Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T02:32:01.815Z Has data issue: false hasContentIssue false

New Findings concerning Cardiovascular Manifestations emerging from Long-term Follow-up of 150 patients with the Williams-Beuren-Beuren syndrome

Published online by Cambridge University Press:  23 September 2009

Alessia Del Pasqua
Affiliation:
Dipartimento di Cardiologia, Università degli Studi di Siena, Siena, Italy
Gabriele Rinelli
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Alessandra Toscano
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Roberta Iacobelli
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Cristina Digilio
Affiliation:
Servizio di Genetica Medica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Bruno Marino
Affiliation:
Dipartimento di Pediatria, Università La Sapienza, Rome, Italy
Claudia Saffirio
Affiliation:
Dipartimento di Pediatria, Università La Sapienza, Rome, Italy
Sergio Mondillo
Affiliation:
Dipartimento di Cardiologia, Università degli Studi di Siena, Siena, Italy
Luciano Pasquini
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Stephen Pruett Sanders
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
Andrea de Zorzi*
Affiliation:
Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Rome, Italy
*
Correspondence to: Dr Andrea de Zorzi, Ospedale Pediatrico Bambino Gesù, DMCCP Cardiologia, Piazza Sant’Onofrio 1, 00165 Rome, Italy. Tel: +390668592333; Fax: +390668592257; E-mail: [email protected]

Abstract

Aims

We investigated the prevalence, type, and course of congenital cardiac defects and systemic hypertension in our patients with Williams-Beuren-Beuren syndrome.

Methods and results

We reviewed the clinical records of all patients with Williams-Beuren syndrome examined between 1981 and 2006. We identified 150 patients, aged from 7 months to 45 years, with a follow-up from 6 months to 25 years, the mean being 6.4 years. A cardiac anomaly was present in 113 of the 150 patients (75%). Defects were typical in over four-fifths of the group. We found supravalvar aortic stenosis in 73 of 113 patients (64.6%), isolated in 43. Pulmonary stenosis, isolated in 18 cases, was found in 51 of 113 (45.1%), while aortic coarctation and mitral valvar prolapse were each found in 7 (6.2%), 3 of the lesions is isolation. Atypical defects were found in 19 patients, tetralogy of Fallot in 2, atrial septal defects in 4, aortic and mitral valvar insufficiencies in 1 each, bicuspid aortic valves in 2, and ventricular septal defects in 9, 4 of the last being isolated. Systemic hypertension, observed in 33 patients (22%), was poorly controlled in 10. Diagnostic and/or interventional cardiac catheterization was undertaken in 24 patients, with 30 surgical procedures performed in 26 patients. Of the group, 3 patients died.

