characteristics and genetic cause underlying TGA remain largely unexplored. OBJECTIVE We sought to systematically examine the clinical characteristics and genetic cause for isolated nonsyndromic TGA. METHODS AND RESULTS We recruited 249 patients with TGA (66 family trios) and performed whole-exome sequencing. The incidence of patent ductus arteriosus in dextro-TGA (52.7%) and dextrocardia/mesocardia in congenitally corrected TGA (32.8%) were significantly higher than that in other subtypes. A high prevalence of bicuspid pulmonic valve (9.6%) was observed in patients with TGA. Similar results were observed in a replication group of TGA (n=132). Through a series of bioinformatics filtering steps, we obtained 82 candidate genes harboring potentially damaging de novo, loss of function, compound heterozygous, or X-linked recessive variants. Established congenital heart disease-causing genes, such as FOXH1, were found among the list of candidate genes. A total of 19 ciliary genes harboring rare potentially damaging variants were also found; for example, DYNC2LI1 with a de novo putatively damaging variant. The enrichment of ciliary genes supports the roles of cilia in the pathogenesis of TGA. In total, 33% of the TGA probands had >1 candidate gene hit by putatively deleterious variants, suggesting that a portion of the TGA cases were probably affected by oligogenic or polygenic inheritance. CONCLUSIONS The findings of clinical characteristic analyses have important implications for TGA patient stratification. The results of genetic analyses highlight the pathogenic role of ciliary genes and a complex genetic architecture underlying TGA.
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Affiliation(s)
- Xuanyu Liu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Wen Chen
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Wenke Li
- Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - James R Priest
- Department of Pediatrics, Stanford University School of Medicine, CA (J.R.P.)
| | - Yuanyuan Fu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital, Beijing, China (K.P.)
| | - Baihui Ma
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Bianmei Han
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Xuewen Liu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Shengshou Hu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.)
| | - Zhou Zhou
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xuanyu Liu, W.C., W.L., Y.F., B.M., B.H., Xuewen Liu, S.H., Z.Z.).,Beijing Key Laboratory for Molecular Diagnostics of Cardiovascular Diseases, Center of Laboratory Medicine, China (Xuanyu Liu, W.C., W.L., Y.F., Z.Z.)
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28
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Isomerism of the atrial appendages: morphology and terminology. Cardiovasc Pathol 2020; 47:107205. [PMID: 32179252 DOI: 10.1016/j.carpath.2020.107205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our aim is to identify the pathognomonic anatomical markers and the best terminology to describe the cardiac malformations associated with absent or multiple spleens, which are known as asplenia or polysplenia syndromes or isomerism. MATERIALS AND METHODS We have reviewed 65 hearts with isomerism of atrial appendages of the Anatomical Collections of Congenital Heart Disease, Institute of Pathological Anatomy of the University of Padua consisting of 1800 specimens. All the hearts were classified according to sequential segmental classification. RESULTS The incidence of isomerism was 3.6%. Of the total, 45 hearts with isomerism of right atrial appendages showed bilateral trilobed lungs, short bronchi, and absent spleen. The atrioventricular junction was univentricular in 49% of cases with a common atrioventricular valve in 91%. Pulmonary atresia and double outlet right ventricle were present in 40% and 47% of cases, respectively. Total anomalous pulmonary venous drainage and absent coronary sinus were always present. In 20 hearts with isomerism of left atrial appendages, bilateral bilobed lungs with long bilateral bronchi and multiple spleens were always found. The biventricular atrioventricular connection was present in 65% with a common valve in 30% of the hearts. The ventriculoarterial connection was concordant in 45% of cases, and aortic atresia and pulmonary atresia were both noted in 15% of each. An anomalous symmetric pulmonary venous drainage was observed in 65% of the hearts and interruption of inferior vena cava was found in 75% of cases. CONCLUSIONS We believe that the appropriate terminology is based on the symmetrical morphology of the atrial appendages. The absence of the coronary sinus and the total anomalous pulmonary venous drainage are the markers of isomerism of the right atrial appendages. Symmetric pulmonary venous drainage and interruption of inferior vena cava are the markers of isomerism of left atrial appendages. In recent years, thanks to the improvement of clinical diagnosis and of surgical techniques these patients have the possibility to survive to adult age.
