Abstract
We describe a 23-year-old female of 46, XXqi Turner's syndrome associated with large atrial sepatal defect(secundum type) and mitral valve prolapse who was admitted due to amenorrhea, sexual infantilism and exertional dyspnea. This patient had only one spontaneous menstrual period at the age of 15 and had a short stature without webbed neck. Chromosomal aberrations cause primarily structural defects of cardiovascular system, and a variety of structural aberrations involving the X chromosome can cause partial or complete Turner's syndrome. In Turner's syndrome, bicuspid aortic valve or coarctaton of aorta is frequendy combined, also aortic root dilatation, partial anomalous venous drainage, hypoplastic left heart and ventricular septal defect, atrial septal defect has been reported. However, this patient had not abnormalities in aortic valve and whole aorta. Atrial septal defect simultaneously with mitral valve prolapse in 46 XXqi Turner's syndrome have not been reported in Korea.
We report this case with a brief review of the literature.
References
1). Miller MJ, Geffner ME, Hendricks SA. Echocardiography reveals a high incidence of bicuspid aortic valve in Turners syndrome. Clin Res. 29:106. 1981 cited from Lippe BM: Primary ovarian failure: in Kaplan AS: Clinical pediatric and adolescent endocrinology. Philadelphia. WB Saunder Co p272–299. 1982.
2). Lippe BM. Primary ovarian failure. Kalpan SA, editor. Clinical pediatric and adolescent endocrinology. WB Saunders Co.;p. 272–299. 1981.
3). Braunwald. Cardiovascular manifestations associated with chromosomal aberrations. Heart disease. 4th ed.p. 1628. W.B. Sounder Co.;1992.
4). 양창현 김덕희 · 검길영 · 양영호: Turner 증후꾼 에 대한 입상적 고찰. 소아과. 30:1143–1151. 1987.
5). 오창수 최상묵 박재옥 ‘ 깅창휘 · 이상주: Turner 증후군에 동반된 Prune Belly 증후군 l례. 소아과. 35:978–983. 1992.
6). 이재웅 · 깅경수 · 김정현 · 임헌길 · 이방헌 · 이정 균: Turner 중후군에 동반된 성 방중격 결손증과 숭 모판일탈증. 순환기. 25:875–879. 1995.
7). Hook EB, Warburton D. The distribution of chromosomal genotypes associated with Turners syndrome: Livebirth prevalence rates and evidence for diminished fetal mortality and severity in genotypes associated with structural X abnormalities or mosaicism. Hum Genet. 64:24–27. 1983.
8). Turner HH. A syndrome of infantilism congenital webbed neck and cubitus valgus. Endocrinology. 23:566. 1938.
9). Albright F, Smith PH, Fraser R. A syndrome characterized by primary ovarian insufficiency and decreased stature. Am J Med Sc. 204:625–648. 1942.
10). Wilkins L, Fleishmann W. Ovarian agenesis: Pathology associated clinical symptoms and the bearing on the theories of sex differentiation. J Clinic Endocrinol. 4:357. 1944.
11). Grumbach MM, Van Wyck VJ, Wilkins L. Chromosomal sex in gonadal dysgenesis(Ovarian agenesis): Relationship to male pseudohermaphroditism and theories of human sex differentiation. J Clin Endocrinol. 15:1161–1193. 1955.
12). Ford CE, Jones KW, Polani PE. A sex chromosomal anomaly in a case of gonadal dysgenesis (Turner syndrome). Lancet. 1:711. 1959.
13). Melvin M, Gunbach , Vanwyk JJ, Wilkins L. Chromosomal sex in gonadal dysgenesis. Lancet. 1:711–713. 1959.
14). Fraccaro M., Ikkos D., Lindsten J., Luft R., kaijer K.A new type of chromosomal abnormality in gonadal dysgenesis. Lancet. 2:1144. 1960.
15). Grumbach MM, Conte FA. Disorders of sexual differentiation. Wilson JD, Foster DW, editors. Williams textbook of Endocrinology. 8th ed.p. 884. Philadelphia: WB Saunders Co.;1992.
16). Stafford TM, Pfalmer CG, Cleary RE. Gonadal dysgenesis with isochromosome X and menstruation. Am J Obstet Gynecol. 116:886. 1973.
17). King CR, Magenis E, Bennett S. Pregnancy and the Turner's syndrome. Obst and Gyn. 52:617. 1978.
18). Flemming S, Cowell C, Bailey J. Hashimotos thyroiditis in Turner's syndrome. Clin Invest Med. 11:243. 1988.
19). Litvak AS, Rlousseu TG, Mabry CC, Microberts JW. The association of significant renal anomalies with Turner's syndrome. J Urol. 120:671–672. 1978.
20). Lippe BM. Primary ovarian failure. Kalpan SA, editor. Clinical pediatric and adolescent endocrinology. 6th ed.p. 455. Philladelphia: WB Saunders Co.;1981.
21). Ferencz C, Rubin JD, McCarter RJ, et al. Congenital heart disease: Prevalence at live birth—the Balmore-Washington Infant Study. Am J Epidemiol. 121:31. 1985.
22). Nora JJ. Multifactorial inheritence hypothesis for the etiology of congenital heart defect “the genetic environmental interaction”. Circulation. 38:604. 1968.
23). Richard VP, Atsuyoshi T. Etiology and morphology of congenital heart disease. p. 21–22. Eutura Co.;1980.
24). Berg KA, Boughman JA, Astemborski JA, Ferencz C. Implications for prenatal cytogenetic analysis from the Baltimore-Washington study of liveborn infants with confirmed congenital heart defects (CHD). Am H Genet. 39:A50. 1986.
25). Lacro RV, Lyons JK, Benirschke K. Coarctation of aorta in Turner's syndrome: A pathologic study of fetuses with nuchal cystic hygromas, hydrops fetalis and female genitalia. J Pediatr. 81:445. 1988.
26). Miller MJ, Geffner ME, Hendricks SA. Echocardiography reveals a high incidence of bicuspid aortic valve in Turner's syndrome. Clin Res. 29:106. 1981.
27). John WM, William CK, William MR, Merrily AP. Partial anomalous pulmonary venous drainage associated with 45, XO Turner s sysndrome. J Pediatr. 86:273–276. 1990.
28). Natowicz M, Kellet RI. Association of turner syndrome with hypoplastic left-heart syndrome. Am J Child. 141:218. 1987.
29). Lin AE, Lippe BM, Gefftner ME. Aortic dilatation, dissection and rupture in patients with Turner's syndrome. J Pediatr. 109:820. 1986.
30). Marchand P. Late systolic murmurs and non-ejection (“mid-late”) systolic clicks: an analysis of 90 patients. Br Heart J. 30:203. 1968.
31). Rippe JM, Sloss JJ, Angof F, Alpert JS. Mitral valve prolapse in adults with congenital heart disease. Am Heart J. 97:561. 1979.
32). 이종섭 · 차학주 ‘ 검기복: Turner 증후군 11례, 소 아과. 26:91–96. 1983.
33). 권혁상 – 이홍재 · 문수지. 대동맥협착증을 동반한 신생아 Turner 증후군 l예. 최신의학. 25:333–336. 1982.