Genetic insights into congenital heart disease: Prevalence, aetiology and clinical implications

Yuan Yuan , Yi Jia , Shasha Peng , Shuru Zhao , Kang Dong , Yuruo Hu , Zicheng Zhao , Xiaofei Jiang , Zhe Zhang

Clinical and Translational Discovery ›› 2025, Vol. 5 ›› Issue (5) : e70087

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Clinical and Translational Discovery ›› 2025, Vol. 5 ›› Issue (5) :e70087 DOI: 10.1002/ctd2.70087
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Genetic insights into congenital heart disease: Prevalence, aetiology and clinical implications

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Abstract

Congenital heart disease (CHDs) pose a significant public health burden, impacting nearly 1% of newborns each year. This review focuses on the genetic aspects of CHDs, examining their prevalence, causes and the significant advancements in genetic technologies used for their diagnosis and management. We cover the wide range of CHDs, from minor septal defects to critical conditions like hypoplastic left heart syndrome, and underscore the complex interaction among genetic and environmental influences contributing to these defects. The review stresses the importance of understanding genetic inheritance patterns, especially in families with a history of CHDs, and the essential role of genetic counselling in evaluating familial risk and informing reproductive choices. We also explore the latest developments in genetic technologies, such as genome-wide association studies, single-nucleotide variations and copy number variants, which have greatly improved our ability to pinpoint genetic risk factors for CHDs. These genetic discoveries have important clinical applications, including their use in tailoring treatment plans and enhancing prenatal diagnosis. This review aims to elucidate the genetic architecture of CHDs by integrating findings from recent research, with the goal of enhancing the lives of those affected and their families.

Keywords

congenital heart disease / genetic aetiology / genomic variation analysis

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Yuan Yuan, Yi Jia, Shasha Peng, Shuru Zhao, Kang Dong, Yuruo Hu, Zicheng Zhao, Xiaofei Jiang, Zhe Zhang. Genetic insights into congenital heart disease: Prevalence, aetiology and clinical implications. Clinical and Translational Discovery, 2025, 5(5): e70087 DOI:10.1002/ctd2.70087

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References

[1]

van der Linde D, Konings EEM, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011; 58(21): 2241-2247.

[2]

Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart disease 1970–2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019; 48(2): 455-463.

[3]

The Children's Heart Foundation. About CHDs | Congenital heart disease. Accessed February 25, 2025. https://www.childrensheartfoundation.org/about-chds/chd-facts.html

[4]

The Mended Hearts I CHD Facts and Statistics. Accessed February 19, 2025. https://mendedhearts.org/story/chd-facts-and-statistics/

[5]

CDC. Data and Statistics | Congenital heart disease (CHDs). Accessed February 21, 2025. https://www.cdc.gov/heart-defects/data/index.html

[6]

Mayo Clinic. Congenital heart disease in Children - Symptoms and Causes. Accessed February 25, 2025. https://www.mayoclinic.org/diseases-conditions/congenital-heart-defects-children/symptoms-causes/syc-20350074

[7]

MedlinePlus. Congenital heart disease. Accessed February 25, 2025. https://medlineplus.gov/congenitalheartdefects.html

[8]

Cincinnati Children's. Congenital Heart Disease, Contributing Factors. Accessed February 24, 2025. https://www.cincinnatichildrens.org/health/c/factors-chd

[9]

Blue GM, Kirk EP, Sholler GF, et al. Congenital heart disease: current knowledge about causes and inheritance. Med J Aust. 2012; 197(3): 155-9.

[10]

Zhang TN, Wu QJ, Liu YS, et al. Environmental risk factors and congenital heart disease: an umbrella review of 165 systematic reviews and meta-analyses with more than 120 million participants. Front Cardiovasc Med. 2021; 8:640729.

[11]

Pediatric Heart Specialists. Maternal Diabetes and Congenital heart disease. Accessed February 18, 2025. https://pediatricheartspecialists.com/heart-education/blog/51-maternal-diabetes-and-congenital-heart-defects

[12]

NHS. Congenital Heart Disease – Causes. Accessed February 27, 2025. https://www.nhs.uk/conditions/congenital-heart-disease/causes/

[13]

Yasuhara J, Garg V. Genetics of congenital heart disease: a narrative review of recent advances and clinical implications. Transl Pediatr. 2021; 10(9): 2366-2386.

