Abstract
We report a three-generation family with nine patients affected by a combination of cardiac abnormalities and left isomerism which, to our knowledge, has not been described before. The cardiac anomalies include non-compaction of the ventricular myocardium, bradycardia, pulmonary valve stenosis, and secundum atrial septal defect. The laterality sequence anomalies include left bronchial isomerism, azygous continuation of the inferior vena cava, polysplenia and intestinal malrotation, all compatible with left isomerism. This new syndrome is inherited in an autosomal dominant pattern. A genome-wide linkage analysis suggested linkage to chromosome 6p24.3–21.2 with a maximum LOD score of 2.7 at marker D6S276. The linkage interval is located between markers D6S470 (telomeric side) and D6S1610 (centromeric side), and overlaps with the linkage interval in another family with heterotaxy reported previously. Taken together, the genomic region could be reduced to 9.4 cM (12 Mb) containing several functional candidate genes for this complex heterotaxy phenotype.
Similar content being viewed by others
References
Agirbasli M, Hamid R, Jennings HS 3rd, Tiller GE (2000) Situs inversus with hypertrophic cardiomyopathy in identical twins. Am J Med Genet 91:327–330
Alonso S, Pierpont ME, Radtke W, Martinez J, Chen SC, Grant JW, Dahnert I, Taviaux S, Romey MC, Demaille J et al (1995) Heterotaxia syndrome and autosomal dominant inheritance. Am J Med Genet 56:12–15
Armstrong EJ, Bischoff J (2004) Heart valve development: endothelial cell signaling and differentiation. Circ Res 95:459–470
Bamford RN, Roessler E, Burdine RD, Saplakoglu U, dela Cruz J, Splitt M, Goodship JA, Towbin J, Bowers P, Ferrero GB, Marino B, Schier AF, Shen MM, Muenke M, Casey B (2000) Loss-of-function mutations in the EGF-CFC gene CFC1 are associated with human left–right laterality defects. Nat Genet 26:365–369
Befeler B (1975) Idiopathic hypertrophic subaortic stenosis in patients with situs inversus totalis. Chest 67:4–5
Bleyl SB, Mumford BR, Brown-Harrison MC, Pagotto LT, Carey JC, Pysher TJ, Ward K, Chin TK (1997a) Xq28-linked noncompaction of the left ventricular myocardium: prenatal diagnosis and pathologic analysis of affected individuals. Am J Med Genet 72:257–265
Bleyl SB, Mumford BR, Thompson V, Carey JC, Pysher TJ, Chin TK, Ward K (1997b) Neonatal, lethal noncompaction of the left ventricular myocardium is allelic with Barth syndrome. Am J Hum Genet 61:868–872
Casey B, Cuneo BF, Vitali C, van Hecke H, Barrish J, Hicks J, Ballabio A, Hoo JJ (1996) Autosomal dominant transmission of familial laterality defects. Am J Med Genet 61:325–328
Cavusoglu Y, Ata N, Timuralp B, Gorenek B, Goktekin O, Kudaiberdieva G, Unalir A (2003) Noncompaction of the ventricular myocardium: report of two cases with bicuspid aortic valve demonstrating poor prognosis and with prominent right ventricular involvement. Echocardiography 20:379–383
Chen R, Tsuji T, Ichida F, Bowles KR, Yu X, Watanabe S, Hirono K, Tsubata S, Hamamichi Y, Ohta J, Imai Y, Bowles NE, Miyawaki T, Towbin JA (2002) Mutation analysis of the G4.5 gene in patients with isolated left ventricular noncompaction. Mol Genet Metab 77:319–325
Chen H, Shi S, Acosta L, Li W, Lu J, Bao S, Chen Z, Yang Z, Schneider MD, Chien KR, Conway SJ, Yoder MC, Haneline LS, Franco D, Shou W (2004) BMP10 is essential for maintaining cardiac growth during murine cardiogenesis. Development 131:2219–2231
Cochran PT, Wanamaker JL (1975) Idiopathic hypertrophic subaortic stenosis in a patient with mirror-image dextrocardia. Chest 67:103–106
Crawford SE, Qi C, Misra P, Stellmach V, Rao MS, Engel JD, Zhu Y, Reddy JK (2002) Defects of the heart, eye, and megakaryocytes in peroxisome proliferator activator receptor-binding protein (PBP) null embryos implicate GATA family of transcription factors. J Biol Chem 277:3585–3592
