eMedicine Specialties > Cardiology > Congenital Heart Disease in the Adult
Holt-Oram Syndrome: Treatment & Medication
Updated: May 28, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Evaluation can usually be performed in an outpatient setting, but inpatient studies and surgical treatment may be necessary.
- Patients with advanced heart block may require a permanent pacemaker.
- Surgical therapy can be used to correct cardiac defects or to possibly improve limb function.
Surgical Care
- Most cardiac lesions such as ASD and VSD are amenable to complete surgical correction if pulmonary hypertension or ventricular failure has not developed. Several percutaneous transcatheter devices that can be placed to occlude the septum are in US Food and Drug Administration–approved clinical trials and may be nonsurgical options in the future.
- Septal defects without hemodynamically significant shunts do not require correction.
- Children with severe limb anomalies can be referred to orthopedic surgeons for consideration of procedures such as pollicization of the fifth digit (to improve upper limb function).
- Children with severe limb shortening may benefit from prostheses.
Consultations
- Cardiologist
- Geneticist
- Cardiothoracic surgeon
- Orthopedic surgeon
Diet
No special diet is required.
Activity
Limit activity if heart failure or persistent cardiac sequelae are present.
Medication
No medications are effective in treating the anatomical defects of patients with Holt-Oram syndrome. Antibiotic prophylaxis should be applied following standard American Heart Association/American College of Cardiology guidelines for patients with congenital heart disease.11 Anticoagulation should be considered in patients with pulmonary hypertension. Cardioversion, antiarrhythmic drug therapy, or anticoagulation should be considered in patients with atrial fibrillation.
More on Holt-Oram Syndrome |
| Overview: Holt-Oram Syndrome |
| Differential Diagnoses & Workup: Holt-Oram Syndrome |
Treatment & Medication: Holt-Oram Syndrome |
| Follow-up: Holt-Oram Syndrome |
| Multimedia: Holt-Oram Syndrome |
| References |
| Further Reading |
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References
HOLT M, ORAM S. Familial heart disease with skeletal malformations. Br Heart J. Apr 1960;22:236-42. [Medline].
Basson CT, Huang T, Lin RC, et al. Different TBX5 interactions in heart and limb defined by Holt-Oram syndrome mutations. Proc Natl Acad Sci U S A. Mar 16 1999;96(6):2919-24. [Medline].
McDermott DA, Hatcher CJ, Basson CT. Atrial Fibrillation and Other Clinical Manifestations of Altered TBX5 Dosage in Typical Holt-Oram Syndrome. Circ Res. Sep 26 2008;103(7):e96. [Medline].
Cerbai E, Sartiani L. Holt-oram syndrome and atrial fibrillation: opening the (T)-box. Circ Res. Jun 6 2008;102(11):1304-6. [Medline].
Basson CT, Cowley GS, Solomon SD, et al. The clinical and genetic spectrum of the Holt-Oram syndrome (heart-hand syndrome). N Engl J Med. Mar 31 1994;330(13):885-91. [Medline].
Basson CT, Solomon SD, Weissman B, et al. Genetic heterogeneity of heart-hand syndromes. Circulation. Mar 1 1995;91(5):1326-9. [Medline].
McDermott DA, Bressan MC, He J, Lee JS, Aftimos S, Brueckner M. TBX5 genetic testing validates strict clinical criteria for Holt-Oram syndrome. Pediatr Res. Nov 2005;58(5):981-6. [Medline].
Pete B, Harmath A, Szigeti Z, Papp C, Hajdú J. [Holt-Oram syndrome: genetic counseling and diagnosis with prenatal ultrasonography]. Orv Hetil. Nov 18 2007;148(46):2173-6. [Medline].
Sunagawa S, Kikuchi A, Sano Y, Kita M, Ono K, Horikoshi T, et al. Prenatal diagnosis of Holt-Oram syndrome: role of 3-D ultrasonography. Congenit Anom (Kyoto). Mar 2009;49(1):38-41. [Medline].
He J, McDermott DA, Song Y, Gilbert F, Kligman I, Basson CT. Preimplantation genetic diagnosis of human congenital heart malformation and Holt-Oram syndrome. Am J Med Genet A. Apr 1 2004;126A(1):93-8. [Medline].
Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. Dec 2 2008;118(23):2395-451. [Medline].
Caglayan AO, Koklu E, Saatci C, Gunes T, Ozkul Y, Narin N, et al. Holt-Oram syndrome in two generations with translocation t(9;15)(p12;q11.2). Ann Saudi Med. May-Jun 2008;28(3):209-12. [Medline].
Saura D, Campos JV, Villegas M, Picó F, de la Morena G, Valdés-Chávarri M. Heart-hand syndrome. Int J Cardiol. Sep 16 2008;129(1):e7-9. [Medline].
Further Reading
Clinical guidelines
Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular disease.
American Heart Association - Professional Association. 2004 Jun 8. 10 pages. NGC:003778
ACR Appropriateness Criteria® suspected congenital heart disease in the adult.
American College of Radiology - Medical Specialty Society. 1998 (revised 2007). 8 pages. NGC:005988
Clinical trials
Clinical and Genetic Studies of VACTERL Association
Modified Perfusion for Neonatal Aortic Arch Reconstruction
Related eMedicine topics
Holt-Oram Syndrome (Pediatrics)
Syndactyly
Hand, Congenital Hand Deformities
Atrial Septal Defect
Radial Clubhand
Keywords
Holt-Oram syndrome, heart-hand syndrome, hand-heart syndrome, heart hand syndrome, hand heart syndrome, congenital heart defect, congenital cardiac defect, atrial septal defect, ASD, ventricular septal defect, VSD, thumb abnormality, heart malformation, upper limb malformation, pseudothalidomide syndrome, carpal bone malformation, carpal bone fusion, carpal bone abnormality, inherited cardiovascular disease, inherited heart disease, inherited cardiac disease, Eisenmenger syndrome
Treatment & Medication: Holt-Oram Syndrome