[14]

Children's Health. Down Syndrome and Heart Defects. Accessed February 25, 2025. https://www.childrens.com/health-wellness/down-syndrome-and-heart-defects

[15]

Wang X, Li P, Chen S, et al. Influence of genes and the environment in familial congenital heart disease. Mol Med Rep. 2014; 9(2): 695-700.

[16]

Health. SMCs Factors That May Lead to a Congenital Heart Defect (CHD). Accessed February 24, 2025. https://www.stanfordchildrens.org/en/topic/default?id=factors-that-may-lead-to-a-congenital-heart-defect-chd-90-P01788

[17]

Global Down Syndrome Foundation. Congenital heart disease and Down Syndrome: What Parents Should Know. Accessed February 26, 2025. https://www.globaldownsyndrome.org/congenital-heart-defects-syndrome-parents-know/

[18]

Cirino AL, Ho CY. Genetic testing for inherited heart disease. Circulation. 2013; 128(1): e4-8.

[19]

Feldman ER, Li Y, Cutler D, et al. Genome-wide association studies of Down syndrome associated congenital heart disease. 2024.

[20]

Ehrlich L, Prakash SK. Copy-number variation in congenital heart disease. Curr Opin Genet Dev. 2022; 77:101986.

[21]

Liu W, Cheng L, Chen K, et al. Identification of novel single-nucleotide variants with potential of mediating malfunction of microRNA in congenital heart disease. Front Cardiovasc Med. 2021; 8:739598.

[22]

Lahm H, Jia M, Dreßen M, et al. Congenital heart disease risk loci identified by genome-wide association study in European patients. J Clin Invest. 2021; 131(2):e141837.

[23]

Pediatrics Nationwide. Using Whole Exome Sequencing to Find Genetic Cause of Congenital Heart Disease in At-Risk Patients. Accessed February 25, 2025. https://pediatricsnationwide.org/2016/08/16/using-whole-exome-sequencing-to-find-genetic-cause-of-congenital-heart-disease-in-at-risk-patients/

[24]

Vanderbilt University Medical Center. Personalizing Care for Congenital Heart Disease Through Genetics. Accessed February 24, 2025. https://news.vumc.org/hope/personalizing-care-for-congenital-heart-disease-through-genetics/

[25]

American Heart Association. Genetic Counseling for Congenital heart disease. Accessed February 20, 2025. https://www.heart.org/en/health-topics/congenital-heart-defects/understand-your-risk-for-congenital-heart-defects/genetic-counseling-for-congenital-heart-defects

[26]

CDC. Congenital heart disease: Prenatal Diagnosis and Postnatal Confirmation. Accessed February 21, 2025. https://archive.cdc.gov/www_cdc_gov/ncbddd/birthdefects/surveillancemanual/chapters/chapter-4/chapter4-5a.html

[27]

Stanford Health Care. Septal Congenital heart disease. Accessed February 20, 2025. https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/congenital-heart-defects/types/septal-congenital-heart-defects.html

[28]

Yale Medicine. Atrioventricular Septal Defect. Accessed February 24, 2025. https://www.yalemedicine.org/conditions/atrioventricular-septal-defect

[29]

CDC. About Congenital heart disease. Accessed February 21, 2025. https://www.cdc.gov/heart-defects/about/index.html

[30]

NHS. Congenital Heart Disease - Types. Accessed February 27, 2025. https://www.nhs.uk/conditions/congenital-heart-disease/types/

[31]

Ibrahim S, Gaborit B, Lenoir M, et al. Maternal pre-existing diabetes: a non-inherited risk factor for congenital cardiopathies. Int J Mol Sci. 2023; 24(22):16258.

[32]

Goldmuntz E, Bamford R, Karkera JD, et al. CFC1 mutations in patients with transposition of the great arteries and double-outlet right ventricle. Am J Hum Genet. 2002; 70(3): 776-80.

[33]

De Luca A, Sarkozy A,Consoli F, et al. Familial transposition of the great arteries caused by multiple mutations in laterality genes. Heart. 2010; 96(9): 673-7.

