eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Velocardiofacial Syndrome: Follow-up

Author: M Silvana Horenstein, MD, Consultant, Pediatric and Fetal Cardiac Diagnostic, Diagnostico Gineco-Obstetrico, PC; Associate Medical Director, Legacy Department, Best Doctors, Inc
Coauthor(s): Thomas J Forbes, MD, FACC, FSCAI, Associate Professor (Clinical-Educator), Director of Catheterization Laboratory, Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University; Robert Ardinger Jr, MD, Associate Professor, Department of Pediatrics, Division of Pediatric Cardiology, University of Kansas Medical Center; Holly Ardinger, MD, Clinical Associate Professor, Section Chief, Pediatric Genetics, Department of Pediatrics, University of Kansas Medical Center
Contributor Information and Disclosures

Updated: Feb 4, 2009

Follow-up

Further Inpatient Care

  • Admit a newborn with cyanosis for heart defect workup. Newborns with or without associated heart defects may require a prolonged hospitalization to work on feeding.

Further Outpatient Care

  • Perform workup in an outpatient setting for other associated problems as needed.

Transfer

  • Newborns who require heart surgery may need transfer to a tertiary center.

Complications

  • Congestive heart failure
  • Pulmonary hypertension
  • Immune deficiency (cellular and humoral) with increased risk of infection and autoimmune diseases
  • Psychiatric disorders

Prognosis

  • Those without serious heart defects can expect a normal lifespan.

Patient Education

  • Genetic counseling of the patient and family should emphasize that most deletions are de novo, secondary to homologous recombination between low-copy repeat sequences located within 22q11.2.  Nonetheless, both somatic and germline mosaicism can also occur, giving unaffected parents a small risk of recurrence. However, once present, velocardiofacial syndrome is dominant, and children of the patient have a 50% risk of being affected; children can be affected more severely or less severely than the parent.15
  • Prenatal diagnosis is available to detect the chromosome region 22q11 deletion.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Tetralogy of Fallot.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize velocardiofacial syndrome (VCFS)
  • Failure to perform chromosome testing
  • Failure to test the chromosomes of the parents or children of the affected person
  • Failure to give correct genetic counseling
  • Failure to use irradiated cell blood products

Special Concerns

  • Consider velocardiofacial syndrome in any fetus diagnosed with conotruncal heart disease on prenatal ultrasound
  • To make a prenatal diagnosis, perform amniocentesis for cytogenetic and fluorescence in situ hybridization (FISH) testing
  • Considerable variability in manifestations is noted among affected family members
 


More on Velocardiofacial Syndrome

Overview: Velocardiofacial Syndrome
Differential Diagnoses & Workup: Velocardiofacial Syndrome
Treatment & Medication: Velocardiofacial Syndrome
Follow-up: Velocardiofacial Syndrome
Multimedia: Velocardiofacial Syndrome
References
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References

  1. Shprintzen RJ, Goldberg RB, Lewin ML, et al. A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome. Cleft Palate J. Jan 1978;15(1):56-62. [Medline].

  2. Ryan AK, Goodship JA, Wilson DI, et al. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet. Oct 1997;34(10):798-804. [Medline].

  3. Goldmuntz E, Clark BJ, Mitchell LE, et al. Frequency of 22q11 deletions in patients with conotruncal defects. J Am Coll Cardiol. Aug 1998;32(2):492-8. [Medline].

  4. Prabhakaran VC, Davis G, Wormald PJ, Selva D. Congenital absence of the nasolacrimal duct in velocardiofacial syndrome. J AAPOS. Feb 2008;12(1):85-6. [Medline].

  5. Shprintzen RJ. Velo-cardio-facial syndrome: 30 Years of study. Dev Disabil Res Rev. 2008;14(1):3-10. [Medline].

  6. Theveniau-Ruissy M, Dandonneau M, Mesbah K, et al. The del22q11.2 candidate gene Tbx1 controls regional outflow tract identity and coronary artery patterning. Circ Res. Jul 18 2008;103(2):142-8. [Medline].

  7. Cuneo BF. 22q11.2 deletion syndrome: DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes. Curr Opin Pediatr. Oct 2001;13(5):465-72. [Medline].

  8. McLean-Tooke A, Spickett GP, Gennery AR. Immunodeficiency and autoimmunity in 22q11.2 deletion syndrome. Scand J Immunol. Jul 2007;66(1):1-7. [Medline].

  9. Li MJ, Wang CC, Chen SJ, et al. Anomalous ascending aorta causing severe compression of the left bronchus in an infant with ventricular septal defect and pulmonary atresia. Eur J Pediatr. Mar 2009;168(3):351-3. [Medline].

  10. Eberle P, Berger C, Junge S, et al. Persistent low thymic activity and non-cardiac mortality in children with chromosome 22q11.2 microdeletion and partial DiGeorge syndrome. Clin Exp Immunol. Feb 2009;155(2):189-98. [Medline].

  11. Robin NH, Taylor CJ, McDonald-McGinn DM, et al. Polymicrogyria and deletion 22q11.2 syndrome: window to the etiology of a common cortical malformation. Am J Med Genet A. Nov 15 2006;140(22):2416-25. [Medline].

