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Seidel L, Nebel K, Achenbach S, Bauer U, Ewert P, Freilinger S, Gundlach U, Kaemmerer H, Nagdyman N, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, Schelling J, Weyand M, Neidenbach R. Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center. J Clin Med 2020; 9:E1943. [PMID: 32580342 PMCID: PMC7355698 DOI: 10.3390/jcm9061943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP's perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP's perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either "very good" or "good". Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.
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Affiliation(s)
- Lavinia Seidel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Ulrike Gundlach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
- Department of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
| | - Lars Pieper
- Department of Behavioural Epidemiology, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Wibke Reinhard
- Cardiology Department, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany;
| | - Linda Sanftenberg
- Institute of General Practice, University of the Ludwig-Maximilians-University Munich, 80336 Munich, Germany;
| | - Jörg Schelling
- Private Group Practice Martinsried, 82152 Martinsried, Germany;
| | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen, 91054 Erlangen, Germany;
| | - Rhoia Neidenbach
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
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Kaemmerer H, Apitz C, Brockmeier K, Eicken A, Gorenflo M, Hager A, de Haan F, Huntgeburth M, Kozlik-Feldmann RG, Miera O, Diller GP. Pulmonary hypertension in adults with congenital heart disease: Updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 2018; 272S:79-88. [PMID: 30195841 DOI: 10.1016/j.ijcard.2018.08.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/24/2018] [Indexed: 01/03/2023]
Abstract
In the summer of 2016, delegates from the German Respiratory Society (DGP), the German Society of Cardiology (DGK) and the German Society of Pediatric Cardiology (DGPK) met in Cologne, Germany, to define consensus-based practice recommendations for the management of patients with pulmonary hypertension (PH). These recommendations were built on the 2015 European Pulmonary Hypertension guidelines, aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH in adults associated with congenital heart disease (CHD). As such patients are often complex and require special attention, and the general PAH treatment algorithm in the ESC/ERS guidelines appears too unspecific for CHD, the working group proposes an analogous algorithm for the management of PH-CHD which takes the special features of this patient group into consideration, and includes general measures, supportive therapy, targeted PAH drug therapy as well as interventional and surgical procedures. The detailed results and recommendations of the working group on PH in adults with CHD, which were last updated in the spring of 2018, are summarized in this article.
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Affiliation(s)
- Harald Kaemmerer
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Germany.
| | - Christian Apitz
- Department of Paediatric Cardiology, University Hospital for Paediatric and Adolescent Medicine, Ulm, Germany
| | - Konrad Brockmeier
- Department for Paediatric Cardiology, Heart Centre, University of Cologne, Germany
| | - Andreas Eicken
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Germany
| | - Matthias Gorenflo
- Department for Congenital Heart Defects/Paediatric Cardiology, Heidelberg University Hospital, Germany
| | - Alfred Hager
- Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich, Germany
| | | | - Michael Huntgeburth
- Clinic for Internal Medicine III, Department of Cardiology, Heart Centre, University of Cologne, Germany
| | - Rainer G Kozlik-Feldmann
- Department for Paediatric Cardiology, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Oliver Miera
- Department for Congenital Heart Disease/Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gerhard P Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Hauser M, Lummert E, Braun SL, Vigl M, Engelhardt A, Pujol C, Neidenbach RC, Oberhoffer R, Ewert P, Kaemmerer H. Nichtkardiale Komorbiditäten bei erwachsenen Patienten mit angeborenen Herzfehlern. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Frequency and spectrum of congenital heart defects among live births in Germany. Clin Res Cardiol 2011; 100:1111-7. [DOI: 10.1007/s00392-011-0355-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/18/2011] [Indexed: 11/25/2022]
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Recommendations for improving the quality of the interdisciplinary medical care of grown-up with congenital heart disease (GUCH). Int J Cardiol 2011; 150:59-64. [DOI: 10.1016/j.ijcard.2010.02.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 02/13/2010] [Indexed: 11/19/2022]
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Huber A, Prompona M, Kozlik-Feldmann R, Mühling O, Rummeny E, Reiser M, Theisen D. [MRI for therapy planning in patients with atrial septum defects]. Radiologe 2011; 51:31-7. [PMID: 21243461 DOI: 10.1007/s00117-010-1998-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to determine the value of a combined magnetic resonance imaging (MRI) protocol including steady-state free precession (SSFP) imaging, phase-contrast measurements and contrast-enhanced MR angiography (CE-MRA) for presurgical or preinterventional diagnostic imaging in patients with suspected atrial septum defects. MATERIAL AND METHODS Out of 65 MRI studies of patients with suspected atrial septum defects, 56 patients were included in the study. The atrial septum defects were identified on cine images. Velocity encoded flow measurements were used to determine shunt volumes, which were compared with invasive oxymetry in 24 patients. Contrast-enhanced MRI was used to assess the thoracic vessels in order to detect vascular anomalies. The findings were compared with the intraoperative results. RESULTS A total of 24 patients with high shunt volumes were treated either surgically (16 patients) or interventionally (8 patients) and 32 patients with low shunt volumes did not require surgical or interventional treatment. The vascular anomaly, which in all cases was anomalous pulmonary venous return, was confirmed by the intraoperative findings. The type and location of atrial septal defects which required treatment, were confirmed intraoperatively or during the intervention. The results of shunt quantification by MRI showed a good correlation with the results of invasive oximetry (r=0.91, p <0.0001). CONCLUSION A combined MRI protocol including cine SSFP images, velocity-encoded flow measurements and CE-MRA is an accurate method for preoperative and preinterventional evaluation of atrial septum defects.