D’Adamo P, Fassone L, Gedeon A, Janssen EA, Bione S, Bolhuis PA, Barth PG, Wilson M, Haan E, Orstavik KH, Patton MA, Green AJ, Zammarchi E, Donati MA, Toniolo D (1997) The X-linked gene G4.5 is responsible for different infantile dilated cardiomyopathies. Am J Hum Genet 61:862–867
Dagdeviren B, Eren M, Oguz E (2002) Noncompaction of ventricular myocardium, complete atrioventricular block and minor congenital heart abnormalities: case report of an unusual coexistence. Acta Cardiol 57:221–224
Friedberg MK, Ursell PC, Silverman NH (2005) Isomerism of the left atrial appendage associated with ventricular noncompaction. Am J Cardiol 96:985–990
Friedman MA, Wiseman S, Haramati L, Gordon GM, Spevack DM (2007) Noncompaction of the left ventricle in a patient with dextroversion. Eur J Echocardiogr 8:70–73
Fukuzawa J, Haneda T, Ishii Y, Kawashima E, Ogawa Y, Matsuhashi H, Kawamura Y, Imamoto T, Tobise K, Onodera S (1993) A case report of isolated levocardia without intracardiac anomalies associated with sick sinus syndrome. Jpn Circ J 57:245–250
Gebbia M, Ferrero GB, Pilia G, Bassi MT, Aylsworth A, Penman-Splitt M, Bird LM, Bamforth JS, Burn J, Schlessinger D, Nelson DL, Casey B (1997) X-linked situs abnormalities result from mutations in ZIC3. Nat Genet 17:305–308
Hermida-Prieto M, Monserrat L, Castro-Beiras A, Laredo R, Soler R, Peteiro J, Rodriguez E, Bouzas B, Alvarez N, Muniz J, Crespo-Leiro M (2004) Familial dilated cardiomyopathy and isolated left ventricular noncompaction associated with lamin A/C gene mutations. Am J Cardiol 94:50–54
Ichida F, Tsubata S, Bowles KR, Haneda N, Uese K, Miyawaki T, Dreyer WJ, Messina J, Li H, Bowles NE, Towbin JA (2001) Novel gene mutations in patients with left ventricular noncompaction or Barth syndrome. Circulation 103:1256–1263
Kakura H, Miyahara K, Sohara H, Amitani S, Koga M, Moriyama Y, Taira A (1998) Isolated levocardia associated with absence of inferior vena cava, lobulated spleen and sick sinus syndrome. A case report. Jpn Heart J 39:235–241
King T, Bland Y, Webb S, Barton S, Brown NA (2002) Expression of Peg1 (Mest) in the developing mouse heart: involvement in trabeculation. Dev Dyn 225:212–215
Kosaki K, Bassi MT, Kosaki R, Lewin M, Belmont J, Schauer G, Casey B (1999a) Characterization and mutation analysis of human LEFTY A and LEFTY B, homologues of murine genes implicated in left–right axis development. Am J Hum Genet 64:712–721
Kosaki R, Gebbia M, Kosaki K, Lewin M, Bowers P, Towbin JA, Casey B (1999b) Left–right axis malformations associated with mutations in ACVR2B, the gene for human activin receptor type IIB. Am J Med Genet 82:70–76
Kurosaki K, Ikeda U, Hojo Y, Fujikawa H, Katsuki T, Shimada K (1999) Familial isolated noncompaction of the left ventricular myocardium. Cardiology 91:69–72
Lee Y, Song AJ, Baker R, Micales B, Conway SJ, Lyons GE (2000) Jumonji, a nuclear protein that is necessary for normal heart development. Circ Res 86:932–938
Miller SA, Dykes DD, Polesky HF (1988) A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res 16:1215
Noguchi A, Ito T, Tamura M, Harada K, Takada G (1997) Chylothorax in a polysplenia infant with cor triatriatum, pulmonary stenosis and sick sinus syndrome. Heart Vessels 12:247–249
Noseda M, McLean G, Niessen K, Chang L, Pollet I, Montpetit R, Shahidi R, Dorovini-Zis K, Li L, Beckstead B, Durand RE, Hoodless PA, Karsan A (2004) Notch activation results in phenotypic and functional changes consistent with endothelial-to-mesenchymal transformation. Circ Res 94:910–917
Pashmforoush M, Lu JT, Chen H, Amand TS, Kondo R, Pradervand S, Evans SM, Clark B, Feramisco JR, Giles W, Ho SY, Benson DW, Silberbach M, Shou W, Chien KR (2004) Nkx2-5 pathways and congenital heart disease; loss of ventricular myocyte lineage specification leads to progressive cardiomyopathy and complete heart block. Cell 117:373–386
Pauli RM, Scheib-Wixted S, Cripe L, Izumo S, Sekhon GS (1999) Ventricular noncompaction and distal chromosome 5q deletion. Am J Med Genet 85:419–423