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Interstitial 5p15.2-p13.3 deletion in association with situs inversus, dextrocardia, L-loop of the ventricles, and transposition of great arteries in a newborn infant. Cardiol Young 2019; 29:1115-1117. [PMID: 31331405 DOI: 10.1017/s1047951119001689] [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] [Indexed: 11/07/2022]
Abstract
We report a rare association of interstitial deletion of 5p15.2-p13.3 with situs inversus, dextrocardia, L-loop of the ventricles, and transposition of great arteries: [I, L, L] Transposition of Great Arteries. We did not find such an association reported in the medical literature.
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Abstract
Congenital heart disease (CHD) represents a small proportion of horses undergoing clinical evaluation; however, both simple and complex defects occur during cardiac development leading to many unique malformations. This article reviews cardiac development and the fetal circulation, describes the morphologic method and the sequential segmental approach to CHD analysis, presents a summary of CHD in horses, and offers an overview of lesions that should be considered during evaluation of horses suspected to have CHD. For many forms of equine CHD, therapies are limited because cardiac interventions and cardiac surgery are not routinely pursued in this species.
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Affiliation(s)
- Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523, USA.
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31
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Wieloch R, Sipahi NF, Boeken U, Albert A, Akhyari P, Westenfeld R, Lichtenberg A, Saeed D. Ventricular assist device in a patient with congenitally corrected transposition of the great arteries and situs inversus totalis. Int J Artif Organs 2019; 42:321-322. [PMID: 30630389 DOI: 10.1177/0391398818823768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenitally corrected transposition of the great arteries and situs inversus totalis are rare congenital anomalies. While congenital heart diseases affect about 0.75%-0.9% of newborns, less than 1% of them have congenitally corrected transposition of the great arteries. Meanwhile, the incidence of situs inversus totalis is about 0.01%. This is a case report of a patient with congenitally corrected transposition of the great arteries and situs inversus totalis who was supported with a ventricular assist device, resulting in a challenging clinical scenario.
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Affiliation(s)
- Radi Wieloch
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Nihat Firat Sipahi
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Udo Boeken
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Alexander Albert
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Payam Akhyari
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Ralf Westenfeld
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Diyar Saeed
- 1 Clinic of Cardiovascular Surgery, Heinrich Heine University Dusseldorf, Dusseldorf, Germany.,2 Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Longitudinal Associations between Neurodevelopment and Psychosocial Health Status in Patients with Repaired D-Transposition of the Great Arteries. J Pediatr 2019; 204:38-45.e1. [PMID: 30274922 PMCID: PMC6309657 DOI: 10.1016/j.jpeds.2018.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine associations between measurements of neurodevelopment and psychosocial health status at age 8 and 16 years in patients with repaired dextro-transposition of the great arteries. STUDY DESIGN In the 16-year follow-up of the Boston Circulatory Arrest Study, 137 parents completed the Child Health Questionnaire-Parent Form-50, of whom 135 had completed the Child Health Questionnaire-Parent Form-50 when their child was age 8 years. Psychosocial and physical summary scores were used to assess change in health status from age 8 to 16 years. A comprehensive battery of neurodevelopmental testing was performed at ages 8 and 16 years to examine associations with adolescent health status. RESULTS Lower psychosocial summary scores of 16 year old subjects with dextro-transposition of the great arteries were highly associated with numerous concurrent domains of neurodevelopmental function, most notably with higher (worse) scores on the Conners' Attention Deficit Hyperactivity Disorder/Diagnostic and Statistical Manual-4th Edition Scales (parent: r = -0.62, P < .001; adolescent: r = -0.43, P < .001) and the Behavior Rating Inventory of Executive Function Global Executive Composite (parent: r = -0.66, P < .001; adolescent: r = -0.39, P < .001). Psychosocial and physical summary scores tracked from ages 8 to 16 years (r = 0.44 and 0.47, respectively, P < .001 for each). Higher (worse) scores of multiple attention measures at age 8 years predicted worse psychosocial summary scores at age 16 years. CONCLUSIONS Attention deficits at age 8 years were highly predictive of worse psychosocial health status in adolescence. Further studies are needed to assess whether treatment of childhood attention deficit hyperactivity disorder could improve adolescent well-being.