[34]

D'Alessandro LC, Latney BC, Paluru PC, et al. The phenotypic spectrum of ZIC3 mutations includes isolated d-transposition of the great arteries and double outlet right ventricle. Am J Med Genet A. 2013; 161A(4): 792-802.

[35]

Dardas Z, Fatih JM, Jolly A, et al. NODAL variants are associated with a continuum of laterality defects from simple D-transposition of the great arteries to heterotaxy. Genome Med. 2024; 16(1): 53.

[36]

Zhang M, Li FX, Liu XY, et al. MESP1 loss‑of‑function mutation contributes to double outlet right ventricle. Mol Med Rep. 2017; 16(3): 2747-2754.

[37]

Dorn C, Perrot A, Grunert M, et al. Human genetics of tetralogy of Fallot and double-outlet right ventricle. Adv Exp Med Biol. 2024; 1441: 629-644.

[38]

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

[39]

Heathcote K, Braybrook C,Abushaban L, et al. Common arterial trunk associated with a homeodomain mutation of NKX2.6. Hum Mol Genet. 2005; 14(5): 585-93.

[40]

Kodo K, Nishizawa T,Furutani M, et al. GATA6 mutations cause human cardiac outflow tract defects by disrupting semaphorin-plexin signaling. Proc Natl Acad Sci U S A. 2009; 106(33): 13933-8.

[41]

Eldadah ZA, Hamosh A, Biery NJ, et al. Familial tetralogy of Fallot caused by mutation in the jagged1 gene. Hum Mol Genet. 2001; 10(2): 163-9.

[42]

Goldmuntz E, Geiger E,Benson DW. NKX2.5 mutations in patients with tetralogy of Fallot. Circulation. 2001; 104(21): 2565-8.

[43]

Garg V, Kathiriya IS, Barnes R, et al. GATA4 mutations cause human congenital heart disease and reveal an interaction with TBX5. Nature. 2003; 424(6947): 443-7.

[44]

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. 1999; 96(6): 2919-24.

[45]

Perrot A, Rickert-Sperling S. Human genetics of ventricular septal defect. Adv Exp Med Biol. 2024; 1441: 505-534.

[46]

Schott JJ, Benson DW, Basson CT, et al. Congenital heart disease caused by mutations in the transcription factor NKX2-5. Science. 1998; 281(5373): 108-11.

[47]

Bu H, Sun G, Zhu Y, et al. The M310T mutation in the GATA4 gene is a novel pathogenic target of the familial atrial septal defect. BMC Cardiovasc Disord. 2021; 21(1): 12.

[48]

Trevino CE, Holleman AM, Corbitt H, et al. Identifying genetic factors that contribute to the increased risk of congenital heart disease in infants with Down syndrome. Sci Rep. 2020; 10(1):18051.

[49]

Robinson SW, Morris CD, Goldmuntz E, et al. Missense mutations in CRELD1 are associated with cardiac atrioventricular septal defects. Am J Hum Genet. 2003; 72(4): 1047-52.

[50]

Elliott DA, Kirk EP, Yeoh T, et al. Cardiac homeobox gene NKX2-5 mutations and congenital heart disease: associations with atrial septal defect and hypoplastic left heart syndrome. J Am Coll Cardiol. 2003; 41(11): 2072-6.

[51]

McElhinney DB, Geiger E,Blinder J, et al. NKX2.5 mutations in patients with congenital heart disease. J Am Coll Cardiol. 2003; 42(9): 1650-5.

[52]

Ye S, Wang C, Xu Z, et al. Impaired human cardiac cell development due to NOTCH1 deficiency. Circ Res. 2023; 132(2): 187-204.

[53]

Debiec RM, Hamby SE, Jones PD, et al. Contribution of NOTCH1 genetic variants to bicuspid aortic valve and other congenital lesions. Heart. 2022; 108(14): 1114-1120.

[54]

Garg V, Muth AN, Ransom JF, et al. Mutations in NOTCH1 cause aortic valve disease. Nature. 2005; 437(7056): 270-4.

[55]

Eckhauser A, South ST, Meyers L, et al. Turner syndrome in girls presenting with coarctation of the aorta. J Pediatr. 2015; 167(5): 1062-6.

[56]

Kerstjens-Frederikse WS, van de Laar IM, Vos YJ, et al. Cardiovascular malformations caused by NOTCH1 mutations do not keep left: data on 428 probands with left-sided CHD and their families. Genet Med. 2016; 18(9): 914-23.

