Human Genetics of Hypoplastic Left Heart Syndrome

• Published in: Advances in experimental medicine and biology Vol. 1441; p. 937
• Main Authors: Pfitzer, Constanze, Schmitt, Katharina R L, Benson, Woodrow D
• Format: Journal Article
• Language: English
• Published: United States 2024
• Subjects: Genetic Predisposition to Disease - genetics; Humans; Hypoplastic Left Heart Syndrome - genetics; Phenotype; Noonan syndrome and Holt–Oram syndrome; GWAS; Hypoplastic left heart syndrome; de novo; Notch 1; CNV; GJA1; Genome-wide association study; ERBB4; ZIC3; BAVAorticvalve, bicuspid (BAV); Linkage analysis; Hypoplasia; IRX1; Copy-number variants; Trisomy 18; Chromosome; Wolf–Hirschhorn syndrome; Rubinstein–Taybi syndrome; TBX5; Turner syndrome; HLHS; Left ventricle; VACTERL association; Smith–Lemli–Opitz syndrome; Bicuspid aortic valveAorticvalve; HAND1; CHARGE syndrome; NKX2–5
• ISSN: 0065-2598
• DOI: 10.1007/978-3-031-44087-8_60

Hypoplastic left heart syndrome (HLHS) is a severe congenital cardiovascular malformation characterized by hypoplasia of the left ventricle, aorta, and other structures on the left side of the heart. The pathologic definition includes atresia or stenosis of both the aortic and mitral valves. Despite considerable progress in clinical and surgical management of HLHS, mortality and morbidity remain concerns. One barrier to progress in HLHS management is poor understanding of its cause. Several lines of evidence point to genetic origins of HLHS. First, some HLHS cases have been associated with cytogenetic abnormalities (e.g., Turner syndrome). Second, studies of family clustering of HLHS and related cardiovascular malformations have determined HLHS is heritable. Third, genomic regions that encode genes influencing the inheritance of HLHS have been identified. Taken together, these diverse studies provide strong evidence for genetic origins of HLHS and related cardiac phenotypes. However, using simple Mendelian inheritance models, identification of single genetic variants that "cause" HLHS has remained elusive, and in most cases, the genetic cause remains unknown. These results suggest that HLHS inheritance is complex rather than simple. The implication of this conclusion is that researchers must move beyond the expectation that a single disease-causing variant can be found. Utilization of complex models to analyze high-throughput genetic data requires careful consideration of study design.