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Affiliation(s)
- A Huber
- Institut für Radiologie, Technische Universität München, München, Deutschland.
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Kaemmerer H, Hess J. [Congenital heart disease. Transition from adolescence to adulthood]. Internist (Berl) 2010; 50:1221-2, 1224-7. [PMID: 19756442 DOI: 10.1007/s00108-009-2400-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a increasing clinical and scientific interest in adults with congenital heart disease. Germany is among, if not the first country worldwide, with a structured care of adults with congenital heart disease. Due to the advances in cardiology and in heart surgery, the primarily high mortality rate of relevant congenital heart disease has declined from 80% to less than 20% during the recent decades. Currently, in Europe the estimated number of adults with congenital heart disease is between 1.2 and 2.7 Mio., and the number in Germany exceeds 180,000. Almost all congenital heart defects, either native or interventionally or surgically treated, need regular control, since even after successful primary treatment significant residua or sequels have to be expected. Optimal care of these patients begins in the childhood and must be continued down to the high adulthood. The complexity of congenital heart defects makes a multidisciplinary approach necessary. A specialized, interdisciplinary cooperation between cardiologists, pediatric cardiologists, cardiac surgeons and other specialists is mandatory.
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Affiliation(s)
- H Kaemmerer
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, 80636 München.
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Fratz S, Hess J, Schuhbaeck A, Buchner C, Hendrich E, Martinoff S, Stern H. Routine clinical cardiovascular magnetic resonance in paediatric and adult congenital heart disease: patients, protocols, questions asked and contributions made. J Cardiovasc Magn Reson 2008; 10:46. [PMID: 18928522 PMCID: PMC2579426 DOI: 10.1186/1532-429x-10-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 10/17/2008] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) of patients with congenital heart disease (CHD) has become routine clinical practice. However, existing CMR protocols focus predominantly on patients with ischemic heart disease, and information is limited on the types of patient with CHD who benefit from CMR investigation, and in what ways. Therefore the aim of this study was to answer the questions: What type of patients were studied by CMR in a centre specializing in paediatric and adult CHD management? What questions were asked, which protocols were used and were the questions successfully answered? To answer these questions, we conducted a cohort study of all 362 patients that received routine clinical CMR during 2007 at the Department of Paediatric Cardiology and Congenital Heart Disease at the Deutsches Herzzentrum München. RESULTS Underlying diagnosis was in 33% Fallot's tetralogy, 17% aortic coarctation, 8% Ebstein's disease, 6% Marfan's disease, 4% single ventricle with Fontan-like circulation, and 32% others. Median age was 26 years (7 days - 75 years). Ventricular volumes were assessed in 67% of the patients; flow in 74%; unknown anatomy only in 9%; specific individual morphology of known anatomy in 83%; myocardial fibrosis in 8%; stress-induced myocardial perfusion defects in 1%. Only in 3% of the cases the question could not be fully answered. CONCLUSION Contrary to common belief, routine CMR of patients with CHD was not requested to address global anatomical questions so much as to clarify specific questions of morphology and function of known anatomy. The CMR protocols used differed markedly from those widely used in patients with ischemic heart disease.