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Yacoub M, Hosny H, Afifi A. Surgery for TGA in Developing Countries: The End of the Beginning. J Am Coll Cardiol 2018; 69:52-55. [PMID: 28057250 DOI: 10.1016/j.jacc.2016.10.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Magdi Yacoub
- Aswan Heart Centre, Aswan, Egypt; Imperial College, London, United Kingdom.
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Lee MY, Won HS, Han YJ, Ryu HM, Lee DE, Jeong BD. Clinical value of chromosomal microarray analysis in prenatally diagnosed dextro-transposition of the great arteries. J Matern Fetal Neonatal Med 2018; 33:1480-1485. [PMID: 30176760 DOI: 10.1080/14767058.2018.1519800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: To evaluate the usefulness of chromosomal microarray analysis (CMA) in fetuses with dextro-transposition of the great arteries (d-TGA).Methods: Thirty-two fetuses with d-TGA were examined for submicroscopic copy number variations (CNVs) using CMA.Results: Among the 32 d-TGA fetuses, 23 had isolated lesions (71.9%) and nine had other cardiac or extracardiac anomalies (28.1%). CNVs were detected in 16/32 (50%) of the fetuses, including benign CNVs detected in nine fetuses (28.1%), pathogenic CNVs detected in three fetuses (9.4%), and variants of unknown significance (VOUS) detected in four fetuses (12.5%). There was no significant difference in the detection rates of pathogenic CNVs between the isolated and nonisolated groups. All four VOUS were found in the nonisolated group.Conclusion: CMA might be an effective tool for identifying submicroscopic chromosomal aberrations in fetuses with d-TGA.
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Affiliation(s)
- Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hyun Mee Ryu
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Da Eun Lee
- Laboratory of Medicine Genetics, Medical Research Institute, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Ba-Da Jeong
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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35
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Anderson RH, Stickley J. Is transposition a defect of laterality? Ann Pediatr Cardiol 2018; 11:235-236. [PMID: 30271011 PMCID: PMC6146863 DOI: 10.4103/apc.apc_122_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Robert H Anderson
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
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Al-Zahrani RS, Alharbi SH, Tuwaijri RMA, Alzomaili BT, Althubaiti A, Yelbuz TM. Transposition of the great arteries: A laterality defect in the group of heterotaxy syndromes or an outflow tract malformation? Ann Pediatr Cardiol 2018; 11:237-249. [PMID: 30271012 PMCID: PMC6146851 DOI: 10.4103/apc.apc_24_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIM Transposition of the great arteries (TGA) is traditionally classified as a "conotruncal heart defect", implying that TGA evolves from abnormal development of the outflow tract (OFT) of the embryonic heart. However, recently published genetic data suggest that TGA may be linked to laterality gene defects rather than OFT gene defects. The aim of our study was to clarify whether there is any statistically significant link between TGA and clinically diagnosed laterality defects (heterotaxy). METHODS Retrospective cross-sectional analysis of 533 patients diagnosed with TGA at our cardiac center over a period of 13 years (2002-2015). Hospital informatics and digital data recording systems were used for collecting patients' data and all patients were reviewed to check the echocardiograms for verification of the diagnosis, type (TGA, congenitally corrected TGA (ccTGA), and levo-position of the great arteries (LGA)), complexity of TGA, and all other variables (e.g., abdominal organ arrangement, cardiac position, presence or absence of other cardiac defects). RESULTS Of 533 TGA patients, 495 (92.9%) had the usual arrangement of the internal organs, 21 (3.9%) had mirror-imagery, 7 (1.3%) had left and 10 (1.8%) had right isomerism. 444 (83.3%) patients had TGA. The number of patients who had usual visceral arrangement in each TGA type was: 418 (94.1%) in TGA, 49 (92.4%) in ccTGA, and 28 (77.7%) in LGA. 6 (1.4%) TGA patients, 4 (11.1%) patients with LGA were found to have right isomerism, while no ccTGA patient presented with this asymmetry. 4 (0.9%) TGA patients, 1 (1.9%) ccTGA patient and 2 (5.6%) patients with LGA had left isomerism. Heterotaxy (mirror-imagery, left and right isomerism) was more associated with LGA than TGA or ccTGA with a statistically significant difference (P value of 0.001). CONCLUSION In contrast to recently published genetic data, our morphological data do not disclose a significant link between TGA and heterotaxy.
