VACTERL association

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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VACTERL association
VACTERL association
Synonyms	VATER association
Pronounce
Specialty	Medical genetics
Symptoms	Vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities
Complications	N/A
Onset	Congenital
Duration	Lifelong
Types	N/A
Causes	Unknown, possibly genetic and environmental factors
Risks
Diagnosis	Clinical evaluation, imaging studies
Differential diagnosis	CHARGE syndrome, Fanconi anemia, Townes-Brocks syndrome
Prevention	None
Treatment	Surgical correction of anomalies, supportive care
Medication
Prognosis	Variable, depends on severity and combination of anomalies
Frequency	Rare
Deaths

A non-random association of birth defects

VACTERL association is a non-random association of birth defects that affects multiple anatomical systems. The acronym VACTERL stands for:

• Vertebral anomalies
• Anal atresia
• Cardiac defects
• Tracheo-Esophageal fistula
• Renal anomalies
• Limb abnormalities

Individuals diagnosed with VACTERL association typically present with at least three of these congenital malformations. The exact cause of VACTERL association is not well understood, but it is believed to result from disruptions in embryonic development.

Clinical Features

Vertebral Anomalies

Vertebral anomalies are present in approximately 60-80% of individuals with VACTERL association. These may include hemivertebrae, vertebral fusion, or scoliosis.

Anal Atresia

Anal atresia, also known as imperforate anus, occurs in about 55-90% of cases. This condition requires surgical intervention shortly after birth to create a functional anal opening.

Cardiac Defects

Cardiac defects are found in 40-80% of individuals with VACTERL association. Common heart defects include ventricular septal defect (VSD), atrial septal defect (ASD), and tetralogy of Fallot.

Tracheo-Esophageal Fistula

Tracheo-esophageal fistula (TEF) is present in approximately 50-80% of cases. This condition involves an abnormal connection between the trachea and esophagus, often accompanied by esophageal atresia.

Renal Anomalies

Renal anomalies occur in 50-80% of individuals and may include renal agenesis, horseshoe kidney, or hydronephrosis.

Limb Abnormalities

Limb abnormalities are present in 40-50% of cases. These may include radial aplasia, polydactyly, or syndactyly.

Diagnosis

Diagnosis of VACTERL association is primarily clinical, based on the presence of at least three of the characteristic anomalies. Prenatal diagnosis may be possible through ultrasound and other imaging techniques, but many cases are identified after birth.

Management

Management of VACTERL association is multidisciplinary, involving pediatricians, surgeons, cardiologists, and other specialists. Treatment is tailored to the specific anomalies present in each individual and may include surgical correction of defects, supportive care, and ongoing monitoring for complications.

Prognosis

The prognosis for individuals with VACTERL association varies depending on the severity and combination of anomalies. With appropriate medical and surgical management, many individuals can lead healthy lives, although they may require ongoing medical care.

See also

• Congenital disorder
• Esophageal atresia
• Congenital heart defect
• Syndrome