  12. Sundram F, Murphy DG, Murphy KC. White matter microstructure in children with Velocardiofacial Syndrome: A Diffusion Tensor Imaging and Voxel Based Morphometry study. J Intellect Disabil Res. Oct 2008;52(10):812. [Medline].

  13. Antshel KM, Fremont W, Kates WR. The neurocognitive phenotype in velo-cardio-facial syndrome: a developmental perspective. Dev Disabil Res Rev. 2008;14(1):43-51. [Medline].

  14. Carotti A, Digilio MC, Piacentini G, Saffirio C, Di Donato RM, Marino B. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. Dev Disabil Res Rev. 2008;14(1):35-42. [Medline].

  15. McDonald-McGinn DM, Zackai EH. Genetic counseling for the 22q11.2 deletion. Dev Disabil Res Rev. 2008;14(1):69-74. [Medline].

  16. Chow EW, Bassett AS, Weksberg R. Velo-cardio-facial syndrome and psychotic disorders: implications for psychiatric genetics. Am J Med Genet. Jun 15 1994;54(2):107-12. [Medline].

  17. De Smedt B, Swillen A, Ghesquiere P, et al. Pre-academic and early academic achievement in children with velocardiofacial syndrome (del22q11.2) of borderline or normal intelligence. Genet Couns. 2003;14(1):15-29. [Medline].

  18. Digilio MC, Angioni A, De Santis M, et al. Spectrum of clinical variability in familial deletion 22q11.2: from full manifestation to extremely mild clinical anomalies. Clin Genet. Apr 2003;63(4):308-13. [Medline].

  19. Driscoll DA, Spinner NB, Budarf ML, et al. Deletions and microdeletions of 22q11.2 in velo-cardio-facial syndrome. Am J Med Genet. Sep 15 1992;44(2):261-8. [Medline].

  20. Dyce O, McDonald-McGinn D, Kirschner RE, et al. Otolaryngologic manifestations of the 22q11.2 deletion syndrome. Arch Otolaryngol Head Neck Surg. Dec 2002;128(12):1408-12. [Medline].

  21. Goldberg R, Motzkin B, Marion R, et al. Velo-cardio-facial syndrome: a review of 120 patients. Am J Med Genet. Feb 1 1993;45(3):313-9. [Medline].

  22. Goldmuntz E. DiGeorge syndrome: new insights. Clin Perinatol. Dec 2005;32(4):963-78, ix-x. [Medline].

  23. Kelly D, Goldberg R, Wilson D, et al. Confirmation that the velo-cardio-facial syndrome is associated with haplo-insufficiency of genes at chromosome 22q11. Am J Med Genet. Feb 1 1993;45(3):308-12. [Medline].

  24. Mehendale FV, Sommerlad BC. Surgical significance of abnormal internal carotid arteries in velocardiofacial syndrome in 43 consecutive hynes pharyngoplasties. Cleft Palate Craniofac J. Jul 2004;41(4):368-74. [Medline].

  25. Saitta SC, Harris SE, Gaeth AP, et al. Aberrant interchromosomal exchanges are the predominant cause of the 22q11.2 deletion. Hum Mol Genet. Feb 15 2004;13(4):417-28. [Medline].

  26. Shprintzen RJ, Goldberg RB, Young D, Wolford L. The velo-cardio-facial syndrome: a clinical and genetic analysis. Pediatrics. Feb 1981;67(2):167-72. [Medline].

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Further Reading

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Keywords

velocardiofacial syndrome, VCFS, DiGeorge sequence, Shprintzen syndrome, Shprintzen's syndrome, 22q11.2 deletion, cardiac defects, hypernasal speech, hypotonia, interrupted aortic arch, truncus arteriosus, tetralogy of Fallot, pulmonary atresia, ventricular septal defect, VSD, absent pulmonary valve syndrome, aortic stenosis, learning disabilities, developmental delay, posterior embryotoxon, bilateral cataracts, tortuous retinal vessels, small optic disks, Pierre Robin syndrome, CHARGE syndrome, lymphoproliferative disorders, cleft palate, velopharyngeal incompetence, congestive heart failure, hypotonia, recurrent otitis media, attention deficit hyperactivity disorder, ADHD, obsessive-compulsive disorder, schizophrenia, heart murmur, cryptorchidism, hypospadias

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Contributor Information and Disclosures

Author

M Silvana Horenstein, MD, Consultant, Pediatric and Fetal Cardiac Diagnostic, Diagnostico Gineco-Obstetrico, PC; Associate Medical Director, Legacy Department, Best Doctors, Inc
M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas J Forbes, MD, FACC, FSCAI, Associate Professor (Clinical-Educator), Director of Catheterization Laboratory, Division of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University
Thomas J Forbes, MD, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Robert Ardinger Jr, MD, Associate Professor, Department of Pediatrics, Division of Pediatric Cardiology, University of Kansas Medical Center
Robert Ardinger Jr, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology
Disclosure: Nothing to disclose.

Holly Ardinger, MD, Clinical Associate Professor, Section Chief, Pediatric Genetics, Department of Pediatrics, University of Kansas Medical Center
Holly Ardinger, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA, Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital
Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, Heart Rhythm Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Ameeta Martin, MD, Clinical Associate Professor, Department of Pediatric Cardiology, University of Nebraska College of Medicine
Ameeta Martin, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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