Skip to main content

Cardiac, Aortic, and Pulmonary Vascular Involvement in Alagille Syndrome

  • Chapter
  • First Online:
Alagille Syndrome

Abstract

Congenital heart disease is present in over 75% of patients with Alagille syndrome. In fact, stenosis and/or hypoplasia of the branch pulmonary arteries, the most common cardiovascular abnormality, is one of the five elements used in the clinical diagnosis of this syndrome. Other commonly occurring lesions include tetralogy of Fallot, pulmonary valve stenosis or atresia, valvar or supravalvar aortic stenosis, and aortic coarctation. The peripheral vasculature is frequently affected as well. In this chapter, we discuss in detail the spectrum and incidence of congenital cardiovascular disease in patients with Alagille syndrome, as well as recommended diagnostic approaches and findings, surveillance, management, and outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Watson GH, Miller V. Arteriohepatic dysplasia: familial pulmonary arterial stenosis with neonatal liver disease. Arch Dis Child. 1973;48:459–66.

    Article  CAS  Google Scholar 

  2. Alagille D, Estrada A, Hadchouel M, Gautier M, Odievre M, Dommergues JP. Syndromic paucity of interlobular bile ducts (Alagille syndrome or arteriohepatic dysplasia): review of 80 cases. J Pediatr. 1987;110:195–200.

    Article  CAS  Google Scholar 

  3. Kamath BM, Spinner NB, Emerick KM, et al. Vascular anomalies in Alagille syndrome: a significant cause of morbidity and mortality. Circulation. 2004;109:1354–8.

    Article  Google Scholar 

  4. McElhinney DB, Krantz ID, Bason L, et al. Analysis of cardiovascular phenotype and genotype-phenotype correlation in individuals with a JAG1 mutation and/or Alagille syndrome. Circulation. 2002;106:2567–74.

    Article  Google Scholar 

  5. Ahn KJ, Yoon JK, Kim GB, et al. Alagille syndrome and a JAG1 mutation: 41 cases of experience at a single center. Korean J Pediatr. 2015;58:392–7.

    Article  Google Scholar 

  6. Rodriguez RM, Feinstein JA, Chan FP. CT-defined phenotype of pulmonary artery stenoses in Alagille syndrome. Pediatr Radiol. 2016;46:1120–7.

    Article  Google Scholar 

  7. Fattouh AM, Mogahed EA, Abdel Hamid N, Sobhy R, Saber N, El-Karaksy H. The prevalence of congenital heart defects in infants with cholestatic disorders of infancy: a single-Centre study. Arch Dis Child. 2016;101:803–7.

    Article  Google Scholar 

  8. Bauer RC, Laney AO, Smith R, et al. Jagged1 (JAG1) mutations in patients with tetralogy of Fallot or pulmonic stenosis. Hum Mutat. 2010;31:594–601.

    Article  CAS  Google Scholar 

  9. Guida V, Chiappe F, Ferese R, et al. Novel and recurrent JAG1 mutations in patients with tetralogy of Fallot. Clin Genet. 2011;80:591–4.

    Article  CAS  Google Scholar 

  10. Kola S, Koneti NR, Golla JP, Akka J, Gundimeda SD, Mundluru HP. Mutational analysis of JAG1 gene in non-syndromic tetralogy of Fallot children. Clin Chim Acta. 2011;412:2232–6.

    Article  CAS  Google Scholar 

  11. Niessen K, Karsan A. Notch signaling in cardiac development. Circ Res. 2008;102:1169–81.

    Article  CAS  Google Scholar 

  12. Hofmann JJ, Briot A, Enciso J, et al. Endothelial deletion of murine Jag1 leads to valve calcification and congenital heart defects associated with Alagille syndrome. Development. 2012;139:4449–60.

    Article  CAS  Google Scholar 

  13. Emerick KM, Rand EB, Goldmuntz E, Krantz ID, Spinner NB, Piccoli DA. Features of Alagille syndrome in 92 patients: frequency and relation to prognosis. Hepatology. 1999;29:822–9.

    Article  CAS  Google Scholar 

  14. Ozcay F, Varan B, Tokel K, Cetin I, Dalgic A, Haberal M. Severe peripheral pulmonary artery stenosis is not a contraindication to liver transplantation in Alagille syndrome. Pediatr Transplant. 2006;10:108–11.

    Article  Google Scholar 

  15. Png K, Veyckemans F, De Kock M, et al. Hemodynamic changes in patients with Alagille's syndrome during orthotopic liver transplantation. Anesth Analg. 1999;89:1137–42.

    Article  CAS  Google Scholar 

  16. Cheng KW, Huang JJ, Wang CH, Chen CL, Jawan B. Anesthetic management of a patient with Alagille's syndrome undergoing living donor liver transplantation without blood transfusion. Chang Gung Med J. 2004;27:449–53.

    PubMed  Google Scholar 

  17. Goldmuntz E, Moore E, Spinner NB. The cardiovascular manifestations of Alagille syndrome and JAGI mutations. Methods Mol Med. 2006;126:217–31.

    CAS  PubMed  Google Scholar 

  18. Spinner NB, Colliton RP, Crosnier C, Krantz ID, Hadchouel M, Meunier-Rotival M. Jagged1 mutations in alagille syndrome. Hum Mutat. 2001;17:18–33.

    Article  CAS  Google Scholar 

  19. Warthen DM, Moore EC, Kamath BM, et al. Jagged1 (JAG1) mutations in Alagille syndrome: increasing the mutation detection rate. Hum Mutat. 2006;27:436–43.

