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Thomas P, Venugopalan A, Narayanan S, Mathew T, Cherukuwada LPD, Chandran S, Pradeep J, Fitzgibbons TP, George V. Case Report: Occurrence of Severe Thoracic Aortic Aneurysms (Involving the Ascending, Arch, and Descending Segments) as a Result of Fibulin-4 Deficiency: A Rare Pathology With Successful Management. Front Cardiovasc Med 2021; 8:756765. [PMID: 34901216 PMCID: PMC8652058 DOI: 10.3389/fcvm.2021.756765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022] Open
Abstract
Aortic diseases requiring surgery in childhood are distinctive and rare. Very few reports in the literature account for the occurrence of multiple thoracic aortic aneurysms in the same pediatric patient because of a genetic cause. We report a rare occurrence of severe thoracic aortic aneurysms (involving the ascending, arch and descending aortic segments) with severe aortic insufficiency in a 7-year-old female child secondary to the extremely rare and often lethal genetic disorder, cutis laxa. She was eventually identified as a carrier of a homozygous EFEMP2 (alias FBLN4) mutation. This gene encodes the extracellular matrix protein fibulin-4, and its mutation is associated with autosomal recessive cutis laxa type 1B that leads to severe aortopathy with aneurysm formation and vascular tortuosity. Parents of the child were not known to be consanguineous. Significant symptomatic improvement in the patient could be discerned after timely intervention with the valve-sparing aortic root replacement (David V procedure) and a concomitant aortic arch replacement. This is a unique report with a successful outcome that highlights the occurrence of a rare hereditary aortopathy associated with a high morbidity and mortality, and the importance of an early diagnosis and timely management. It also offers insight to physicians in having a very broad differential and multimodal approach in handling rare pediatric cardio-pathologies with a genetic predisposition.
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Affiliation(s)
- Paul Thomas
- Department of Cardiology, Government General Hospital, Ernakulam, India
| | | | - Siddharth Narayanan
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Thomas Mathew
- Department of Cardiothoracic and Vascular Surgery, Government Medical College, Kottayam, India
| | | | - Shilpa Chandran
- Department of Radiodiagnosis, Government Medical College, Thiruvananthapuram, India
| | - Jithu Pradeep
- Department of Internal Medicine, Montefiore Hospitals, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Timothy P Fitzgibbons
- Department of Cardiology, University of Massachussetts Medical School, Worcester, MA, United States
| | - Vijo George
- Department of Cardiology, Government General Hospital, Ernakulam, India
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