[57]

Birjiniuk A, Weisman AG, Laternser C, et al. Cardiovascular manifestations of Turner syndrome: phenotypic differences between karyotype subtypes. Pediatr Cardiol. 2024; 45(7): 1407-1414.

[58]

Brida M, Gatzoulis MA. Pulmonary arterial hypertension in adult congenital heart disease. Heart. 2018; 104(19): 1568-1574.

[59]

Kalisch-Smith JI, Ved N, Sparrow DB. Environmental risk factors for congenital heart disease. Cold Spring Harb Perspect Biol. 2020; 12(3):a037234.

[60]

Better Health Channel. Congenital Heart Disease - Birth Defects. Accessed February 21, 2025. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congenital-heart-disease

[61]

Maduro C, Castro LF, Moleiro ML, et al. Pregestational diabetes and congenital heart disease. Rev Bras Ginecol Obstet. 2022; 44(10): 953-961.

[62]

Battino D, Tomson T, Bonizzoni E, et al. Risk of major congenital malformations and exposure to antiseizure medication monotherapy. JAMA Neurol. 2024; 81(5): 481-489.

[63]

MedlinePlus. Critical Congenital Heart Disease. Accessed February 26, 2025. https://medlineplus.gov/genetics/condition/critical-congenital-heart-disease/

[64]

Rodríguez-Pérez JM, Ortega-Zhindón DB, Villamil-Castañeda C, et al. Congenital heart diseases: recent insights into epigenetic mechanisms. Cells. 2025; 14(11): 820.

[65]

Sheng W, Qian Y, Wang H, et al. DNA methylation status of NKX2-5, GATA4 and HAND1 in patients with tetralogy of Fallot. BMC Med Genomics. 2013; 6: 46.

[66]

Wamstad JA, Alexander JM, Truty RM, et al. Dynamic and coordinated epigenetic regulation of developmental transitions in the cardiac lineage. Cell. 2012; 151(1): 206-20.

[67]

Grunert M, Appelt S, Dunkel I, et al. Altered microRNA and target gene expression related to tetralogy of Fallot. Sci Rep. 2019; 9(1):19063.

[68]

Cheng Z, Zhang Q, Yin A, et al. The long non-coding RNA uc.4 influences cell differentiation through the TGF-beta signaling pathway. Exp Mol Med. 2018; 50(2):e447.

[69]

Lu Y, Fang Q, Qi M, et al. Copy number variation-associated lncRNAs may contribute to the etiologies of congenital heart disease. Commun Biol. 2023; 6(1): 189.

[70]

Benhaourech S, Drighil A, Hammiri AE. Congenital heart disease and Down syndrome: various aspects of a confirmed association. Cardiovasc J Afr. 2016; 27(5): 287-290.

[71]

Goldmuntz E. 22q11.2 deletion syndrome and congenital heart disease. Am J Med Genet C Semin Med Genet. 2020; 184(1): 64-72.

[72]

Kosiv KA, Gossett JM, Bai S, et al. Congenital heart surgery on in-hospital mortality in trisomy 13 and 18. Pediatrics. 2017; 140(5):e20170772.

[73]

Rashkin SR, Cleves M, Shaw GM, et al. A genome-wide association study of obstructive heart defects among participants in the National Birth Defects Prevention Study. Am J Med Genet A. 2022; 188(8): 2303-2314.

[74]

Martin LJ, Benson DW. Focused strategies for defining the genetic architecture of congenital heart disease. Genes (Basel). 2021; 12(6): 827.

[75]

Hanchard NA, Swaminathan S, Bucasas K, et al. A genome-wide association study of congenital cardiovascular left-sided lesions shows association with a locus on chromosome 20. Hum Mol Genet. 2016; 25(11): 2331-2341.

[76]

Mitchell LE, Agopian AJ, Bhalla A, et al. Genome-wide association study of maternal and inherited effects on left-sided cardiac malformations. Hum Mol Genet. 2015; 24(1): 265-273.

[77]

Sumathi IR, Kristen AM, Ina HL, et al. Genetic detection of congenital heart disease. Gynecol Obstet Clin Med. 2022; 2(3): 109-123.

