Incidence of congenital malformations in children born after ICSI

The aim of this study was to determine the incidence of congenital malformations in a complete cohort of children born after intracytoplasmic sperm injection (ICSI). The medical records were retrieved for 1139 infants, 736 singletons, 200 sets of twins and one set of triplets. The total number of infants with an identified anomaly was 87 (7.6%), 40 of which were minor. The incidence of malformations in children born after ICSI was also compared with all births in Sweden using data from the Swedish Medical Birth Registry and the Registry of Congenital Malformations. For ICSI children, the odds ratio (OR) for having any major or minor malformation was 1.75 [95% confidence interval (CI) 1.19-2.58] after stratification for delivery hospital, year of birth and maternal age. If stratification for singletons/twins was also done, the OR was reduced to 1.19 (95% CI 0.79-1.81). The increased rate of congenital malformations is thus mainly a result of a high rate of multiple births. The only specific malformation which was found to occur in excess in children born after ICSI was hypospadias (relative risk 3.0, exact 95% CI 1. 09-6.50) which may be related to paternal subfertility.     

T-box genes and congenital heart/limb malformations

Congenital malformations cause significant morbidity and mortality; however, the underlying basis for many of these developmental defects is not well understood. Over the past years, a new family of genes called T-box genes has been identified that play essential roles during the development of various tissues and organs. A number of developmental syndromes have recently been shown to be linked to mutations in T-box genes, and brought direct medical relevance to their study. This review emphasizes emerging data on the molecular, cell, and disease levels, which establish a basis for parallel events in limb and heart development, and suggests that common regulatory pathways are crucial for proper differentiation and growth of these embryonic structures.     

Parental consanguinity and congenital heart malformations in a developing country

The association between isolated congenital heart defects and consanguinity was examined in 759 Lebanese patients with different types of congenital heart malformations. The subjects were patients of the Children's Cardiac Registry Center (CCRC) at the American University of Beirut Medical Center. The proportion of first-cousin marriages among cardiac subjects was compared to that of the National Collaborative Perinatal Neonatal Network (NCPNN), after adjusting for the subjects' geographic distribution, and to the highest proportion reported by NCPNN. In general, the proportion of overall parental consanguinity and first-cousin matings among CCRC subjects (34.7 and 20.2%, respectively) were significantly higher than the highest proportion of first-cousin marriages reported by NCPNN (Bekaa subjects; 13.2%) (P < 0.0001). Comparison with the NCPNN-adjusted first-cousin mating proportion revealed a significantly increased rate of consanguinity in all categories of cardiac malformations except great vessel and coronary artery lesions (P < 0.05). The following lesions were significantly associated with increased parental consanguinity: aortic anomalies (aortic insufficiency, aortic stenosis, bicuspid aortic valve), atrial septal defect, double-outlet right ventricle, pulmonary atresia, patent ductus arteriosus, pulmonic stenosis, tetralogy of Fallot, and ventricular septal defect (P < 0.05). Higher maternal education was the only variable that was negatively correlated with parental consanguinity (P = 0.037). Our study emphasizes the role of homozygous recessive genes in the causation of different types of isolated congenital heart malformations, known to follow a multifactorial pattern of inheritance. There is an urgent need for educating the public on the deleterious effects of inbreeding, especially in developing countries with high overall consanguinity rates and limited financial resources.     

Genetic factors in non‐syndromic congenital heart malformations

Wessels MW, Willems PJ. Genetic factors in non‐syndromic congenital heart malformations. The genetic defect in most patients with non‐syndromic congenital heart malformations (CHM) is unknown, although more than 40 different genes have already been implicated. Only a minority of CHM seems to be due to monogenetic mutations, and the majority occurs sporadically. The multifactorial inheritance hypothesis of common diseases suggesting that the cumulative effect of multiple genetic and environmental risk factors leads to disease, might also apply for CHM. We review here the monogenic disease genes with high‐penetrance mutations, susceptibility genes with reduced‐penetrance mutations, and somatic mutations implicated in non‐syndromic CHM.     

