Biomedical subjects
A E Lin
Publications and source records attributed to A E Lin.
Genetic counseling for congenital heart defects.
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Cardiac abnormalities in neurofibromatosis.
Cardiac abnormalities are potentially important features of neurofibromatosis (NF), but they are rarely discussed in this regard. Several literature reviews have suggested that congenital heart defects (CHD) occur with increased frequency in NF, and several isolated case reports have described hypertrophic cardiomyopathy (HCM) with NF. However, it is not clear whether the occurrence of CHD and HCM in patients with NF is coincidental or representative of an intrinsic, albeit uncommon, manifestation of the disorder. Adequate prospective studies documenting their true prevalence in NF are lacking. As an alternative, we reviewed the available relevant literature and, on that basis, have concluded that there is no clear evidence that CHD occurs with increased frequency among patients with NF, and that no statements can be made about the prevalence of HCM among patients with NF.
Aortic-root dilatation in Noonan's syndrome.
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The pattern of cardiovascular malformation in the CHARGE association.
Congenital heart disease occurred in 64% of patients with the CHARGE (coloboma, heart disease, choanal atresia, retardation of postnatal growth and mental development, genitalia hypoplasia, and ear anomalies) association (55% of 67 previously described patients and 100% of 16 new patients). Of those with congenital heart disease, 42% had conotruncal anomalies (tetralogy of Fallot, double-outlet right ventricle, truncus arteriosus), and 36% had aortic arch anomalies (vascular ring, aberrant subclavian artery, interrupted aortic arch). This striking pattern of cardiovascular malformations is similar to that found in the DiGeorge sequence.
Unusual pedigree patterns in families with spinal muscular atrophy.
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Balloon and blade atrial septostomy facilitated by two-dimensional echocardiography.
Two-dimensional echocardiography (2-D echo) was used as an imaging device for the performance of balloon atrial septostomy (n = 25) and blade atrial septostomy (n = 3). Biplane fluoroscopy with 2-D echo or 2-D echo alone were used in the cardiac catheterization laboratory to place the balloon or blade septostomy catheter in the left atrium. Echocardiography confirmed the position of the septostomy catheter before pullback. Balloon inflation and balloon or blade pullback to the right atrium was performed with 2-D echocardiographic visualization. In 8 critically ill newborn infants, balloon atrial septostomy was done in the neonatal intensive care unit without flouroscopy. The safety and efficacy of 2-D echo to assist balloon or blade atrial septostomy in the catheterization laboratory or as the sole imaging device in the neonatal intensive care unit are confirmed. Use of the subcostal 4-chamber and sagittal views to image cardiac anatomy and catheter position during the procedure are emphasized. Two-dimensional echo is particularly helpful in cases of cardiac malposition and during transseptal puncture of the atrial septum before blade septostomy, and lowers radiation dose when used in conjunction with fluoroscopy.
Aortic dilation, dissection, and rupture in patients with Turner syndrome.
We report two patients with Turner syndrome who had aortic dissection and rupture, one with prior repair of coarctation. We also note the high incidence (8.8%) of unrecognized aortic root dilation in a group of 57 patients with Turner syndrome whom we prospectively evaluated by echocardiography. Our analysis and review of previously reported cases suggests that multiple risk factors may exist for aortic dissection, including coarctation, bicuspid aortic valve, and systemic hypertension, but that these need not be present. Aortic root dilation may be an additional finding that suggests the patient with Turner syndrome is also at risk. When it is present, magnetic resonance imaging visualizes the entire aorta and allows quantification of the site and degree of dilation. In patients with dissection, the aorta often exhibits pathologic evidence of cystic medial necrosis similar to the finding in patients with Marfan syndrome. Therapeutic methods to decrease risk, such as those directed toward prevention of bacterial endocarditis, blood pressure control, and perhaps prophylactic beta blockade or surgical reconstruction, may need to be considered. Patients with Turner syndrome, their families, and the physicians who care for them should be aware of the significance of unexplained chest pain, dyspnea, or hypotension as potential manifestations of aortic dissection or rupture.
