[Aneurysm of the ascending aorta with aortic valve insufficiency]

Nine cases are reported who had aneurysms of the ascending aorta and aortic valve incompetence and in whom aortic valve prostheses and aortic prostheses had to be implanted. Two patients had dissecting aneurysms. In five patients, the origins of the coronary arteries were involved, and these had to be implanted into the prostheses. Chest x-rays in two planes, kymograms and CT provided the diagnosis. The most important pre-operative examination in order to assess valve function and the origins of the coronary arteries is catheter angiography.

Echocardiographic assessment of cardiovascular abnormalities in the Marfan syndrome. Comparison with clinical findings and with roentgenographic estimation of aortic root size

Echocardiographic abnormalities of the mitral valve and aortic root were compared with auscultatory findings and with assessment of aortic root size by chest roentgenography in 61 patients with the Marfan syndrome. Echocardiography was more sensitive than physical examination in detecting valvular and aortic root abnormalities. Although physical examination revealed findings of mitral valve disease and/or of aortic regurgitation in 52 percent of patients (mitral valve disease in 44 percent and aortic regurgitation in 23 percent), echocardiography detected abnormalities of the mitral valve and/or aortic root in 82 percent of patients (mitral valve prolapse in 57 percent and aortic root enlargement in 69 percent). Prevalence of mitral valve prolapse was approximately equal in male and female patients, whereas aortic root enlargement was more frequent in males (83 percent) than in females (50 percent). Echocardiographically detected aortic root enlargement was frequently not apparent on chest x-ray films. Indeed, five patients with markedly increased aortic root diameters (ranging from 6.0 to 7.9 cm) had no evident enlargement of the aortic root on routine chest x-ray films. In all four of those patients who had angiographic and/or pathologic correlations, confirmation of marked aortic root dilatation was obtained. There are limitations to echocardiographic evaluation of the presence and severity of underlying cardiovascular disease in patients with the Marfan syndrome. Mitral valve disease may not be detected, especially in patients with left ventricular dilatation. In addition, due to anteroposterior compression of the left atrium by the enlarged aorta, left atrial size may be underestimated in patients with aortic root enlargement.

The Antley-Bixler syndrome

Three unrelated children (two girls and one boy) with the Antley-Bixler syndrome have been evaluated, bringing to five the number of patients reported with this disorder. All have had brachycephaly, midface hypoplasia, dysplastic ears, radiohumeral synostosis, and joint contractures. Craniosynostosis has been documented radiographically in four of the five patients. All five have had a severely shortened cranial base. Femoral bowing with neonatal fractures has been a variable feature. All have represented sporadic occurrences in otherwise normal families.

The marfan skull

The classic clinical features of Marfan syndrome include ectopic lens, valvular heart disease and dissecting aneurysm, and long, narrow extremeties associated with tall stature. When the classic features are incomplete, diagnosis is uncertain. This study presents some radiographic measurements of the skull in patients with the Marfan syndrome, in an attempt to aid diagnosis by quantitating the features defining the syndrome. Compared with the normal skull, the Marfan skull was found to be longer, taller, thicker, and to have have increased frontal sinus area. The most consistent and therefore diagnostic abnormality ws increased height.

Atlantoaxial instability in Marfan's syndrome. Diagnosis and treatment. A case report

A case of Marfan's syndrome is described in which progressive neurological signs and symptoms were produced by flexion of the head. Radiological examinations revealed hypermotility between the atlas and axis, as well as compression of the medulla oblongata by the odontoid process on flexion, since low positioned cerebellar tonsils prevented dorsal shift of the oblongata. The signs and symptoms disappeared after occipitocervical internal transfixation.

Case report and study of collagen metabolism in Marfan's syndrome

The case report on a 33 year old woman with prominent features of Marfan's syndrome is presented. Characteristic signs were seen in the bones, the eyes, the cardiovascular system, and the lungs. Due to regurgitation of both the aortic and mitral valves and an aneurysm of the ascending aorta a double valve replacement was made, including a prosthesis of the aorta. The problems of early diagnosis and therapy of the life-threatening cardiovascular complications are discussed. Tissue specimens from the aorta were analysed histochemically and biochemically. Histology showed a typical necrosis of the media with cyst formation. Biochemical analysis by in vitro labeling of collagen in tissue explants and by electron microscopical evaluation showed proportions of type I and type III collagen which were significantly different from controls. In both the media and the adventitia the amount of type I collagen was drastically reduced as shown by quantitation of collagen and procollagen. Fibroblasts derived from the skin of the patient showed a normal content of type I and type III collagen. It is conceivable that the reduced content of type I collagen in the aortic wall is responsible for the weakness of the vessel wall causing formation of aneurysm and its sequelae.