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Affiliation(s)
- Rana S Al-Zahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Samaher H Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Rawan M A Tuwaijri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Bayan T Alzomaili
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Alaa Althubaiti
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Talat Mesud Yelbuz
- Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Section of Pediatric Cardiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
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Mostefa-Kara M, Houyel L, Bonnet D. Anatomy of the ventricular septal defect in congenital heart defects: a random association? Orphanet J Rare Dis 2018; 13:118. [PMID: 30021599 PMCID: PMC6052685 DOI: 10.1186/s13023-018-0861-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/29/2018] [Indexed: 12/02/2022] Open
Abstract
Background A ventricular septal defect (VSD) is an integral part of most congenital heart defects (CHD). To determine the prevalence of VSD in various types of CHD and the distribution of their anatomic types. Methods We reviewed 1178 heart specimens with CHD from the anatomic collection of the French Reference Centre for Complex Congenital Heart Defects. During the morphologic study a special attention was paid to the localisation of the VSD viewed from the right ventricular side. The VSDs were classified as muscular, central perimembranous, outlet located between the two limbs of the septal band, and inlet. The specimens were classified according to the 9 categories and 23 subcategories of the anatomic and clinical classification of CHD1 (ACC-CHD). Results Ventricular septum was almost always intact in anomalies of pulmonary veins (4/73, 5%), Ebstein anomaly (3/21, 14%), and double-inlet right ventricle (DIRV, 1/10, 10%). There was always a VSD in tetralogy of Fallot and variants (TOF, 123 cases) and common arterial trunk (CAT, 55 cases), always of the outlet type. There was almost always a VSD in double inlet left ventricle (33/34, 97%, always muscular), congenitally corrected transposition of great arteries (ccTGA, 23/24, 96%), interrupted aortic arch (IAA, 25/27, 93%), and double outlet right ventricle (DORV, 92/106, 87%). A VSD was found in 68% of aortic coarctation (CoA, 43/63), 62% of heterotaxy syndromes (21/34), 54% of transposition of the great arteries (TGA, 104/194). The VSD was located between the two limbs of the septal band in 100% of TOF and CAT, 80% of IAA, 77% of DORV, 82% of DD. The VSD was of the inlet type in 17% of cc TGA and in 71% of heterotaxy syndromes. In TGA, the VSD was outlet in 40%, central perimembranous in 25%, muscular in 25%, inlet in 10%. In CoA, the VSD was outlet in 44%, central perimembranous in 35%, muscular in 21%. In the 10% hearts with isolated VSD, the distribution was outlet in 44%, central perimembranous in 36%, muscular in 18%, and inlet in 2%. Conclusion The anatomic distribution of VSD is similar in isolated VSD, CoA and TGA, while the VSD is predominantly outlet in outflow tract defects except TGA. This reinforces the allegedly different mechanisms in TGA and cardiac neural crest defects. This anatomic approach could provide new insights in the grouping and aetiology of CHD.
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Affiliation(s)
- Meriem Mostefa-Kara
- Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sevres, 75004, Paris, France. .,Congenital and Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Lucile Houyel
- Congenital Cardiac Surgery, Hôpital Marie-Lannelongue, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Université Paris-Sud, 133 avenue de la Résistance, 92350, Le Plessis-Robinson, France
| | - Damien Bonnet
- Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sevres, 75004, Paris, France.,Congenital and Paediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France
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Kurtz JD, Boucek K, Kavarana M, Atz AM. Two Brothers With Dextro-Transposition of the Great Arteries. World J Pediatr Congenit Heart Surg 2018; 11:NP155-NP157. [PMID: 29848184 DOI: 10.1177/2150135118768718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dextro-transposition of the great arteries (d-TGA) is a common cause of cyanotic heart disease in neonates. Current thought is d-TGA is a sporadic occurrence in families with an unclear etiology. We describe a case of brothers with d-TGA. Genetic testing revealed that both are heterozygous for two gene variations that are associated with congenital heart disease.
