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updated August 06, 2010

Marfan syndrome

Filed under: Boomer's Health
Marfan syndrome is an inherited disorder that affects connective tissue, which supports and anchors your organs and other structures in your body. Because connective tissue is such an integral part of your body, Marfan syndrome may disrupt development and function in several sites. Most common are your heart, eyes, blood vessels and skeleton.

People with Marfan syndrome are usually tall and thin with disproportionately long arms, legs, fingers and toes. Marfan syndrome is caused by a dominant gene, which means one of your parents also has the gene and passed it to you.

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The signs and symptoms of Marfan syndrome vary greatly, even among members of the same family. Some people experience only mild effects, but others develop life-threatening complications. In most cases, the disease tends to worsen with age.

Marfan syndrome features may include:

  • Tall and slender build
  • Disproportionately long arms, legs, fingers and toes
  • A breastbone that protrudes outward or dips inward
  • A high, arched palate and crowded teeth
  • Heart murmurs
  • Extreme nearsightedness
  • A curved spine
  • Flat feet

When to see a doctor
If you think that you or your child may have Marfan syndrome, talk to your doctor or pediatrician. If your doctor suspects a problem, you'll likely be referred to a specialist for further evaluation.

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Marfan syndrome is caused by a defect in the gene that enables your body to produce a protein that helps give connective tissue its elasticity and strength.

Most people with Marfan syndrome inherit the abnormal gene from a parent who has the disorder. Marfan syndrome is an autosomal dominant condition, which means that a defective gene from only one parent is needed to pass the disease on. It also means that each child of an affected parent has a 50-50 chance of inheriting the defective gene.

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Marfan syndrome affects men and women equally and occurs among all races and ethnic groups. Because it's a genetic condition, the greatest risk factor for Marfan syndrome is having a parent with the disorder.

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Because Marfan syndrome can affect almost any part of your body, it may cause a wide variety of complications.

Cardiovascular complications
The most dangerous complications of Marfan syndrome involve the heart and blood vessels. Faulty connective tissue can weaken the aorta, the large artery that curves over your heart and supplies blood to the body, then splits in your pelvis to supply blood to your legs.

  • Aortic aneurysm. The pressure of blood leaving your heart can cause the wall of your artery to bulge out, like a weak spot in a tire. In people who have Marfan syndrome, this is most likely to happen at the aortic root — where the artery leaves your heart. The bulge can spread along the entire length of the aorta, into your abdomen. If it ruptures or tears, you may die.
  • Aortic dissection. The wall of the aorta is made up of thin layers. Dissection occurs when a small tear in the innermost layer of the aorta's wall allows blood to squeeze in between the inner and outer layers of the wall. This can cause severe pain in the chest or back. An aortic dissection weakens the vessel's structure and often results in a rupture, which can be fatal.
  • Valve malformations. People who have Marfan syndrome are also more likely to have problems with their heart valves, which may be malformed or overly elastic. When heart valves don't work properly, your heart muscle often has to work harder to compensate. This can eventually lead to heart failure.

Eye complications
Eye complications may include:

  • Dislocation of the lens in one or both eyes because of weakness in the ligaments that hold the lens in place.
  • Glaucoma, a condition in which abnormally high pressure within your eyes damages the optic nerve. Symptoms may range from sensitivity to light and glare to severe eye pain, blurred vision and blindness.
  • A cataract, which clouds the eye's normally clear lens.
  • Detachment or tear in the retina, the light-sensitive tissue that lines the back wall of your eye.

Lung complications
Marfan syndrome can cause breathing difficulties, either from defective connective tissue or from chest wall abnormalities. Severe spinal curvature or a concave chest, for instance, may restrict your breathing and cause you to feel short of breath during mild or moderate activity. People with Marfan syndrome are also at higher risk of:

  • Emphysema
  • Chronic obstructive pulmonary disease
  • Collapsed lung
  • Sleep apnea

Complications of pregnancy
Women with Marfan syndrome face possible complications during pregnancy. The main threat is a rapid increase in the size of your aorta, leading to life-threatening aortic dissection or rupture.

Although the risk of dissection during pregnancy is unpredictable, it's generally low if your aorta isn't enlarged before you become pregnant. But if your aorta is even slightly enlarged, the risk increases greatly. Pregnancy isn't recommended if your aorta is enlarged.

