Trisomy 13 (Patau Syndrome) and Craniosynostosis

By Rafael F.M. Rosa,1,2 Rosana C.M. Rosa,2 Jos e A.M. Flores,3 Daniel T. Chazan,4 Cristine Dietrich,5 Mariana B. de Barth,5 Vanessa F. Carpes,5 Andr e C. da Cunha,5 Carla Graziadio,2,6 and Paulo R.G. Zen2,6*
1Clinical Genetics, Hospital Materno Infantil Presidente Vargas (HMIPV), RS, Brazil
2Graduate Program in Pathology, Universidade Federal de Ci^encias da Sa ude de Porto Alegre (UFCSPA), RS, Brazil
3Pediatric Radiology Service, Hospital da Crianc¸a Santo Ant^onio (HCSA)/Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA), RS, Brazil
4Pediatrics Service, HMIPV, RS, Brazil
5Fetal Medicine Service, HMIPV, RS, Brazil
6Clinical Genetics, UFCSPA and CHSCPA, RS, Brazil
Received 18 March 2011; Accepted 6 April 2011
Trisomy 13 or Patau syndrome is considered a rare chromosomal disease. It was first described by Patau et al. [1960] and its prevalence ranges from 1 to 5,000–12,000 births. It is clinical characterized by multiple malformations, involving especially the face, heart, and limbs, besides a very limited survival [Jones, 2006; Pont et al., 2006; Carey, 2010]. Despite the great variability of the clinical picture presented by the syndrome, craniosysnostosis seems to be a feature uncommonly described among these patients [Mankinen and Sears, 1976; Sullivan et al., 1990; Unal et al., 2009; Aypar et al., 2011].
We report on two patients with trisomy 13 presenting craniosynostosis who show involvement of different sutures. The first was a 1-day-old Caucasian girl, the fourth child of nonconsanguineous parents aged 44 years (mother) and 26 years (father). The child was born through vaginal delivery, prematurely at 36 weeks and 3 days of gestation, weighing 2,640 g (10–50th centile), measuring 46 cm (10–50th centile), with head circumference of 32 cm (10–50th centile), and Apgar score of 5 at first minute and 6 at fifth minute. The mother had chronic hypertension and used the angiotensin-converting enzyme inhibitor captropril during the first 2 months of gestation. Later, she was changed to methyldopa. She denied the use of other drugs or smoking. She drank occasionally (beer) during the pregnancy. During the pregnancy she had an ultrasound at 36 weeks, which showed the fetus had a keel shaped skull (trigonocephaly) (Fig. 1), long bones at 10th centile, and bilateral pyelocalicial dilatation. This last feature was confirmed postnatally through an abdominal ultrasound.
Onphysical exam, the proposita presented with a keel shape skull (trigonocephaly); upslanting palpebral fissures; broad nose; anteverted nares; micrognathia; small, dysplastic, and low set ears; and postaxial polydactyly of the right hand. The images of the patient at age of 16 days can be seen in Figure 2. Skull radiographies confirmed the finding of premature closure of the metopic suture. Ophthalmologic assessment disclosed a bilateral cataract. The echocardiographic study showed a heart deviatedto the right presenting a small atrial septal defect of ostium secundum type and a tinny patent ductus arteriosus. Karyotype with GTG-Banding showed 47,XX,þ13[15]. The child developed seizures and episodes of apnea and cyanosis, and died at 20 days of life.

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