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Affiliation(s)
- Joshua D Kurtz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Both the authors have equal contribution to this publication
| | - Katerina Boucek
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Both the authors have equal contribution to this publication
| | - Minoo Kavarana
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew M Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Versacci P, Pugnaloni F, Digilio MC, Putotto C, Unolt M, Calcagni G, Baban A, Marino B. Some Isolated Cardiac Malformations Can Be Related to Laterality Defects. J Cardiovasc Dev Dis 2018; 5:jcdd5020024. [PMID: 29724030 PMCID: PMC6023464 DOI: 10.3390/jcdd5020024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
Human beings are characterized by a left–right asymmetric arrangement of their internal organs, and the heart is the first organ to break symmetry in the developing embryo. Aberrations in normal left–right axis determination during embryogenesis lead to a wide spectrum of abnormal internal laterality phenotypes, including situs inversus and heterotaxy. In more than 90% of instances, the latter condition is accompanied by complex and severe cardiovascular malformations. Atrioventricular canal defect and transposition of the great arteries—which are particularly frequent in the setting of heterotaxy—are commonly found in situs solitus with or without genetic syndromes. Here, we review current data on morphogenesis of the heart in human beings and animal models, familial recurrence, and upstream genetic pathways of left–right determination in order to highlight how some isolated congenital heart diseases, very common in heterotaxy, even in the setting of situs solitus, may actually be considered in the pathogenetic field of laterality defects.
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Affiliation(s)
- Paolo Versacci
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Flaminia Pugnaloni
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Carolina Putotto
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Marta Unolt
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
| | - Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, 00165 Rome, Italy.
| | - Bruno Marino
- Department of Pediatrics, Sapienza University of Rome, 00161 Rome, Italy.
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Muntean I, Toma D, Togănel R. Predictors of Inadequate Mixing in Transposition of the Great Arteries — a Critical Neonatal Condition. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.1515/jce-2017-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Simple transposition of the great arteries (TGA) is a cyanotic critical congenital heart defect representing a neonatal cardiovascular emergency, which requires surgery early after birth. In case of inadequate mixing between systemic and pulmonary circulations, creating an unrestrictive interatrial communication is mandatory. The aim of the present study was to identify the most important echocardiographic parameters that can predict the need for balloon atrial septostomy (BSA) in TGA neonates.
Material and methods: We retrospectively reviewed the echocardiographic recordings of newborns with TGA referred to our emergency room during a 6-year period. We measured the following echocardiographic parameters: atrial septal defect (ASD) size, interatrial septum (IAS) length, peak/mean inter-atrial pressure gradient, transverse diameter of the left atrium (LA), and transverse diameter of the right atrium (RA). Also, the ratio between ASD/IAS, the ratio between LA/RA, the ratio between mitral/tricuspid annulus, the ASD peak gradient/ASD diameter and the ASD diameter/(LA:RA ratio) were calculated.
Results: There were 37 neonates with simple TGA presented to the emergency room, split into two groups: those with BAS (n = 21) and those without BAS (n = 16). Besides significant differences between the two groups in ASD size, peak/mean interatrial pressure gradient, and LA:RA ratio, we found that ASD peak gradient/ASD diameter was significantly higher, but ASD diameter/(LA:RA ratio) was significantly lower in the group that required BAS compared with the group without BAS. Multivariate analysis showed that ASD diameter/(LA:RA ratio) was an independent predictor of septostomy requirement, with a cut-off value of 2.58.
Conclusion: ASD diameter/(LA/RA ratio) is a useful echocardiographic parameter that can provide supplementary information regarding inadequate mixing and the need for BAS in neonates with TGA.