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Affiliation(s)
- Sohrab Fratz
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - John Hess
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Annika Schuhbaeck
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Christine Buchner
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Eva Hendrich
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Stefan Martinoff
- Department of Radiology, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
| | - Heiko Stern
- Department of Paediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München an der Technischen Universität München, Munich, Germany
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Surgery-related posttraumatic stress disorder in parents of children undergoing cardiopulmonary bypass surgery: a prospective cohort study. Pediatr Crit Care Med 2008; 9:217-23. [PMID: 18477936 DOI: 10.1097/pcc.0b013e318166eec3] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed at evaluating surgery-related posttraumatic stress disorder (PTSD) in parents of children undergoing cardiopulmonary bypass surgery. Risk factors for parental PTSD symptoms were explored. DESIGN A prospective cohort study was performed assessing PTSD symptoms immediately after discharge and 6 months after cardiopulmonary bypass surgery. SETTING Recruitment took place at a tertiary pediatric medical center in Switzerland. SUBJECTS German-speaking parents of children with congenital heart defects aged between 0 and 16 yrs undergoing cardiopulmonary bypass surgery were eligible (n = 228). After child discharge, 135 mothers and 98 fathers of 139 children (response rate 61.0%) participated. Six months after surgery, 121 mothers and 92 fathers of 128 children (response rate, 56.1%) took part in the study. INTERVENTIONS Assessment via a screening instrument and self-rating scale, and extraction of data from charts. MEASUREMENTS AND MAIN RESULTS The Posttraumatic Diagnostic Scale was applied to estimate self-reported symptoms of PTSD. Following discharge, 16.4% of mothers and 13.3% of fathers met diagnostic criteria for acute PTSD. Another 15.7% of mothers and 13.3% of fathers experienced significant symptoms of posttraumatic stress. Six months after surgery, PTSD rates were 14.9% and 9.5%, respectively. Mothers experienced more severe symptoms of PTSD, but gender differences were not detected with regard to the frequency of PTSD at either time. After controlling for socioeconomic status and child preoperative morbidity, PTSD symptom severity after discharge remained the only significant predictor of PTSD severity at 6 months. Pre-, peri-, and postoperative factors did not predict parental PTSD. CONCLUSIONS Parents of children undergoing cardiopulmonary bypass surgery are at increased risk for intermediate and long-term psychological malfunctioning. Acute symptoms of PTSD in parents shortly after discharge of their child are a major risk factor for the development of chronic PTSD. Clinicians need to identify parents at risk at an early stage to provide them with systematic support.
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Abstract
BACKGROUND Noncardiac conditions may complicate heart disease care, contribute to the progression of the disease and alter the response to treatment. The aim of this prospective study was to evaluate the proportion of cardiac children with such significant conditions. METHODS Of the 1058 children with congenital heart disease primarily diagnosed during a 10-year-period in one hospital, we identified those patients who had significant congenital and acquired comorbidities. RESULTS Associated problems were diagnosed in 224 children (21.2%). Among them, 118 children (11.2%) had genetic or syndromic conditions, of which 38 had Trisomy 21. Six subspecialty areas accounted for the vast majority of the cases: neurology (n = 140), pulmonology (n = 36), orthopaedics (n = 26), nephro-urology (n = 19), gastroenterology (n = 14) and endocrinology (n = 13). The most frequent associated conditions were mental retardation, asthma, epilepsy and scoliosis. During the study period, death occurred in 46 of the children (4.3%) and was not related to the cardiac disease in 20 cases (1.9%). CONCLUSION A substantial proportion of children with congenital heart disease have significant noncardiac comorbidities. Close collaboration between paediatric cardiologists and paediatricians of other subspecialties is imperative to optimize care for these children.
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Affiliation(s)
- Martial M Massin
- Department of Pediatric Cardiology, Queen Fabiola Children's University Hospital, Free University of Brussels (ULB), Brussels, Belgium.
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Kaemmerer H, Breithardt G. Empfehlungen zur Qualitätsverbesserung der interdisziplinären Versorgung von Erwachsenen mit angeborenen Herzfehlern (EMAH). Clin Res Cardiol 2006; 95 Suppl 4:76-84. [PMID: 16598609 DOI: 10.1007/s00392-006-2003-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- H Kaemmerer
- Deutsches Herzzentrum München des Freistaates Bayern, Klinik für Kinderkardiologie und angeborene Herzfehler, Lazarettstr. 36, 80636 München, Germany.