    Article  CAS  Google Scholar 

  20. Guegan K, Stals K, Day M, Turnpenny P, Ellard S. JAG1 mutations are found in approximately one third of patients presenting with only one or two clinical features of Alagille syndrome. Clin Genet. 2012;82:33–40.

    Article  CAS  Google Scholar 

  21. Lu F, Morrissette JJ, Spinner NB. Conditional JAG1 mutation shows the developing heart is more sensitive than developing liver to JAG1 dosage. Am J Hum Genet. 2003;72:1065–70.

    Article  CAS  Google Scholar 

  22. Davit-Spraul A, Pourci ML, Atger V, et al. Abnormal lipoprotein pattern in patients with Alagille syndrome depends on Icterus severity. Gastroenterology. 1996;111:1023–32.

    Article  CAS  Google Scholar 

  23. Bojanovski M, Lukermann R, Schulz-Falten J, Sturm E, Burdelski M, Bojanovski D. Parameters of lipoprotein metabolism and cholestasis in healthy and cholestatic infants and children. Prog Lipid Res. 1991;30:295–300.

    Article  CAS  Google Scholar 

  24. May L, Hanley FL, Connolly AJ, Reddy S. Atherosclerosis causing recurrent catastrophic aortopulmonary shunt dehiscence in a patient with Alagille syndrome. Pediatr Cardiol. 2013;34:1945–8.

    Article  CAS  Google Scholar 

  25. Nagasaka H, Yorifuji T, Egawa H, et al. Evaluation of risk for atherosclerosis in Alagille syndrome and progressive familial intrahepatic cholestasis: two congenital cholestatic diseases with different lipoprotein metabolisms. J Pediatr. 2005;146:329–35.

    Article  CAS  Google Scholar 

  26. Arnon R, Annunziato R, Miloh T, et al. Orthotopic liver transplantation for children with Alagille syndrome. Pediatr Transplant. 2010;14:622–8.

    Article  Google Scholar 

  27. Madan N, Arnon R, Arnon R. Evaluation of cardiac manifestations in pediatric liver transplant candidates. Pediatr Transplant. 2012;16:318–28.

    Article  CAS  Google Scholar 

  28. Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465–95; quiz 576–7

    Article  Google Scholar 

  29. Simpson J, Lopez L, Acar P, et al. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30:1–27.

    Article  Google Scholar 

  30. Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014;129:2183–242.

    Article  Google Scholar 

  31. Trivedi KR, Benson LN. Interventional strategies in the management of peripheral pulmonary artery stenosis. J Interv Cardiol. 2003;16:171–88.

    Article  Google Scholar 

  32. Mainwaring RD, Hanley FL. Surgical techniques for repair of peripheral pulmonary artery stenosis. Semin Thorac Cardiovasc Surg. 2016;28:418–24.

    Article  Google Scholar 

  33. Gandy KL, Tweddell JS, Pelech AN. How we approach peripheral pulmonary stenosis in Williams-Beuren syndrome. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2009;12:118–21.

    Article  Google Scholar 

  34. Monge MC, Mainwaring RD, Sheikh AY, Punn R, Reddy VM, Hanley FL. Surgical reconstruction of peripheral pulmonary artery stenosis in Williams and Alagille syndromes. J Thorac Cardiovasc Surg. 2013;145:476–81.

    Article  Google Scholar 

  35. Cunningham JW, McElhinney DB, Gauvreau K, et al. Outcomes after primary transcatheter therapy in infants and young children with severe bilateral peripheral pulmonary artery stenosis. Circ Cardiovasc Interv. 2013;6:460–7.

    Article  Google Scholar 

  36. Zussman M, Hirsch R, Beekman RH 3rd, Goldstein BH. Impact of percutaneous interventions for pulmonary artery stenosis in Alagille syndrome. Congenit Heart Dis. 2015;10:310–6.

    Article  Google Scholar 

  37. Hallbergson A, Lock JE, Marshall AC. Frequency and risk of in-stent stenosis following pulmonary artery stenting. Am J Cardiol. 2014;113:541–5.

    Article  Google Scholar 

  38. Bauser-Heaton H, Borquez A, Han B, et al. Programmatic approach to management of tetralogy of Fallot with major aortopulmonary collateral arteries: a 15-year experience with 458 patients. Circ Cardiovasc Interv. 2017;10:e004952.

    Article  CAS  Google Scholar 

  39. Vobecky SJ, Williams WG, Trusler GA, et al. Survival analysis of infants under age 18 months presenting with tetralogy of Fallot. Ann Thorac Surg. 1993;56:944–9; discussion 949–50

    Article  CAS  Google Scholar 

  40. Ovaert C, Germeau C, Barrea C, et al. Elevated right ventricular pressures are not a contraindication to liver transplantation in Alagille syndrome. Transplantation. 2001;72:345–7.

    Article  CAS  Google Scholar 

  41. Razavi RS, Baker A, Qureshi SA, et al. Hemodynamic response to continuous infusion of dobutamine in Alagille's syndrome. Transplantation. 2001;72:823–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Doff B. McElhinney .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tretter, J.T., McElhinney, D.B. (2018). Cardiac, Aortic, and Pulmonary Vascular Involvement in Alagille Syndrome. In: Kamath, B., Loomes, K. (eds) Alagille Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-94571-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-94571-2_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94570-5

  • Online ISBN: 978-3-319-94571-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics