title: Polyvalvular heart disease with joint hypermobility, characteristic facies, and particular skin abnormalities: new cases of "polyvalvular heart disease syndrome" or new association?
abstract: Polyvalvular heart disease has been reported in a handful of "private" syndromes that have been recently suggested to represent a single dominantly inherited condition, the polyvalvular heart disease syndrome. We report five cases in two unrelated families (one sporadic case in the first family and three siblings and their father in the second family) with the same association of polyvalvular heart disease, distinctive facial appearance, and, except the father in family 2, major joint hypermobility. Interestingly, in three of our patients (2 siblings and the sporadic case), electron microscopy revealed characteristic ultrastructural skin abnormalities with abnormal amorphous or microfibrillar deposits under the capillary basal membrane in the papillary dermis, suggestive of a connective tissue disorder, but different from Marfan syndrome or Ehlers-Danlos syndrome. Moreover, in family 2, three others sibs died in early infancy of their heart defect. Our two families and the other published cases might illustrate intrafamilial and interfamilial variability within a single condition. However, our two families disclose major joint hypermobility, normal stature, and ultrastructural skin abnormalities that were not described in the previous reports. These discrepancies let us to consider them as affected by a distinct disorder of the connective tissue.
authors.affiliation: Department of Endocrinology, Children's University Hospital, 330 Avenue de Grande Bretagne, Toulouse cedex 9, France. edouard.t@chu-toulouse.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Edouard
authors.forename: Catherine
authors.initials: C
authors.lastname: Prost-Squarcioni
authors.forename: Yves
authors.initials: Y
authors.lastname: Dulac
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vaysse
authors.forename: Hélène
authors.initials: H
authors.lastname: Cavé
authors.forename: Pascale
authors.initials: P
authors.lastname: Saugier-Veber
authors.forename: Georges
authors.initials: G
authors.lastname: Bourrouillou
authors.forename: Alain
authors.initials: A
authors.lastname: Verloes
authors.forename: Maithé
authors.initials: M
authors.lastname: Tauber
authors.forename: Eric
authors.initials: E
authors.lastname: Bieth
mesh_terms: D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003240:Connective Tissue Diseases / Q000235:genetics*; D062109:Dermatologic Surgical Procedures; D004535:Ehlers-Danlos Syndrome / Q000235:genetics; D019066:Facies; D005260:Female; D006330:Heart Defects, Congenital / Q000235:genetics*; D006801:Humans; D007593:Joint Instability / Q000235:genetics*; D008297:Male; D008382:Marfan Syndrome / Q000235:genetics; D010375:Pedigree; D012867:Skin / Q000648:ultrastructure; D012868:Skin Abnormalities / Q000235:genetics*; D013577:Syndrome