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Affiliation(s)
- Iolanda Muntean
- University of Medicine and Pharmacy , Emergency Institute of Cardiovascular Diseases and Transplantation , Tîrgu Mureș , Romania
| | - Daniela Toma
- Emergency Institute of Cardiovascular Diseases and Transplantation , Tîrgu Mureș , Romania
| | - Rodica Togănel
- University of Medicine and Pharmacy , Emergency Institute of Cardiovascular Diseases and Transplantation , Tîrgu Mureș , Romania
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Karunanithi Z, Vestergaard EM, Lauridsen MH. Transposition of the great arteries - a phenotype associated with 16p11.2 duplications? World J Cardiol 2017; 9:848-852. [PMID: 29317992 PMCID: PMC5746628 DOI: 10.4330/wjc.v9.i12.848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/21/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
Genetic analyses of patients with transposition of the great arteries have identified rare copy number variations, suggesting that they may be significant to the aetiology of the disease. This paper reports the identification of a 16p11.2 microduplication, a variation that has yet to be reported in association with transposition of the great arteries. The 16p11.2 microduplication is associated with autism spectrum disorder and developmental delay, but with highly variable phenotypic effects. Autism and attention deficit disorders are observed more frequently in children with congenital heart disease than in the general population. Neonatal surgery is proposed as a risk factor, but as yet unidentified genetic abnormalities should also be taken into account. Thus, congenital heart abnormalities may constitute a part of the phenotypic spectrum associated with duplications at 16p11.2. We suggest chromosomal microarray be considered part of the diagnostic work-up in patients with transposition of the great arteries.
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Affiliation(s)
- Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N 8200, Denmark
| | | | - Mette H Lauridsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N 8200, Denmark
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Kohnken R, Schober K, Godman J, Gardner A, Jenkins T, Schroeder E, Baker P, Dunbar L. Double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) and other complex congenital cardiac malformations in an American Quarter Horse foal. J Vet Cardiol 2017; 20:64-72. [PMID: 29174590 DOI: 10.1016/j.jvc.2017.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022]
Abstract
A 4-week-old American Quarter Horse colt presented with a recent history of diarrhea and decreased activity level. On initial physical examination, the animal was bright and alert and major findings were limited to a loud systolic heart murmur radiating widely over both sides of the thorax. While in the hospital, the clinical condition of the foal warranted further imaging to determine the cause and extent of cardiac disease. A variety of congenital cardiac malformations were identified during echocardiographic examination and autopsy, including a double outlet right ventricle and a subpulmonary interventricular septal defect (Taussig-Bing anomaly), ventricular inversion with atrioventricular discordance, tricuspid valve atresia, a septum primum interatrial septal defect, mitral valve dysplasia with a cleft in the septal mitral valve cusp, aortic, and subaortic stenosis, tubular hypoplasia of the ascending aorta and the aortic arch, a patent ductus arteriosus, an aberrant circumflex coronary artery, and aberrant left and right subclavian arteries. Echocardiographic and postmortem findings of the cardiac defects in this foal are presented and discussed.
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Affiliation(s)
- Rebecca Kohnken
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
| | - Karsten Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Jennifer Godman
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Alison Gardner
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Tiffany Jenkins
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA
| | - Eric Schroeder
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Peter Baker
- Department of Laboratory Medicine and Anatomic Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Laura Dunbar
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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Identification of ZFPM2 mutations in sporadic conotruncal heart defect patients. Mol Genet Genomics 2017; 293:217-223. [PMID: 29018978 DOI: 10.1007/s00438-017-1373-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
Conotruncal heart defects (CTDs) are a group of cardiac malformations that involve outflow tract anomalies and the arterial pole of the heart. Recent reports have identified mutations in a number of genes associated with CTDs in human and animal models. ZFPM2 plays a role in cardiac development by acting as a transcriptional cofactor that interacts with GATA4. Because ZFPM2 was found to be important for cardiac development in a knockout mouse model, we screened for ZFPM2 mutations in 528 CTD patients. We identified six rare and nonsynonymous ZFPM2 variants, and this was the first time that five of these variants (R698Q, R736L, E1005K, T32A, and I488V) were reported in East Asians. Western blots showed that there was no significant difference in the protein expression of wild-type ZFPM2, ZFPM2R698Q, or ZFPM2R736L. A dual luciferase reporter assay demonstrated that both ZFPM2 mutants R698Q and R736L reduced GATA4-mediated transcription. However, when ZFPM2R698Q was co-transfected with GATA4, BNP promoter activity increased significantly, whereas co-transfection with ZFPM2R736L and GATA4 did not significantly increase BNP promoter activity. This suggests that the R698Q mutation may affect the ability of ZFPM2 to bind GATA4.
