Cardiac features of Noonan syndrome in Japanese patients

Cardiol Young. 2023 Apr;33(4):564-569. doi: 10.1017/S104795112200124X. Epub 2022 Apr 27.


Background: Cardiovascular disease is one of the most important problems in long-term follow-up for Noonan syndrome. We examined cardiovascular issues and clinical manifestations, with a focus on the cardiovascular disease and prognosis of patients with Noonan syndrome.

Methods: This single-centre study evaluated patients who were clinically and genetically diagnosed with Noonan syndrome.

Results: Forty-three patients diagnosed with Noonan syndrome were analysed. The most prevalent responsible mutation was found in PTPN11 (25/43). The second and third most prevalent causative genes were SOS1 (6/43) and RIT1 (5/43), respectively, and 67.4% of genetically diagnosed patients with Noonan syndrome had structural cardiovascular abnormalities. Pulmonary valve stenosis was prevalent in patients with mutations in PTPN11 (8/25), SOS1 (4/6), and RIT1 (4/5). Hypertrophic cardiomyopathy was found in two of three patients with mutations in RAF1. There was no difference in the cardiovascular events or cardiovascular disease prevalence in patients with or without PTPN11 mutations. The proportion of RIT1 mutation-positive patients who underwent intervention due to cardiovascular disease was significantly higher than that of patients with PTPN11 mutations. Patients who underwent any intervention for pulmonary valve stenosis exhibited significantly higher pulmonary flow velocity than patients who did not undergo intervention, when they visited our hospital for the first time. All patients who underwent intervention for pulmonary valve stenosis had a pulmonary flow velocity of more than 3.0 m/s at first visit.

Conclusions: These findings suggest that genetic information can provide a clinical prognosis for cardiovascular disease and may be part of genotype-based follow-up in Noonan syndrome.

Keywords: Noonan syndrome; PTPN11; RIT1; hypertrophic cardiomyopathy; pulmonary valve stenosis.

MeSH terms

  • Cardiomyopathy, Hypertrophic* / genetics
  • East Asian People
  • Genotype
  • Humans
  • Mutation
  • Noonan Syndrome* / complications
  • Noonan Syndrome* / genetics
  • Pulmonary Valve Stenosis* / epidemiology
  • Pulmonary Valve Stenosis* / genetics


  • Raf1 protein, human
  • RIT1 protein, human
  • SOS1 protein, human
  • PTPN11 protein, human