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Völkl TMK, Degenhardt K, Koch A, Simm D, Dörr HG, Singer H. Cardiovascular anomalies in children and young adults with Ullrich-Turner syndrome the Erlangen experience. Clin Cardiol 2005; 28:88-92. [PMID: 15757080 PMCID: PMC6654047 DOI: 10.1002/clc.4960280209] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Females with Ullrich-Turner syndrome (UTS) have typical clinical features such as short stature, ovarian failure, visible dysmorphic stigmata, and abnormalities in different organs such as kidney or heart. HYPOTHESIS The aim of the present study was to analyze the distribution, prevalence, and relative risk of cardiovascular anomalies (CVA) in females with Ullrich-Turner syndrome (UTS) seen at one single center compared with that of the regional Bavarian population. METHODS The associations between CVA and karyotype were determined. In all, 117 girls and women with UTS, aged between 3 and 43 years (median 17.4 years) were studied retrospectively. The detailed cardiologic status including echocardiography was available in all patients. The prevalences of each cardiovascular anomaly were determined. On the basis of published epidemiologic data of CVA in Bavarian children, we assessed the relative risks of each CVA. RESULTS Thirty-five (29.9%) girls with UTS had at least one CVA. In all of these CVAs, coarctation of the aorta and bicuspid aortic valve occurred most often (18.5% each). The aortic malformations represented over two-thirds of all CVA (72.8%), whereas anomalies of the septum (8.6%), mitral valve (6.2%), pulmonary veins (4.9%), and other locations together accounted for the other third. Bicuspid aortic valve and partial anomalous pulmonary venous drainage were associated with the highest relative risk (RR) (3603 and 1293, respectively) compared with the Bavarian population. The overall RR of CVA was 48.7. Of the 117 girls and women examined, 64 (54.7%) had complete monosomy 45 X. CONCLUSIONS Our data demonstrate that about every third female with UTS is affected with at least one CVA, mainly left sided and associated with aortic structures. Our results underline the necessity of thorough cardiologic evaluation.
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Affiliation(s)
- Thomas M. K. Völkl
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
| | - Karin Degenhardt
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
| | - Andreas Koch
- Division of Cardiology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
| | - Diemud Simm
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
| | - Helmuth G. Dörr
- Division of Pediatric Endocrinology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
| | - Helmut Singer
- Division of Cardiology, Hospital for Children and Adolescents, University of Erlangen‐Nuremberg, Erlangen, Germany
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Muncke N, Jung C, Rüdiger H, Ulmer H, Roeth R, Hubert A, Goldmuntz E, Driscoll D, Goodship J, Schön K, Rappold G. Missense mutations and gene interruption in PROSIT240, a novel TRAP240-like gene, in patients with congenital heart defect (transposition of the great arteries). Circulation 2003; 108:2843-50. [PMID: 14638541 DOI: 10.1161/01.cir.0000103684.77636.cd] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital heart disease represents the most common severe birth defect, affecting 0.7% to 1% of all neonates, among whom 5% to 7% display transposition of the great arteries (TGA). TGA represents a septation defect of the common outflow tract of the heart, manifesting around the fifth week during embryonic development. Despite its high prevalence, very little is known about the pathogenesis of this disease. METHODS AND RESULTS Using a positional cloning approach, we isolated a novel gene, PROSIT240 (also termed THRAP2), that is interrupted in a patient with a chromosomal translocation and who displays TGA and mental retardation. High expression of PROSIT240 within the heart (aorta) and brain (cerebellum) was well correlated with the malformations observed in the patient and prompted further analyses. PROSIT240 shows significant homology to the nuclear receptor coactivator TRAP240, suggesting it to be a new component of the thyroid hormone receptor-associated protein (TRAP) complex. Interestingly, several TRAP components have been previously shown to be important in early embryonic development in various organisms, making PROSIT240 an excellent candidate gene to be correlated to the patient's phenotype. Subsequent mutational screening of 97 patients with isolated dextro-looped TGA revealed 3 missense mutations in PROSIT240, which were not detected in 400 control chromosomes. CONCLUSIONS Together, these genetic data suggest that PROSIT240 is involved in early heart and brain development.
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MESH Headings
- Abnormalities, Multiple/genetics
- Adaptor Proteins, Signal Transducing
- Amino Acid Sequence
- Aorta/metabolism
- Carrier Proteins/genetics
- Carrier Proteins/physiology
- Cerebellar Ataxia/genetics
- Cerebellum/abnormalities
- Cerebellum/metabolism
- Child
- Chromosome Deletion
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 12/ultrastructure
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/ultrastructure
- Chromosomes, Human, Pair 22/genetics
- Cohort Studies
- Female
- Heart Defects, Congenital/genetics
- Humans
- Intellectual Disability/genetics
- Mediator Complex
- Microcephaly/genetics
- Molecular Sequence Data
- Multigene Family
- Mutation, Missense
- Organ Specificity
- Sequence Alignment
- Sequence Homology, Amino Acid
- Translocation, Genetic
- Transposition of Great Vessels/genetics
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Affiliation(s)
- Nadja Muncke
- Institut für Humangenetik, Universität Heidelberg, Heidelberg, Germany
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