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Marfan syndrome can affect many different parts of your body, so you may need to see a variety of medical specialists, such as:

  • A cardiologist, a doctor who specializes in heart disorders
  • An ophthalmologist, a doctor who specializes in eye disorders
  • An orthopedist, a doctor who specializes in bones
  • A geneticist, a doctor who specializes in genetic disorders

Appointments can be brief. To make the best use of the limited time, plan ahead and have important information available, including:

  • Detailed descriptions of all your symptoms
  • Details of your past medical history, including any previous surgical reports
  • A list of all your medications and dosages, including nonprescription drugs and supplements
  • Questions for the doctor, such as what tests or treatments he or she may recommend

What to expect from your doctor
The examinations will vary depending on the type of specialist you're seeing. For example, a cardiologist will listen carefully to your heart while an ophthalmologist may dilate your pupils to check the insides of your eyes. All your doctors will want to hear about your specific symptoms, and whether anyone in your family has had Marfan syndrome or experienced an early, unexplained heart-related death.

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Marfan syndrome can be challenging for doctors to diagnose because many connective tissue disorders have similar signs and symptoms. And even among members of the same family, the signs and symptoms of Marfan syndrome vary widely — both in their features and in their severity.

Certain combinations of symptoms and family history must be present to confirm a diagnosis of Marfan syndrome. In some cases, a person may have some features of Marfan syndrome, but not enough of them to be diagnosed with the disorder.

Diagnostic tests may include:

  • Echocardiogram. This test is an ultrasound of your heart. It uses sound waves to capture real time images of your heart in motion. Echocardiograms show how well your heart chambers and valves are working. In addition, the ascending aorta, aortic arch, and upper descending aorta can usually be seen and measured with an echocardiogram. Occasionally, to better see your aorta, your doctor may recommend a transesophageal echocardiogram — in which the sound waves are generated from within your body by a device threaded down your esophagus.

    You'll likely have an echocardiogram as the first test to check for Marfan syndrome. If your doctor thinks you have Marfan syndrome, the size of your aorta will be recorded, and your doctor will likely order another echocardiogram within six to 12 months to make sure your aorta hasn't grown larger.

    In addition, if you're diagnosed with Marfan syndrome, your doctor will recommend that images be taken of your entire aorta. This is usually done with magnetic resonance angiography (MRA) or computerized tomography (CT) scans.

  • Magnetic resonance angiography (MRA) or computerized tomography (CT) scans. These tests both use a special dye — called a contrast medium — to highlight structures in your aorta. In MRA, radio waves in a strong magnetic field produce data that can be computer-translated into detailed images of your blood vessels. A CT scan combines a series of X-ray views taken from many different angles to produce cross-sectional images of the aorta.
  • Slit-lamp exam. This eye test checks for lens dislocation, cataracts or a detached retina. Your eyes will need to be completely dilated with drops for this exam.
  • Eye pressure test. To check for glaucoma, your eye doctor may measure the pressure inside your eyeball by touching it with a special tool. Numbing eyedrops are usually used before this test.

Tests for blood relatives
Marfan syndrome and other conditions that affect the upper part of your aorta (thoracic aorta) tend to run in families. Because of this, your doctor may recommend that your first-degree blood relatives, such as your siblings or children, have tests to check for Marfan syndrome or other conditions. These tests include:

  • Genetic testing. If findings from standard exams for Marfan syndrome are not clear cut, genetic testing can be helpful. Genetic testing can also be used to test symptom-free relatives in families where a genetic mutation has been identified.

    You may also want to consider genetic testing and genetic counseling before starting a family, to see what your chances are of passing on Marfan syndrome to your future children.

  • Imaging tests. Your doctor may recommend that your first-degree relatives have an echocardiogram or another type of imaging test to check for Marfan syndrome or another thoracic aortic condition.

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In the past few decades, treatment advances to prevent aortic ruptures have allowed many people with Marfan syndrome to live a near-average life span. Researchers are working to develop more-targeted treatment approaches for Marfan syndrome, and the outlook for this condition continues to improve.

While no treatment exists yet for Marfan syndrome itself, therapy focuses on preventing the various complications of the disease. For that reason, the treatment you receive will depend on the nature and severity of your symptoms.

Cardiovascular problems
The cardiovascular complications association with Marfan syndrome can be life-threatening, so doctors typically recommend an annual heart exam.

