Cardiopatias Congênitas como um Sinal de Alerta para o Diagnóstico da Deleção do 22q11.2

Carregando...
Imagem de Miniatura
Citações na Scopus
12
Tipo de produção
article
Data de publicação
2014
Título da Revista
ISSN da Revista
Título do Volume
Editora
ARQUIVOS BRASILEIROS CARDIOLOGIA
Citação
ARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.103, n.5, p.382-390, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: To alert for the diagnosis of the 22q11.2 deletion syndrome (22q11.2DS) in patients with congenital heart disease (CHD). Objective: To describe the main CHDs, as well as phenotypic, metabolic and immunological findings in a series of 60 patients diagnosed with 22q11.2DS. Methods: The study included 60 patients with 22q11.2DS evaluated between 2007 and 2013 (M: F = 1.3, age range 14 days to 20 years and 3 months) at a pediatric reference center for primary immunodeficiencies. The diagnosis was established by detection of the 22q11.2 microdeletion using FISH (n = 18) and/or MLPA (n = 42), in association with clinical and laboratory information. Associated CHDs, progression of phenotypic facial features, hypocalcemia and immunological changes were analyzed. Results: CHDs were detected in 77% of the patients and the most frequent type was tetralogy of Fallot (38.3%). Surgical correction of CHD was performed in 34 patients. Craniofacial dysmorphisms were detected in 41 patients: elongated face (60%) and/or elongated nose (53.3%), narrow palpebral fissure (50%), dysplastic, overfolded ears (48.3%), thin lips (41.6%), elongated fingers (38.3%) and short stature (36.6%). Hypocalcemia was detected in 64.2% and decreased parathyroid hormone (PTH) level in 25.9%. Decrease in total lymphocytes, CD4 and CD8 counts were present in 40%, 53.3% and 33.3%, respectively. Hypogammaglobulinemia was detected in one patient and decreased concentrations of immunoglobulin M (IgM) in two other patients. Conclusion: Suspicion for 22q11.2DS should be raised in all patients with CHD associated with hypocalcemia and/or facial dysmorphisms, considering that many of these changes may evolve with age. The 22q11.2 microdeletion should be confirmed by molecular testing in all patients.
Palavras-chave
DiGeorge Syndrome, Crromosome Delection, Heart Defects, Congenital, Hypocalcemia, Chromosomes, Human
Referências
  1. Aksu G, 2005, TURKISH J PEDIATR, V47, P19
  2. Al-Herz Waleed, 2011, Front Immunol, V2, P54, DOI 10.3389/fimmu.2011.00054
  3. Belangero Sintia Iole Nogueira, 2009, Arq Bras Cardiol, V92, P307, DOI 10.1590/S0066-782X2009000400010
  4. Carneiro-Sampaio M, 2011, PEDIAT ALLERG IMM-UK, V22, P345, DOI 10.1111/j.1399-3038.2010.01084.x
  5. Carneiro-Sampaio M, 2013, J CLIN IMMUNOL, V33, P716, DOI 10.1007/s10875-013-9865-6
  6. de la Morena MT, 2013, CLIN IMMUNOL, V147, P11, DOI 10.1016/j.clim.2013.01.011
  7. Drew LJ, 2011, INT J DEV NEUROSCI, V29, P259, DOI 10.1016/j.ijdevneu.2010.09.007
  8. Duke SG, 2000, ARCH OTOLARYNGOL, V126, P1141
  9. Dutra RL, 2012, BMC RES NOTES, V9, P13
  10. Edelmann L, 2009, ANN NY ACAD SCI, V1151, P157, DOI 10.1111/j.1749-6632.2008.03610.x
  11. Fahed AC, 2013, CIRC RES, V112, P707, DOI 10.1161/CIRCRESAHA.112.300853
  12. Fomin ABF, 2010, CLINICS, V65, P865, DOI 10.1590/S1807-59322010000900009
  13. Gennery AR, 2012, CELL MOL LIFE SCI, V69, P17, DOI 10.1007/s00018-011-0842-z
  14. Goldmuntz E, 2005, CLIN PERINATOL, V32, P963, DOI 10.1016/j.clp.2005.09.006
  15. Hospital das Clinicas/FMUSP, 12 SIN AL IM PRIM 1
  16. Jacob CMA, 2008, J CLIN IMMUNOL, V28, pS56, DOI 10.1007/s10875-007-9163-2
  17. Karayiorgou M, 2010, NAT REV NEUROSCI, V11, P402, DOI 10.1038/nrn2841
  18. Kobrynski LJ, 2007, LANCET, V370, P1443, DOI 10.1016/S0140-6736(07)61601-8
  19. Markert ML, 2010, CLIN IMMUNOL, V135, P236, DOI 10.1016/j.clim.2010.02.007
  20. McDonald R, 2013, PEDIATR CARDIOL, V34, P341, DOI 10.1007/s00246-012-0454-x
  21. McDonald-McGinn DM, 2011, MEDICINE, V90, P1, DOI 10.1097/MD.0b013e3182060469
  22. Momma K, 2010, AM J CARDIOL, V105, P1617, DOI 10.1016/j.amjcard.2010.01.333
  23. Patel K, 2012, J PEDIATR-US, V161, P950, DOI 10.1016/j.jpeds.2012.06.018
  24. Pena DJ, 2011, PLOS ONE, V6
  25. PINKEL D, 1986, P NATL ACAD SCI USA, V83, P2934, DOI 10.1073/pnas.83.9.2934
  26. PORTO M H O, 1988, Revista do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, V43, P294
  27. Rosa RFM, 2011, REV ASSOC MED BRAS, V57, P62, DOI 10.1590/S0104-42302011000100018
  28. Rosa RFM, 2009, ARQ BRAS CARDIOL, V93, pE67, DOI 10.1590/S0066-782X2009001000025
  29. Ryan AK, 1997, J MED GENET, V34, P798, DOI 10.1136/jmg.34.10.798
  30. Sullivan KE, 2002, PROGR PEDIAT CARDIOL, V15, P103, DOI 10.1016/S1058-9813(02)00034-6
  31. van Gent R, 2009, CLIN IMMUNOL, V133, P95, DOI 10.1016/j.clim.2009.05.020
  32. Ziolkowska L, 2008, EUR J PEDIATR, V167, P1135, DOI 10.1007/s00431-007-0645-2