Przemeck GK, Heinzmann U, Beckers J, Hrabe de Angelis M (2003) Node and midline defects are associated with left–right development in Delta1 mutant embryos. Development 130:3–13
Rigopoulos A, Rizos IK, Aggeli C, Kloufetos P, Papacharalampous X, Stefanadis C, Toutouzas P (2002) Isolated left ventricular noncompaction: an unclassified cardiomyopathy with severe prognosis in adults. Cardiology 98:25–32
Ritter M, Oechslin E, Sutsch G, Attenhofer C, Schneider J, Jenni R (1997) Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 72:26–31
Robinson SW, Morris CD, Goldmuntz E, Reller MD, Jones MA, Steiner RD, Maslen CL (2003) Missense mutations in CRELD1 are associated with cardiac atrioventricular septal defects. Am J Hum Genet 72:1047–1052
Sasse-Klaassen S, Gerull B, Oechslin E, Jenni R, Thierfelder L (2003) Isolated noncompaction of the left ventricular myocardium in the adult is an autosomal dominant disorder in the majority of patients. Am J Med Genet A 119:162–167
Sasse-Klaassen S, Probst S, Gerull B, Oechslin E, Nurnberg P, Heuser A, Jenni R, Hennies HC, Thierfelder L (2004) Novel gene locus for autosomal dominant left ventricular noncompaction maps to chromosome 11p15. Circulation 109:2720–2723
Sengupta PP, Mohan JC, Arora R (2001) Noncompaction of left ventricular myocardium in the presence of calcific aortic stenosis in an adult. Indian Heart J 53:766–768
Shi W, Chen H, Sun J, Buckley S, Zhao J, Anderson KD, Williams RG, Warburton D (2003) TACE is required for fetal murine cardiac development and modeling. Dev Biol 261:371–380
Shou W, Aghdasi B, Armstrong DL, Guo Q, Bao S, Charng MJ, Mathews LM, Schneider MD, Hamilton SL, Matzuk MM (1998) Cardiac defects and altered ryanodine receptor function in mice lacking FKBP12. Nature 391:489–492
Stollberger C, Finsterer J (2006) Left ventricular noncompaction, cardiac magnetic resonance imaging, and neuromuscular disorders. J Am Coll Cardiol 47:1233–1234; author reply 1234–1235
Vatta M, Mohapatra B, Jimenez S, Sanchez X, Faulkner G, Perles Z, Sinagra G, Lin JH, Vu TM, Zhou Q, Bowles KR, Di Lenarda A, Schimmenti L, Fox M, Chrisco MA, Murphy RT, McKenna W, Elliott P, Bowles NE, Chen J, Valle G, Towbin JA (2003) Mutations in Cypher/ZASP in patients with dilated cardiomyopathy and left ventricular non-compaction. J Am Coll Cardiol 42:2014–2027
Vitale E, Brancolini V, De Rienzo A, Bird L, Allada V, Sklansky M, Chae CU, Ferrero GB, Weber J, Devoto M, Casey B (2001) Suggestive linkage of situs inversus and other left–right axis anomalies to chromosome 6p. J Med Genet 38:182–185
Watanabe Y, Benson DW, Yano S, Akagi T, Yoshino M, Murray JC (2002) Two novel frameshift mutations in NKX2.5 result in novel features including visceral inversus and sinus venosus type ASD. J Med Genet 39:807–811
Wells DE, Befeler B (1975) Situs inversus totalis associated with subaortic and subpulmonic stenosis. Chest 67:101–103
Xing Y, Ichida F, Matsuoka T, Isobe T, Ikemoto Y, Higaki T, Tsuji T, Haneda N, Kuwabara A, Chen R, Futatani T, Tsubata S, Watanabe S, Watanabe K, Hirono K, Uese K, Miyawaki T, Bowles KR, Bowles NE, Towbin JA (2006) Genetic analysis in patients with left ventricular noncompaction and evidence for genetic heterogeneity. Mol Genet Metab 88:71–77
Acknowledgments
The authors thank the family members for their cooperation. They also thank Tom De Vries-Lentsch for the photographic work, and Deon Venter for suggestions.
Author information
Authors and Affiliations
Corresponding author
Additional information
M. W. Wessels, B. M. De Graaf: Both authors contributed equally.
Rights and permissions
About this article
Cite this article
Wessels, M.W., De Graaf, B.M., Cohen-Overbeek, T.E. et al. A new syndrome with noncompaction cardiomyopathy, bradycardia, pulmonary stenosis, atrial septal defect and heterotaxy with suggestive linkage to chromosome 6p. Hum Genet 122, 595–603 (2008). https://doi.org/10.1007/s00439-007-0436-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00439-007-0436-x