The immunocompetence of children with congenital heart disease

We studied the immunocompetence of 18 children with conotruncal malformations (13 with tetralogy of Fallot, 5 with truncus arteriosus) and 22 children with cardiac shunt lesions. There were reduced total T cell percentages and T helper cells in the conotruncal group but no T cell abnormality in the shunt group. Also, 7 of the 18 cases in the conotruncal group had facial dysmorphism reminiscent of the Di George syndrome. These results suggest that patients with conotruncal malformations fall into the wide spectrum of the Di George syndrome. There was some humoral deficiency in both groups with reduced levels of immunoglobulins IgG and IgA and low levels of complement C3 and C4. The clinical records showed a high frequency of infections. Hospital admissions for these episodes had occurred in 61% of the conotruncal group and 32% of the shunt group. Thus, there is an increased susceptibility to infection in children with congenital heart disease, and the predilection to infection has an immunological basis.     

Myocardial regulatory proteins in children with congenital heart defects

The purpose of this study was to compare the protein profiling of the regulatory proteins. The samples of myocardial tissue were obtained during surgical intervention from children (age 8.2 +/- 1.8 years) operated for different types of congenital heart diseases. The arterial oxygen saturation was 95.5 +/- 0.07% in normoxaemic patients (ventricular and atrial septal defects), resp. 76.9 +/- 2.1% in hypoxaemic patients (tetralogy of Fallot). The both cytosolic and myofibrillar fractions of cardiac troponin T (cTnT) were isolated by stepwise extraction (4) from the both right ventricular and right atrial musculature. The concentration of proteins was measured using Coomasie Plus Protein Reagent Kit (Pierce). After isolation, one-dimensional SDS polyacrylamide gel electrophoresis was carried out according to a modified version of the method of Laemmli (1970), using a 12% separating gel and a 4% stacking gel. In some cases after SDS-PAGE, proteins were electroblotted onto nitrocellulose membrane for immunoblotting and analysed using the JLT-12 monoclonal antibodies (Sigma Chemicals). The cytosolic pool of cTnT (measured by commercial kit Elecsys Troponin T STAT Immunoassay--Roche) represents about 12.5%, the myofibrillar pool of cTnT was about 87.5%; hypoxaemia did not affect this proportion.     

Psychomotor slowness in school-age children with congenital heart disease

Psychomotor problems are common in children with congenital heart disease (CHD) but their neuropsychological basis remains unknown. This study investigated motor planning, motor control, and motor slowness, three subprocesses potentially underlying these psychomotor deficits. Using various drawing tasks, 45 school-age children with CHD were compared with 41 healthy peers on several kinematic properties. Taking longer to initiate and execute their movements than the controls, the children with CHD exhibited significant motor slowness. No evidence was found for deficits in planning or motor control. Thus, motor slowness appears to be the major determinant of psychomotor problems in school-age children with CHD.     

Neonatal outcome and congenital malformations in children born after IVF

Dear Sir, We wish to thank Dr Merlob and Dr Fisch for their interest inour article concerning neonatal outcome and congenital malformationsafter IVF (Koivurova et al., 2002). We would like     

