title: Symptomatic children with hereditary hemorrhagic telangiectasia: a pediatric center experience.
abstract: OBJECTIVE
  To assess the clinical and genetic characteristics of symptomatic children with hereditary hemorrhagic telangiectasia (HHT).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The HHT clinics in Toronto.
  
  
  METHODS
  All children with symptomatic HHT treated from April 1, 1996, through December 31, 2002.
  
  
  METHODS
  Participants were screened for visceral arteriovenous malformations (AVMs). Molecular testing was performed in the children or their affected family members.
  
  
  METHODS
  Prevalence of epistaxis, telangiectases, pulmonary and cerebral AVMs, and genetic characteristics.
  
  
  RESULTS
  Fourteen children presented with manifestations of HHT. Seven had cardiorespiratory symptoms related to pulmonary AVMs. Three had neurological symptoms secondary to bleeding from spinal or cerebral AVMs. Two were referred because of skin telangiectases and 2, because of multiple episodes of epistaxis. Screening results revealed a cerebral AVM in 1 of 11 neurologically asymptomatic children. Of the children without respiratory symptoms, 1 was diagnosed as having definite and 1, suspected pulmonary AVMs. Four children with pulmonary AVMs carried an endoglin gene mutation (HHT type 1), and 1 carried an activin receptor-like kinase 1 gene mutation (HHT type 2). The 2 children with spinal AVMs belong to the same HHT type 2 family. No mutation was found in 1 child with pulmonary and 1 with cerebral AVMs.
  
  
  CONCLUSIONS
  Visceral AVMs and mucosal telangiectases are present in children with HHT and can lead to life-threatening events. Failure to identify a disease-associated mutation for each child suggests complex mutations or novel HHT genes.
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. meirmeizahav@hotmail.com
authors.forename: Meir
authors.initials: M
authors.lastname: Mei-Zahav
authors.forename: Michelle
authors.initials: M
authors.lastname: Letarte
authors.forename: Marie E
authors.initials: ME
authors.lastname: Faughnan
authors.forename: Salma A
authors.initials: SA
authors.lastname: Abdalla
authors.forename: Ursula
authors.initials: U
authors.lastname: Cymerman
authors.forename: Ian B
authors.initials: IB
authors.lastname: MacLusky
mesh_terms: D000293:Adolescent; D001165:Arteriovenous Malformations / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004844:Epistaxis / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D009154:Mutation; D011652:Pulmonary Circulation; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000175:diagnosis / Q000235:genetics*