Conclusion

Cardiac defects were present in three-quarters of our patients. Pulmonary arterial lesions generally improved, while supravalvar aortic stenosis often progressed. Atypical cardiac malformations, particularly ventricular septal defects, occurred frequently. Systemic hypertension was found in one-fifth, even in the absence of structural cardiac defects. The short-term mortality was low.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Morris, CA, Demsey, SA, Leonard, CO, Dilts, C, Blackburn, BL. Natural history of Williams-Beuren syndrome: physical characteristics. J Pediatr 1988; 113: 318326.CrossRefGoogle ScholarPubMed
2.Francke, U. Williams-Beuren syndrome: genes and mechanisms. Hum Mol Genet 1999; 8: 19471954.CrossRefGoogle ScholarPubMed
3.Edelmann, L, Prosnitz, A, Pardo, S, et al. An atypical deletion of the Williams-Beuren syndrome interval implicates genes associated with defective visuospatial processing and autism. J Med Genet 2007; 44: 136143.CrossRefGoogle ScholarPubMed
4.Bruno, E, Rossi, N, Thuer, O, Cordoba, R, Alday, LE. Cardiovascular findings, and clinical course, in patients with Williams syndrome. Cardiol Young 2003; 13: 532536.CrossRefGoogle ScholarPubMed
5.Pascual-Castroviejo, I, Pascual-Pascual, SI, Moreno Granado, F, et al. Williams-Beuren syndrome: presentation of 82 cases. An Pediatr (Barc) 2004; 60: 530536. Spanish.CrossRefGoogle ScholarPubMed
6.Zalzstein, E, Moes, CA, Musewe, NN, Freedom, RM. Spectrum of cardiovascular anomalies in Williams-Beuren syndrome. Pediatr Cardiol 1991; 12: 219223.CrossRefGoogle ScholarPubMed
7.Hallidie-Smith, KA, Karas, S. Cardiac anomalies in Williams-Beuren syndrome. Arch Dis Child 1988; 63: 809813.CrossRefGoogle ScholarPubMed
8.Sugayama, SM, Moises, RL, Wagenfur, J, et al. Williams-Beuren syndrome: cardiovascular abnormalities in 20 patients diagnosed with fluorescence in situ hybridization. Arq Bras Cardiol 2003; 81: 462473.CrossRefGoogle ScholarPubMed
9.American Academy of Pediatrics: Health care supervision for children with Williams syndrome. Pediatrics 2001; 107: 11921204; Erratum in: Pediatrics 2002; 109: 329.CrossRefGoogle Scholar
10.Kim, YM, Yoo, SJ, Choi, JY, Kim, SH, Bae, EJ, Lee, YT. Natural course of supravalvar aortic stenosis and peripheral pulmonary arterial stenosis in Williams’ syndrome. Cardiol Young 1999; 9: 3741.CrossRefGoogle ScholarPubMed
11.Dridi, SM, Foucault Bertaud, A, Igondjo Tchen, S, et al. Vascular wall remodeling in patients with supravalvar aortic stenosis and Williams-Beuren syndrome. J Vasc Res 2005; 42: 190201.CrossRefGoogle ScholarPubMed
12.Tassabehji, M. Williams-Beuren syndrome: a challenge for genotype-phenotype correlations. Hum Mol Genet 2003; 12 Spec No 2: R229R237.CrossRefGoogle ScholarPubMed
13.Eronen, M, Peippo, M, Hiippala, A, et al. Cardiovascular manifestations in 75 patients with Williams syndrome. J Med Genet 2002; 39: 554558.CrossRefGoogle ScholarPubMed
14.Amenta, S, Sofocleous, C, Kolialexi, A, et al. Clinical manifestations and molecular investigation of 50 patients with Williams syndrome in the Greek population. Pediatr Res 2005; 57: 789795.CrossRefGoogle ScholarPubMed
15.Geggel, RL, Gauvreau, K, Lock, JE. Balloon dilation angioplasty of peripheral pulmonary stenosis associated with Williams syndrome. Circulation 2001; 103: 21652170.CrossRefGoogle ScholarPubMed
16.Brown, JW, Ruzmetov, M, Vijay, P, Turrentine, MW. Surgical repair of congenital supravalvar aortic stenosis in children. Eur J Cardiothorac Surg 2002; 21: 5056.CrossRefGoogle ScholarPubMed
17.Medley, J, Russo, P, Tobias, JD. Perioperative care of the patient with Williams syndrome. Paediatr Anaesth 2005; 15: 243247.CrossRefGoogle ScholarPubMed
18.Ferencz, C, Rubin, JD, McCarter, RJ, et al. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 1985; 121: 3136.CrossRefGoogle ScholarPubMed
19.Broder, K, Reinhardt, E, Ahern, J, Lifton, R, Tamborlane, W, Pober, B. Elevated ambulatory blood pressure in 20 subjects with Williams syndrome. Am J Med Genet 1999; 83: 356360.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
20.Giordano, U, Turchetta, A, Giannotti, A, Digilio, MC, Virgilii, F, Calzolari, A. Exercise testing and 24-hour ambulatory blood pressure monitoring in children with Williams syndrome. Pediatr Cardiol 2001; 22: 509511.CrossRefGoogle ScholarPubMed
21.Martyn, CN, Greenwald, SE. Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet 1997; 350: 953955.CrossRefGoogle Scholar
22.Mackenzie, HS, Brenner, BM. Fewer nephrons at birth: a missing link in the etiology of essential hypertension? Am J Kidney Dis 1995; 26: 9198.CrossRefGoogle ScholarPubMed