Perspectives

Screening Echocardiography in Adults with Down Syndrome

Authors: Thomas C. King, Abhinav Karan, MD, Linda Edwards, MD, Rafik Jacob, MD

Abstract

Down syndrome is the most common chromosomal disorder in the United States, occurring in about 14.14/10,000 births. It is associated with multiple medical anomalies, including cardiac, gastrointestinal, musculoskeletal, and genitourinary abnormalities, which increases the burden of morbidity for this patient population. Management is typically directed toward optimizing health and function throughout childhood and into adulthood; however, consensus regarding their management in adulthood is controversial. The burden of congenital cardiac diseases in children with trisomy 21 is well established, seen in more than 40% of cases. Although screening echocardiography is performed routinely within 1 month of birth, current consensus advocates for diagnostic echocardiography only in symptomatic adults with Down syndrome. Here, we advocate that screening echocardiography should be performed routinely in this patient population at all ages, particularly in late adolescence and early adulthood, because of a high percentage of residual cardiac defects and an increased risk of developing valvular and structural cardiac disease.

 

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References

1. Mai CT, Isenburg JL, Canfield MA, et al. National population-based estimates for major birth defects, 2010–2014. Birth Defects Res 2019; 111:1420–1435.
 
2. Stoll C, Dott B, Alembik Y, et al. Associated congenital anomalies among cases with Down syndrome. Eur J Med Genet 2015;58:674–680.
 
3. Presson AP, Partyka G, Jensen KM, et al. Current estimate of Down syndrome population prevalence in the United States. J Pediatr 2013;163:1163–1168.
 
4. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics: Committee on Genetics; Society for Maternal-Fetal Medicine. Screening for fetal chromosomal abnormalities. ACOG practice bulletin, number 226. Obstet Gynecol 2020;136:48–69.
 
5. American Academy of Pediatrics Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics 2001;107:442–449.
 
6. Smith DS. Health care management of adults with Down syndrome. Am Fam Phys 2001;64:1031.
 
7. Marder L, Tulloh R, Pascall E. Cardiac problems in Down syndrome. Paediatr Child Health 2015;25:23–29.
 
8. Irving CA, Chaudhari MP. Cardiovascular abnormalities in Down’s syndrome: spectrum, management and survival over 22 years. Arch Dis Child 2012;97:326–330.
 
9. Frid C, Drott P, Lundell B, et al. Mortality in Down’s syndrome in relation to congenital malformations. J Intellect Disabil Res 1999;43(Part 3): 234–241.
 
10. Flanders L, Tulloh RMR. Cardiac problems in Down syndrome. Paediatr Child Health 2004;21:25–31.
 
11. Morales-Demori R. Congenital heart disease and cardiac procedural outcomes in patients with trisomy 21 and Turner syndrome. Congenit Heart Dis 2017;12:820–827.
 
12. Bush D, Galambos C, Ivy DD, et al. Clinical characteristics and risk factors for developing pulmonary hypertension in children with Down syndrome. J Pediatr 2018;202:212–219.
 
13. Balli S, Yucel IK, Kibar AE, et al. Assessment of cardiac function in absence of congenital and acquired heart disease in patients with Down syndrome. World J Pediatr 2016;12:463–469.
 
14. Clauss SB, Gidding SS, Cochrane CI, et al. Prevalence of unsuspected abnormal echocardiograms in adolescents with down syndrome. Am J Med Genet Part A 2019;179:2420–2424.
 
15. Vis JC, Bruin-Bon RH, Bouma BJ, et al. Congenital heart defects are under-recognised in adult patients with Down’s syndrome. Heart 2010;96: 1480–1484.
 
16. Hamada T, Kuroda M, Miyakoshi M, et al. Echocardiographic study in adult patients with Down’s syndrome [article in Japanese]. Rinsho Byori 1993;41: 807–812.
 
17. Fitzpatrick V, Rivelli A, Bria K, et al. Heart disease in adults with Down syndrome between 1996 and 2016. J Am Board Fam Med 2020;33:923–931.
 
18. King N, Daham AN, Al-Meshhadani MH. Cardiac auscultation versus two-dimensional transthoracic echocardiography in the detection of native aortic and mitral valve disease in Erbil City. J Med Sci Clin Res 2017;4: 11492–11499.
 
19. Patel A, Tomar NS, Bharani A. Utility of physical examination and comparison to echocardiography for cardiac diagnosis. Indian Heart J 2017;69:141–145.
 
20. Geggel RL, O’Brien JE, Feingold M. Development of valve dysfunction in adolescents and young adults with Down syndrome and no known congenital heart disease. J Pediatr 1993;122:821–823.
 
21. Feingold M, Geggel RL. Health supervision for children with Down syndrome. Pediatrics 2001;108:1384–1385.
 
22. Jensen KM, Campagna EJ, Juarez-Colunga E, et al. Low rates of preventive healthcare service utilization among adolescents and adults with Down syndrome. Am J Prev Med 2021;60:1–12.
 
23. Jensen KM, Taylor LC, Davis M. Primary care for adults with Down syndrome: adherence to preventive healthcare recommendations. J Intellect Disabil Res 2013;57:409–421.
 
24. Santoro SL, Martin LJ, Pleatman SI, et al. Stakeholder buy-in and physician education improve adherence to guidelines for Down syndrome. J Pediatr 2016;171:262–268.