Potential of endovascular surgery in children with congenital heart diseases

Bakulev Scientific Center for Cardiovascular Surgery has very broad experience (3,774 cases) in endovascular operations on patients with different congenital heart diseases. 648 patients have undergone atrioseptostomy, 1,500 patients--balloon valvuloplastic, 546 patients--balloon angioplasty, 565 patients--coil embolization; stents have been used in 86 patients; in 114 cases the surgeons of the Center have used different occluders to close pathological communications, in 315 patients others types of treatment have been applied. In many cases of congenital heart diseases (valvular stenosis of pulmonary artery and aorta, patent ductus arteriosus, atrium and ventricular septal defect, coronary-cardial fistula, coarctation and recoarctation of aorta) endovascular techniques present a good alternative to open surgical procedures. In some cases endovascular techniques are palliative (Rashcind's and Park's procedure, balloon valvuloplasty in stenosis of pulmonary artery and angioplasty in stenosis of peripheral pulmonary artery and aorto-pulmonary anastomosis in patient with cyanotic congenital heart disease, stenting of PDA, coil embolization of collateral artery from aorta to pulmonary artery etc.) Multi-stage endovascular and surgical treatment allows radical or hemodynamic correction in patient with complex congenital heart disease. Nowadays the spectrum of endovascular treatment is wide; it is going to develop in the future, which will allow endovascular techniques to be of wide use in treatment of patient with complex heart diseases.     

Post mortem radiology in children with congenital heart disease.

Contrast radiology has valuable applications in routine necropsy practice. Contrast radiology was used to study the vascular anatomy in four normal fetuses, in five children with cardiovascular malformations, and in two hearts prepared by the perfusion fixation method. A contrast radiograph provides permanent documentation of anatomical associations before they are disrupted by dissection and permits a planned approach to the necropsy. While these injection studies are seldom undertaken by pathologists because they are felt to be too difficult and time-consuming, contrast studies should form part of the post mortem investigation of children with congenital heart disease, even when angiography has been performed in life.     

The heart in selected congenital malformations. A lesson in pathogenetic relationships

The application of new knowledge on the pathogenesis of congenital heart defects has increased our understanding of associated, non-cardiac malformations seen in certain syndromes. Defects in the proliferation and migration of neural crest cells are thought to contribute to conotruncal defects. These are seen in association with conditions such as DiGeorge syndrome. CHARGE association, hemifacial microsomia, and Shprintzen syndrome. They also form part of the isotretinoin and thalidomide embryopathies. Their association with conotruncal defects suggests that abnormal migration of neural crest cells may play a role in the pathogenesis of these syndromes.     

Intestinal malrotation: genetics features and other congenital malformations in children

The article is devoted to features of prenatal development of children with intestinal malrotation. Mass, height, head and chest circumferences of children after birth have been studied. In addition all associated malformations, a blood group (ABO system) and the rhesus-factor have been investigated. In comparison to the control group of newborn the disorders of prenatal development have included associated malformations, low anthropometric data after birth, decreasing of pA gene frequency. Notable, children with intestinal malrotation have had high frequency of malformations as in the abdominal and thoracic cavities as outside intestinal innervations: the small pelvis, the facial skeleton, the upper and lower extremity.     

Neonatal outcome and congenital malformations in children born after in-vitro fertilization

BACKGROUND: To evaluate the neonatal outcome and the prevalence of congenital malformations in children born after IVF in northern Finland we carried out a population-based study with matched controls. METHODS: Firstly, 304 IVF children born in 1990-1995 were compared with 569 controls, representing the general population in proportion of multiple births, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class. Secondly, plurality matched controls (n = 103) for IVF twins (n =103) were randomly chosen from the FMBR and analysed separately. Additionally, IVF singletons (n = 153) were compared with singleton controls (n = 287). Mortality rates were compared with national figures from FMBR. RESULTS: Most mortality rates were twice as high as national figures in the general population. When compared with the control group representing the general population, the incidences of preterm birth [odds ratio (OR) 5.6, 95% confidence interval (CI) 3.7-8.6], very low birth weight (OR 6.2, 95% CI 2.0-19.0), low birth weight (OR 9.8, 95% CI 5.6-17.3), neonatal morbidity (OR 2.4, 95% CI 1.7-3.4) and hospitalization (OR 3.2, 95% CI 2.2-4.6) were significantly higher in the IVF group. The prevalence of heart malformations was four-fold in the IVF population than in the controls representing the general population (OR 4.0, 95% CI 1.4-11.7). CONCLUSIONS: Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multifetal births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes. In order to improve neonatal outcome after IVF, the number of embryos transferred should be limited to a minimum.