Two main approaches exist for treating cardiovascular complications:

  • Medications. Doctors often prescribe blood pressure lowering drugs to help prevent the aorta from enlarging and to reduce the risk of dissection, even though your blood pressure may be normal. The most commonly used drugs are beta blockers, which cause your heart to beat more slowly and with less force and reduce your risk of aortic dissection and rupture.

    If you can't tolerate the side effects of beta blockers, your doctor may prescribe an angiotensin-converting enzyme (ACE) inhibitor or calcium channel blocker instead. Medications called angiotensin receptor blockers also are often used in people with Marfan syndrome due to beneficial results in animal and human studies. Children often receive the same medications as adults.

  • Surgery. If your aorta's diameter enlarges quickly or reaches a dangerous size — usually around 2 inches (5 cm) — your doctor may recommend an operation to replace a portion of your aorta with a tube made of synthetic material. This can help prevent a life-threatening rupture. Your aortic valve may need to be replaced as well. Some people with Marfan syndrome may require multiple operations.

Skeletal problems
Many of the skeletal problems that affect people with Marfan syndrome also occur in the general population and are treated the same way. They include:

  • Scoliosis. For some children and adolescents, doctors recommend a custom-made back brace, which is worn nearly continuously until growth is complete. Although a brace can't permanently straighten the spine, it may help stop spinal curvature from becoming worse. If the curve in your child's spine is too great, a brace may not be effective, and your doctor may suggest surgery to straighten the spine.
  • Concave chest. When a concave chest affects your child's breathing, surgery may be an option. The operation consists of raising the sternum and ribs and holding them in place. A convex chest usually doesn't cause functional problems, but it may be a cosmetic concern and can also be corrected surgically.

Eye problems
Because of the eye problems that can occur with Marfan syndrome, doctors usually recommend an annual eye exam for people with the disease. These problems include:

  • Dislocated lens. In younger children, a dislocated lens can be treated effectively with glasses or contact lenses that refract around or through the lens. Adolescents who find glasses cosmetically unacceptable or their visual field too restricted may be candidates for a type of intraocular lens implant.
  • Glaucoma. While glaucoma can't be cured, the disease can be controlled with early detection and treatment. Eyedrops, oral medications and surgical procedures can prevent or slow further damage.
  • Cataracts. Surgery to replace your clouded lens with an artificial lens is usually very successful at improving vision damaged by cataracts. You may want to consider cataract surgery once vision loss begins to interfere with everyday activities.
  • Retinal detachment. In most cases, eye surgeons can repair sections of the retina that have torn or detached.

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Depending on your risk of heart, eye or skeletal complications, your doctor may recommend that you avoid competitive sports and certain recreational activities.

High risk

  • Weightlifting
  • Ice hockey
  • Football
  • Rock climbing
  • Surfing
  • Scuba diving

Medium risk

  • Basketball
  • Racquetball
  • Squash
  • Running
  • Skiing
  • Singles tennis
  • Touch football
  • Soccer
  • Baseball
  • Biking
  • Lap swimming

Low risk

  • Bowling
  • Golf
  • Skating
  • Snorkeling
  • Brisk walking
  • Modest hiking
  • Doubles tennis

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Living with a genetic disorder can be extremely difficult for both adults and children. Adults who receive a diagnosis later in life may wonder how the disease will affect their careers, their relationships and their sense of themselves. And they may worry about passing the defective gene to their children.

But Marfan syndrome can be even harder on young people, especially because the often-inherent self-consciousness of childhood and adolescence may be exacerbated by the disease's effect on appearance, academic performance and motor skills.

Providing emotional, practical support
Working together, parents, teachers and medical professionals can provide children with both emotional support and practical solutions for some of the more distressing aspects of the disease. For example, children with Marfan syndrome may struggle in school because of eye problems that can be corrected with glasses or contact lenses. And difficulty with handwriting, a fine-motor skill, can be remedied by allowing students to use laptop computers in the classroom or by giving them more time on handwritten assignments.

For most young people, though, cosmetic concerns are at least as important as academic ones. Parents can help by anticipating these concerns and offering solutions: contact lenses instead of glasses; a brace for scoliosis; dental work for crowded teeth; and clothes that flatter a tall, thin frame.

In the long run, accurate information about the disease, good medical care and strong social support can help both children and adults cope with Marfan syndrome.

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