[78]

Sun S, Ji Y, Shao D, et al. Genomic insights into prenatal diagnosis of congenital heart disease: value of CNV-seq and WES in clinical practice. Front Genet. 2024; 15:1448383.

[79]

De Backer J, Breckpot J, Bondue A. When to Consider Genetic Counseling and Testing in Patients With Congenital Heart Disease. Accessed February 21, 2025. https://www.escardio.org/Councils/Council-on-Cardiovascular-Genomics/Cardiovascular-Genomics-Insight/Volume-4/when-to-consider-genetic-counseling-and-testing-in-patients-with-congenital-heart-disease

[80]

Kikano S, Kannankeril PJ. Precision medicine in pediatric cardiology. Pediatr Ann. 2022; 51(10): e390-e395.

[81]

Wikipedia. Copy Number Variation. Accessed February 18, 2025. https://en.wikipedia.org/wiki/Copy_number_variation

[82]

Liu Y, Chang X, Glessner J, et al. Association of rare recurrent copy number variants with congenital heart disease based on next-generation sequencing data from family trios. Front Genet. 2019; 10: 819.

[83]

Findley TO, Crain AK, Mahajan S, et al. Congenital heart disease and copy number variants associated with neurodevelopmental impairment. Am J Med Genet A. 2022; 188(1): 13-23.

[84]

Moustakli E, Christopoulos P, Potiris A, et al. Long-read sequencing and structural variant detection: unlocking the hidden genome in rare genetic disorders. Diagnostics (Basel). 2025; 15(14): 1803.

[85]

Samad T, Wu SM. Single cell RNA sequencing approaches to cardiac development and congenital heart disease. Semin Cell Dev Biol. 2021; 118: 129-135.

[86]

Fear VS, Forbes CA, Shaw NC, et al. Gene editing and cardiac disease modelling for the interpretation of genetic variants of uncertain significance in congenital heart disease. Stem Cell Res Ther. 2023; 14(1): 345.

[87]

Snider P, Conway SJ. Probing human cardiovascular congenital disease using transgenic mouse models. Prog Mol Biol Transl Sci. 2011; 100: 83-110.

[88]

Lyons I, Parsons LM,Hartley L, et al. Myogenic and morphogenetic defects in the heart tubes of murine embryos lacking the homeo box gene Nkx2-5. Genes Dev. 1995; 9(13): 1654-66.

[89]

Bakkers J. Zebrafish as a model to study cardiac development and human cardiac disease. Cardiovasc Res. 2011; 91(2): 279-288.

[90]

Lin H, McBride KL, Garg V, et al. Decoding genetics of congenital heart disease using patient-derived induced pluripotent stem cells (iPSCs). Front Cell Dev Biol. 2021; 9:630069.

[91]

Zhang YS, Arneri A, Bersini S, et al. Bioprinting 3D microfibrous scaffolds for engineering endothelialized myocardium and heart-on-a-chip. Biomaterials. 2016; 110: 45-59.

[92]

Ma J, Gu Y, Liu J, et al. Functional screening of congenital heart disease risk loci identifies 5 genes essential for heart development in zebrafish. Cell Mol Life Sci. 2022; 80(1): 19.

[93]

Parrott A, Ware SM. The role of the geneticist and genetic counselor in an ACHD Clinic. Prog Pediatr Cardiol. 2012; 34(1): 15-20.

[94]

Arya B. Fetal cardiac imaging for congenital heart disease—is cardiac magnetic resonance imaging the future? JAMA Netw Open. 2021; 4(3):e214617.

[95]

Blue GM, Kirk EP, Giannoulatou E, et al. Advances in the genetics of congenital heart disease: a clinician's guide. J Am Coll Cardiol. 2017; 69(7): 859-870.

[96]

de Denus S, Kantor PF. Pharmacogenomics and heart failure in congenital heart disease. Can J Cardiol. 2013; 29(7): 779-785.

[97]

Solomon A. CRISPR-Cas9 in vivo gene editing for transthyretin amyloidosis. N Engl J Med. 2021; 385(18): 1721-1722.

[98]

Kim Y, Landstrom AP, Shah SH, et al. Gene therapy in cardiovascular disease: recent advances and future directions in science: a science advisory from the American Heart Association. Circulation. 2024; 150(23): e471-e480.

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