Echocardiographic evaluation of asymptomatic parental and sibling cardiovascular anomalies associated with congenital left ventricular outflow tract lesions.
OBJECTIVE
Left ventricular outflow tract obstructive (LVOTO) malformations are a leading cause of infant mortality from birth defects. Genetic mechanisms are likely, and there may be a higher rate of asymptomatic LVOTO anomalies in relatives of affected children. This study sought to define the incidence of cardiac anomalies in first-degree relatives of children with congenital aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS).


METHODS
A total of 113 probands with a nonsyndromic LVOTO malformation of AVS (n = 25), BAV (n = 3), CoA (n = 52), HLHS (n = 30), and aortic hypoplasia with mitral valve atresia (n = 2) were ascertained through chart review or enrolled at the time of diagnosis. Echocardiography was performed on 282 asymptomatic first-degree relatives.


RESULTS
Four studies had poor acoustic windows, leaving 278 studies for analysis. BAV were found in 13 (4.68%) first-degree relatives. The relative risk of BAV in the relatives was 5.05 (95% confidence interval: 2.2-11.7), and the broad sense heritability was 0.49, based on a general population frequency of 0.9%. BAV was more common in multiplex families compared with sporadic cases. An additional 32 relatives had anomalies of the aorta, aortic valve, left ventricle, or mitral valve.


CONCLUSIONS
The presence of an LVOTO lesion greatly increases the risk of identifying BAV in a parent or sibling, providing additional support for a complex genetic cause. The parents and siblings of affected patients should be screened by echocardiography as the presence of an asymptomatic BAV may carry a significant long-term health risk.
Lewin
Mark B
MB
Division of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
McBride
Kim L
KL
Pignatelli
Ricardo
R
Fernbach
Susan
S
Combes
Ana
A
Menesses
Andres
A
Lam
Wilbur
W
Bezold
Louis I
LI
Kaplan
Norman
N
Towbin
Jeffrey A
JA
Belmont
John W
JW
D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000235:genetics; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000235:genetics; D015150:Echocardiography, Doppler; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000235:genetics*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000235:genetics; D008297:Male; D010290:Parents; D012306:Risk; D035781:Siblings