Skip to main content
Log in

Heart failure and pulmonary arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia type 2

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominantly inherited vascular-malformation syndrome associated with gene mutations including ENG, ACVRL1 and SMAD4 gene. Clinically indistinguishable HHT1 and HHT2 are caused by mutations in ENG and ACVRL1 gene, respectively. Generally, pulmonary arteriovenous malformations (PAVMs) and pulmonary arterial hypertension (PAH) are rare manifestations of HHT related to ACVRL1 gene mutations. We described a female patient with HHT2 whose clinical features included epistaxis, mucocutaneous telangiectases, systemic AVMs and PAH. She also suffered from severe iron deficiency anemia and recurrent heart failure. A genetic mutation analysis disclosed a missense mutation in exon 7 of ACVRL1 gene in this patient and her daughter. A nonsense mutation in exon 7 of ACVRL1 gene was detected in her brother and her niece. This case supports that PAVMs and PAH can be rare manifestations of HHT2 patients.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Plauchu H, de Chadarevian JP, Bideau A, Robert JM (1989) Age-related clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population. Am J Med Genet 32(3):291–297

    Article  CAS  PubMed  Google Scholar 

  2. Marchuk DA, Guttmacher AE, Penner JA, Ganguly P (1998) Report on the workshop on hereditary hemorrhagic telangiectasia, July 10–1, 19971. Am J Med Genet 76(3):269–273

    Article  CAS  PubMed  Google Scholar 

  3. McAllister KA, Grogg KM, Johnson DW et al (1994) Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet 8(4):345–351

    Article  CAS  PubMed  Google Scholar 

  4. Johnson DW, Berg JN, Gallione CJ et al (1995) A second locus for hereditary hemorrhagic telangiectasia maps to chromosome 12. Genome Res 5(1):21–28

    Article  CAS  PubMed  Google Scholar 

  5. Gallione CJ, Repetto GM, Legius E et al (2004) A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet 363(9412):852–859

    Article  CAS  PubMed  Google Scholar 

  6. Richards-Yutz J, Grant K, Chao EC, Walther SE, Ganguly A (2010) Update on molecular diagnosis of hereditary hemorrhagic telangiectasia. Hum Genet 128(1):61–77

    Article  CAS  PubMed  Google Scholar 

  7. Prigoda NL, Savas S, Abdalla SA et al (2006) Hereditary haemorrhagic telangiectasia: mutation detection, test sensitivity and novel mutations. J Med Genet 43(9):722–728

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Cole SG, Begbie ME, Wallace GM, Shovlin CL (2005) A new locus for hereditary haemorrhagic telangiectasia (HHT3) maps to chromosome 5. J Med Genet 42(7):577–582

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Bayrak-Toydemir P, McDonald J, Akarsu N, Toydemir RM, Calderon F, Tuncali T, Tang W, Miller F, Mao R (2006) A fourth locus for hereditary hemorrhagic telangiectasia maps to chromosome 7. Am J Med Genet A 140(20):2155–2162

    Article  PubMed  Google Scholar 

  10. David L, Mallet C, Mazerbourg S, Feige JJ, Bailly S (2007) Identification of BMP9 and BMP10 as functional activators of the orphan activin receptor-like kinase 1 (ALK1) in endothelial cells. Blood 109(5):1953–1961

    Article  CAS  PubMed  Google Scholar 

  11. Castonguay R, Werner ED, Matthews RG et al (2011) Soluble endoglin specifically binds bone morphogenetic proteins 9 and 10 via its orphan domain, inhibits blood vessel formation, and suppresses tumor growth. J Biol Chem 286(34):30034–30046

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Tillet E, Bailly S (2014) Emerging roles of BMP9 and BMP10 in hereditary hemorrhagic telangiectasia. Front Genet 5:456

    PubMed Central  PubMed  Google Scholar 

  13. Shovlin CL, Guttmacher AE, Buscarini E, Faughnan ME, Hyland RH, Westermann CJ, Kjeldsen AD, Plauchu H (2000) Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 91(1):66–67

    Article  CAS  PubMed  Google Scholar 

  14. Pasculli G, Resta F, Guastamacchia E, Di Gennaro L, Suppressa P, Sabba C (2004) Health-related quality of life in a rare disease: hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease. Qual Life Res 13(10):1715–1723

    Article  PubMed  Google Scholar 

  15. Faughnan ME, Palda VA, Garcia-Tsao G et al (2011) International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 48(2):73–87

    Article  CAS  PubMed  Google Scholar 

  16. Stross P (2013) Woman presenting with chronic iron deficiency anemia associated with hereditary hemorrhagic telangiectasia: a case report. Drug Healthc Patient Saf 5:203–210

    Article  PubMed Central  PubMed  Google Scholar 

  17. Letteboer TG, Mager JJ, Snijder RJ, Koeleman BP, Lindhout D, Ploos van Amstel JK, Westermann CJ (2006) Genotype-phenotype relationship in hereditary haemorrhagic telangiectasia. J Med Genet 43(4):371–377

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Mahmoud M, Borthwick GM, Hislop AA, Arthur HM (2009) Endoglin and activin receptor-like-kinase 1 are co-expressed in the distal vessels of the lung: implications for two familial vascular dysplasias, HHT and PAH. Lab Investig 89(1):15–25

    Article  CAS  PubMed  Google Scholar 

  19. Gossage JR, Kanj G (1998) Pulmonary arteriovenous malformations: a state of the art review. Am J Respir Crit Care Med 158(2):643–661

    Article  CAS  PubMed  Google Scholar 

  20. Moyer JH, Glantz G, Brest AN (1962) Pulmonary arteriovenous fistulas: physiologic and clinical considerations. Am J Med 32:417–435

    Article  CAS  PubMed  Google Scholar 

  21. Rodan BA, Goodwin JD, Chen JT, Ravin CE (1981) Worsening pulmonary hypertension after resection of arteriovenous fistula. AJR Am J Roentgenol 137(4):864–866

    Article  CAS  PubMed  Google Scholar 

  22. Cottin V, Dupuis-Girod S, Lesca G, Cordier JF (2007) Pulmonary vascular manifestations of hereditary hemorrhagic telangiectasia (Rendu-Osler disease). Respiration 74(4):361–378

    Article  CAS  PubMed  Google Scholar 

  23. Trembath RC, Thomson JR, Machado RD et al (2001) Clinical and molecular genetic features of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia. N Engl J Med 345(5):325–334

    Article  CAS  PubMed  Google Scholar 

  24. Harrison RE, Flanagan JA, Sankelo M et al (2003) Molecular and functional analysis identifies ALK-1 as the predominant cause of pulmonary hypertension related to hereditary haemorrhagic telangiectasia. J Med Genet 40(12):865–871

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Koyalakonda SP, Pyatt J (2011) High output heart failure caused by a large pelvic arteriovenous malformation. JRSM Short Rep 2(8):66

    Article  PubMed Central  PubMed  Google Scholar 

  26. Girerd B, Montani D, Coulet F et al (2010) Clinical outcomes of pulmonary arterial hypertension in patients carrying an ACVRL1 (ALK1) mutation. Am J Respir Crit Care Med 181(8):851–861

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Xiao-Hua Luo or Lin Liu.

Additional information

Juan Du and Yan Zhu have contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 50 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Du, J., Zhu, Y., Zhang, YL. et al. Heart failure and pulmonary arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia type 2. J Thromb Thrombolysis 40, 515–519 (2015). https://doi.org/10.1007/s11239-015-1253-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-015-1253-z

Keywords

Navigation