Loeys-Dietz 증후군으로 진단된 젊은 여자 환자의 상행 대동맥 파열: 국내 첫 번째 증례 보고

Ascending Aortic Rupture in a Young Woman with Loeys-Dietz Syndrome: The First Case Report in Korea

  • 김환욱 (가톨릭대학교 의과대학 서울성모병원 흉부외과학교실) ;
  • 이택연 (울산대학교 의과대학 서울아산병원 흉부외과교실) ;
  • 문덕환 (울산대학교 의과대학 서울아산병원 흉부외과교실) ;
  • 주석중 (울산대학교 의과대학 서울아산병원 흉부외과교실) ;
  • 정철현 (울산대학교 의과대학 서울아산병원 흉부외과교실) ;
  • 이재원 (울산대학교 의과대학 서울아산병원 흉부외과교실)
  • Kim, Hwan-Wook (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lee, Taek-Yeon (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Unviersity of Ulsan College of Medicine) ;
  • Moon, Duk-Hwan (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Unviersity of Ulsan College of Medicine) ;
  • Choo, Suk-Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Unviersity of Ulsan College of Medicine) ;
  • Chung, Cheal-Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Unviersity of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Unviersity of Ulsan College of Medicine)
  • 발행 : 2009.10.05

초록

대동맥 동맥류/대동맥 박리증, 두눈먼거리증, 목젖갈림증/입천장갈림증, 그리고 동맥혈관계의 이상과다 뒤틀림 등을 독특한 표현형으로 하는 Loeys-Dietz 증후군은 새로이 기술된 공격적 성향의 결체 조직 질환으로, transforming growth factor-$\beta$ receptor type 1 또는 type 2를 encoding 하는 유전자 돌연 변이가 발병 원인이다. Loeys-Dietz 증후군은 Marfan 증후군, Ehlers-Danlos 증후군 4형 등의 표현형과 일부 비슷한 형태를 공유한다. 그러나, Loeys-Dietz 증후군은 다른 질환보다 더 심한 병태생리적 특성을 가지고 있기 때문에, 임상의들은 이들 결체 조직 질환들을 감별하여야 한다. 강한 의심, 조기 진단, 예방적 수술, 그리고 지속적 영상 검사가 적절한 Loeys-Dietz 증후군 치료를 위해 실행되어야 한다. 저자들은 대동맥 파열, 목젖갈림증, 그리고 두눈먼거리증의 3징후를 가진 Loeys-Dietz 증후군의 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Characterized by unique phenotypic features such as aortic aneurysm/dissection, hypertelorism, bifid uvula/cleft palate and generalized tortuosity in the arterial system, Loeys-Dietz syndrome is a newly described aggressive connective tissue disorder associated with mutation in the gene encoding transforming growth factor-$\beta$ receptor type I or type II. Some phenotypic manifestations of Loeys-Dietz syndrome overlap with those of Marfan syndrome or Ehlers-Danlos syndrome type IV. However, due to its more malignant pathophysiologic nature, physicians should be alert to Loeys-Dietz syndrome. High suspicion, early diagnosis, preventive surgery and serial imaging assessments are warranted for optimal management of Loeys-Dietz syndrome. We present here a case of a young patient with Loeys-Dietz syndrome who had aortic rupture, bifid uvula and hypertelorism. We also present a review of the medical literature.

키워드

참고문헌

  1. Loeys BL, Chen J, Neptune ER, et al. A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet 2005;37:275-81 https://doi.org/10.1038/ng1511
  2. Loeys B, Schwarze U, Holm T, et al. Aneurysmal syndromes caused by mutations in the TGF-beta receptor. N Engl J Med 2006;355:788-98 https://doi.org/10.1056/NEJMoa055695
  3. Akutsu K, Morisaki H, Takeshita S, et al. Phenotypic heterogeneity of Marfan-like connective tissue disorders associated with mutations in the transforming growth factor- $\beta$ receptor genes. Circ J 2007;71:1305-9 https://doi.org/10.1253/circj.71.1305
  4. Neptune E, Frischmeyer P, Arking D, et al. Dysregulation of the TGF-β activation contributes to pathogenesis in Marfan syndrome. Nat Genet 2003;33:407-11 https://doi.org/10.1038/ng1116
  5. Williams JA, Loeys BL, Nwakanma LU, et al. Early surgical experience with Loeys-Dietz: A new syndrome of aggressive thoracic aortic aneurysmal disease. Ann Thorac Surg 2007;83:S757-63 https://doi.org/10.1016/j.athoracsur.2006.10.091
  6. Pepin M, Schwarze U, Superti-Furga A, Byers PH. Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 2000;342:573-80