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Abstract
There is an old adage in paediatric cardiology that, despite the high prevalence and wide spectrum of CHD, transposition of the great arteries does not occur in trisomy 21. We present a case of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis in a patient with trisomy 21.
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Aghajanian H, Cho YK, Rizer NW, Wang Q, Li L, Degenhardt K, Jain R. Pdgfrα functions in endothelial-derived cells to regulate neural crest cells and the development of the great arteries. Dis Model Mech 2017; 10:1101-1108. [PMID: 28714851 PMCID: PMC5611965 DOI: 10.1242/dmm.029710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/05/2017] [Indexed: 12/16/2022] Open
Abstract
Originating as a single vessel emerging from the embryonic heart, the truncus arteriosus must septate and remodel into the aorta and pulmonary artery to support postnatal life. Defective remodeling or septation leads to abnormalities collectively known as conotruncal defects, which are associated with significant mortality and morbidity. Multiple populations of cells must interact to coordinate outflow tract remodeling, and the cardiac neural crest has emerged as particularly important during this process. Abnormalities in the cardiac neural crest have been implicated in the pathogenesis of multiple conotruncal defects, including persistent truncus arteriosus, double outlet right ventricle and tetralogy of Fallot. However, the role of the neural crest in the pathogenesis of another conotruncal abnormality, transposition of the great arteries, is less well understood. In this report, we demonstrate an unexpected role of Pdgfra in endothelial cells and their derivatives during outflow tract development. Loss of Pdgfra in endothelium and endothelial-derived cells results in double outlet right ventricle and transposition of the great arteries. Our data suggest that loss of Pdgfra in endothelial-derived mesenchyme in the outflow tract endocardial cushions leads to a secondary defect in neural crest migration during development. Summary: Loss of Pdgfrα in endothelial-derived mesenchyme results in defective neural crest behavior and is associated with conotruncal defects including, surprisingly, transposition of the great arteries.
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Affiliation(s)
- Haig Aghajanian
- Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Institute for Regenerative Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, 61186, South Korea
| | - Nicholas W Rizer
- Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Institute for Regenerative Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Qiaohong Wang
- Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Institute for Regenerative Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li Li
- Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Institute for Regenerative Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Karl Degenhardt
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rajan Jain
- Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Institute for Regenerative Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Kloesel B, DiNardo JA, Body SC. Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists. Anesth Analg 2017; 123:551-69. [PMID: 27541719 DOI: 10.1213/ane.0000000000001451] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Congenital heart disease is diagnosed in 0.4% to 5% of live births and presents unique challenges to the pediatric anesthesiologist. Furthermore, advances in surgical management have led to improved survival of those patients, and many adult anesthesiologists now frequently take care of adolescents and adults who have previously undergone surgery to correct or palliate congenital heart lesions. Knowledge of abnormal heart development on the molecular and genetic level extends and improves the anesthesiologist's understanding of congenital heart disease. In this article, we aim to review current knowledge pertaining to genetic alterations and their cellular effects that are involved in the formation of congenital heart defects. Given that congenital heart disease can currently only occasionally be traced to a single genetic mutation, we highlight some of the difficulties that researchers face when trying to identify specific steps in the pathogenetic development of heart lesions.
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Affiliation(s)
- Benjamin Kloesel
- From the Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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47
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Paliwal AK. Letter to the Editor. Med J Armed Forces India 2017; 73:209-210. [PMID: 38597821 PMCID: PMC5592269 DOI: 10.1016/j.mjafi.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amit Kumar Paliwal
- Graded Specialist (Radiodiagnosis), Military Hospital Dehradun, C/o 56 APO, 900461, India
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48
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Sequential segmental classification of feline congenital heart disease. J Vet Cardiol 2016; 17 Suppl 1:S10-52. [PMID: 26776571 DOI: 10.1016/j.jvc.2015.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/01/2015] [Accepted: 04/21/2015] [Indexed: 12/17/2022]
Abstract
Feline congenital heart disease is less commonly encountered in veterinary medicine than acquired feline heart diseases such as cardiomyopathy. Understanding the wide spectrum of congenital cardiovascular disease demands a familiarity with a variety of lesions, occurring both in isolation and in combination, along with an appreciation of complex nomenclature and variable classification schemes. This review begins with an overview of congenital heart disease in the cat, including proposed etiologies and prevalence, examination approaches, and principles of therapy. Specific congenital defects are presented and organized by a sequential segmental classification with respect to their morphologic lesions. Highlights of diagnosis, treatment options, and prognosis are offered. It is hoped that this review will provide a framework for approaching congenital heart disease in the cat, and more broadly in other animal species based on the sequential segmental approach, which represents an adaptation of the common methodology used in children and adults with congenital heart disease.