Subaortic obstruction in complex congenital heart disease: management by proximal pulmonary artery to ascending aorta end to side anastomosis.
Six patients with univentricular heart and one patient with d-transposition of the great arteries had transection of the main pulmonary artery with an end to side anastomosis of the main pulmonary artery to the ascending aorta to relieve subaortic obstruction. Two operations were performed as a palliative procedure within the first 6 months of life and five were performed as part of a definitive repair (four modified Fontan procedures and one repair of transposition of the great arteries with ventricular septal defect). There was one surgical death (14%) occurring 1 day postoperatively from low cardiac output. The remaining six patients are doing well 1 to 19 months postoperatively (mean 11.4 months). The proximal pulmonary artery to ascending aorta end to side anastomosis is an effective means of bypassing subaortic obstruction associated with complex congenital heart disease.
Congenital heart disease in supernumerary der(22),t(11;22) syndrome.
Congenital heart disease occurred in 62% of the reported cases of supernumerary der(22) syndrome. These were most commonly acyanotic lesions such as atrial septal defect, ventricular septal defect or patent ductus arteriosus. Heart disease did not, however, appear to be a major determinant of survival.
Upper limb malformations associated with congenital heart disease.
Upper limb malformations occur in patients with congenital heart disease as multifactorial, chromosomal or teratogenic combinations, and can be predictable (nonrandom) or sporadic (random) associations. The cardiac and limb defects represent either essential features of a syndrome or less common or less significant components. A practical classification is proposed based on the frequency and relative consistency of upper limb and cardiac associations. Recognition of upper limb malformations helps to identify accompanying cardiac disease and aids in the choice of diagnostic and therapeutic interventions in determination of prognosis and in genetic counseling. Upper limb malformations are the commonest skeletal abnormalities in patients with congenital heart disease, but it is also important to know with which limb defects concordance is low.
Familial persistent pulmonary hypertension.
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Maple syrup smell in the intensive care unit.
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Airway foreign body.
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I heartily praise the first issue of Genetics in Medicine for its immediate applicability to clinical genetic practice.
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Heterotaxy: associated conditions and hospital-based prevalence in newborns.
PURPOSE: To provide insight into the possible etiology and prevalence of heterotaxy, we studied conditions associated with heterotaxy in a consecutive hospital population of newborns. METHODS: From 1972 to March, 1999 (except February 16, 1972 to December 31, 1978), 58 cases of heterotaxy were ascertained from a cohort of 201,084 births in the ongoing Active Malformation Surveillance Program at the Brigham and Women's Hospital. This registry includes livebirths, stillbirths, and elective abortions. Prevalence among nontransfers (i.e., patients whose mothers had planned delivery at this hospital) was calculated as approximately 1 per 10,000 total births (20 of 201,084). RESULTS: We analyzed a total of 58 patients consisting of 20 (34%) nontransfers and 38 (66%) transfers. Patients were categorized by spleen status as having asplenia (7 nontransfers, 25 total), polysplenia (8, 20), right spleen (4, 11), normal left (0, 1), and unknown (1, 0). Among the 20 nontransfer and 59 total heterotaxy patients, the following associated medical conditions were present: chromosome abnormality (1 nontransfer, 2 total), suspected Mendelian or chromosome microdeletion disorder (1 nontransfer, 6 total), and maternal insulin-dependent diabetes mellitus (1 nontransfer, 2 total). There were 6 twins (1 member each from 6 twin pairs including 1 dizygous, 4 monozygous, 1 conjoined; 2 were nontransfers). An associated condition occurred in 5 (25%) nontransfer and 16 (28%) total patients, or among 10 of 53 singleton births (19%). CONCLUSIONS: Although most cases of heterotaxy in this series were sporadic events, an associated condition was present in about one-fourth of the cases. Not all of these conditions would be considered causative etiologies. Based on this small series alone, maternal insulin-dependent diabetes cannot be viewed as a risk factor for heterotaxy. However, the specific association of diabetes with polysplenia with/without left atrial isomerism is noteworthy, and adds weight to animal and epidemiologic case-control data.