Bronchiectasis and Marfan's syndrome

Marfan's syndrome is a rare hereditary disorder characterized by skeletal, cardiovascular and ocular abnormalities. Pulmonary abnormalities occur in approximately 10% of patients the commonest being spontaneous pneumothorax and emphysema. A patient is described who had Marfan's syndrome and bronchiectasis, an association only described on 2 previous occasions in the literature.

Comparison of echocardiography and radiology in the diagnosis of aortic root dilatation in Marfan's syndrome and in syphilis

Aortic root dilatation was sought by echocardiography and radiology in 500 consecutive patients referred to an echocardiography laboratory from cardiac or medical clinics and wards. Forty-four of these patients (8.8%) had false echocardiographic evidence of aortic root dissection, but no clinical evidence of the disease. These false findings were attributed to the changing of the transducer angulation, post-stenotic dilatation, calcific aortic stenosis, generalised arteriosclerosis, and thin reverberations behind the posterior wall echo. In one patient with Marfan's syndrome, the chest radiograph was normal and a diagnosis was established by echocardiography. In another patient with syphilis, the dilatation was seen in the chest radiograph while echocardiography revealed a normal proximal aorta. In syphilis the dilatation begins distally and because of the intervening lung tissue echocardiography is unhelpful. Echocardiograms easily detect the aortic valve ring while radiographs show the more distal ascending aorta. These observations may be of added value in the diagnosis of aortic root disease.

Protrusio acetabuli in Marfan's syndrome

In an unselected series of 14 patients with Marfan's syndrome, protrusio acetabuli was documented by both presence of a center edge (CE) angle of 40 degrees or more and crossing of the teardrop by the femoral head. The disorder was unilateral in 8 patients, bilateral in 6. Since most of the CE angles were measured on scoliosis roentgenograms, the measurements were made in a control group with an average CE angle of 33.1 degree, compared with an average of 43.4 degree in the Marfan's group. One of the hips with protrusio was associated with chondrolysis. Protrusio acetabuli is a common abnormality of persons with Marfan's syndrome. It may be related to the same mesenchymal tissue disorder that predisposes these persons to scoliosis, chest wall deformities, and other skeletal malformations.

Congenital contractural arachnodactyly: description of a new kindred

A previously unreported case of congenital contractural arachnodactyly (CCA) is described. This hereditary connective tissue abnormality resembles Marfan's syndrome in certain respects, but is characterized by camptodactyly rather than joint laxity, as well as by congenital contractural deformities of the knees and elbows. In addition, there is a peculiar, fairly characteristic deformity of the external ear. Like Marfan's syndrome, it is transmitted in autosomal dominant fashion. Despite the superficial skeletal resemblance, however, the cardiovascular and ocular complications of Marfan's do not seem to occur and therefore differentiation of the two syndromes is important.

Cardiac, skeletal and ophthalmologic abnormalities in relatives of patients with the Marfan syndrome

Nine patients with the Marfan syndrome and 40 of their first degree relatives were evaluated for the presence of cardiac, skeletal and ophthalmologic abnormalities. Aortic root dilatation and mitral valve prolapse were sought by echocardiography, and the metacarpal index was calculated from hand X-rays. Abnormalities of all the tests performed were present in all nine index cases, except for one normal eye exam. Mitral prolapse was present in thirteen relatives (33%) and aortic root dilatation in seven (18%). At least one cardiac abnormality was present in nineteen (47%) relatives. Aortic root dilatation was more common in male relatives; the incidence of mitral prolapse was approximately equal in the two sexes. Abnormal metacarpal index (greater than 8.0) occurred in fifteen of twenty-six relatives examined (58%). Ophthalmologic abnormalities were found in only four relatives. Two relatives had abnormalities of all three organ systems evaluated, five others had abnormalities of two systems, and fourteen had abnormalities of one system. We conclude that cardiac and skeletal abnormalities are demonstrable in a high percentage of first degree relatives of patients with the Marfan syndrome.

[Calcification of the mitral valve ring, a cardiac manifestation of Marfan's syndrome (author's transl)]

A 29-year-old patient with calcification of the mitral valve annulus with Marfan's syndrome and severe malformation of the chest is reported. There are 8 other cases with calcification of the mitral annulus in this syndrome in the literature. It seems to be a specific but rare cardiac manifestation of Marfan's syndrome with calcification occurring also in the younger age group. These patients, in contrast to other patients with Marfan's syndrome who mostly have mitral insufficiency of minor degree mainly in late systole, present with hemodynamically severe mitral regurgitation. Our patient died 7 weeks after implantation of a prosthetic valve in low output syndrome, probably caused by a paraprosthetic leak and newly developed aortic insufficiency. It therefore seems that indication for prosthetic replacement of the mitral valve in these patients should be made with caution, particularly in regard to the technical difficulties at operation.

Contraposed curve patterns in monozygotic twins

Monozygotic twins with Marfan's disease presented with opposing lumbar curve patterns. Differences in degrees of curvature correspond to the levels of severity of other clinical manifestations of the disease.