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Ahrens-Nicklas RC, Khan S, Garbarini J, Woyciechowski S, D'Alessandro L, Zackai EH, Deardorff MA, Goldmuntz E. Utility of genetic evaluation in infants with congenital heart defects admitted to the cardiac intensive care unit. Am J Med Genet A 2016; 170:3090-3097. [PMID: 27605484 DOI: 10.1002/ajmg.a.37891] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/30/2016] [Indexed: 01/01/2023]
Abstract
Congenital heart defects (CHDs) are heterogeneous and present with a spectrum of severity, with roughly 25% of patients requiring intervention before age 1. The etiology of disease is unknown in many individuals; however, there is a rapidly expanding understanding of genetic risk factors that may contribute to pathogenesis. Through this work, we sought to evaluate the diagnostic yield of a clinical genetics evaluation and associated genetic testing among infants with critical CHDs. Furthermore, we aimed to both determine the utility of microarray and establish a strong baseline that can be used in future studies of the impact of exome sequencing in this population. We completed a retrospective chart review of 364 infants with CHDs admitted to the Cardiac Intensive Care Unit who underwent a clinical genetics evaluation. A genetic diagnosis was established in 25% of patients: 9% of infants were diagnosed prenatally, while 16% were diagnosed postnatally. Cardiac lesion subtype greatly influenced the diagnostic yield. On physical exam, the presence of dysmorphic features, as assessed by a clinical geneticist, was associated with a sevenfold increased likelihood of reaching a diagnosis. Directed by clinical acumen, diagnostic rates varied by testing modality with rates of 23% for karyotype, 12% for fluorescent in situ hybridization or multiplex-dependent ligation probe analysis, 9% for genome wide microarray, and 17% for targeted gene sequencing. Careful consideration of lesion subtype and physical exam findings clarify populations of infants with CHD that benefit from a genetics evaluation and inform an efficient testing paradigm. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Shama Khan
- Division of Maternal Fetal Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Stacy Woyciechowski
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa D'Alessandro
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Elaine H Zackai
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew A Deardorff
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Goldmuntz
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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50
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Nakajima Y. Mechanism responsible for D-transposition of the great arteries: Is this part of the spectrum of right isomerism? Congenit Anom (Kyoto) 2016; 56:196-202. [PMID: 27329052 DOI: 10.1111/cga.12176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 12/25/2022]
Abstract
D-transposition of the great arteries (TGA) is one of the most common conotruncal heart defects at birth and is characterized by a discordant ventriculoarterial connection with a concordant atrioventricular connection. The morphological etiology of TGA is an inverted or arrested rotation of the heart outflow tract (OFT, conotruncus), by which the aorta is transposed in the right ventral direction to the pulmonary trunk. The rotational defect of the OFT is thought to be attributed to hypoplasia of the subpulmonic conus, which originates from the left anterior heart field (AHF) residing in the mesodermal core of the first and second pharyngeal arches. AHF, especially on the left, at the early looped heart stage (corresponding to Carnegie stage 10-11 in the human embryo) is one of the regions responsible for the impediment that causes TGA morphology. In human or experimentally produced right isomerism, malposition of the great arteries including D-TGA is frequently associated. Mutations in genes involving left-right (L-R) asymmetry, such as NODAL, ACTRIIB and downstream target FOXH1, have been found in patients with right isomerism as well as in isolated TGA. The downstream pathways of Nodal-Foxh1 play a critical role not only in L-R determination in the lateral plate mesoderm but also in myocardial specification and differentiation in the AHF, suggesting that TGA is a phenotype in heterotaxia as well as the primary developmental defect of the AHF.
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Affiliation(s)
- Yuji Nakajima
- Department of Anatomy and Cell Biology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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