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Fortea-Sanchis C, Ángel Yepes V, Priego Jiménez P, Martínez-Ramos D, Escrig Sos J. Marfan Syndrome and Pneumothorax. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cireng.2013.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neuville M, Jondeau G, Crestani B, Taillé C. [Respiratory manifestations of Marfan's syndrome]. Rev Mal Respir 2014; 32:173-81. [PMID: 25765122 DOI: 10.1016/j.rmr.2014.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
Marfan's syndrome is a rare genetic disorder caused by a mutation of the gene FBN1, coding for the protein fibrillin-1. Cardiovascular, musculoskeletal and ophthalmic manifestations are the most commonly observed, but minor diagnostic criteria also include pulmonary manifestations. Pneumothorax, frequently relapsing, affects 5 to 11% of patients. Rib cage abnormalities (pectus excavatum or pectus carinatum) and apical blebs may contribute to their occurrence. Treatment does not require any specific procedure but there is an increased risk of recurrence. Pectus excavatum affects up to 60% of the patients, without any functional impairment in most cases. Surgery may be required (using the Nuss procedure) in case of cardiovascular or psychological symptoms. Marfan's syndrome is frequently associated with obstructive sleep apnoea, which may itself contribute to aortic dilatation. Some studies suggest a potential role of craniofacial abnormalities in the pathogenesis of sleep apnea in these patients. Pulmonologists should consider Marfan's syndrome when treating patients for recurrent spontaneous pneumothorax or rib cage abnormalities, since early detection of cardiac abnormalities improves the prognosis significantly.
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Affiliation(s)
- M Neuville
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence pour les maladies pulmonaires rares, hôpital Bichat-Claude-Bernard, 75018 Paris, France
| | - G Jondeau
- Service de cardiologie, département hospitalo-universitaire FIRE, centre national de référence pour le syndrome de Marfan et apparentés, hôpital Bichat-Claude-Bernard, 75018 Paris, France
| | - B Crestani
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence pour les maladies pulmonaires rares, hôpital Bichat-Claude-Bernard, 75018 Paris, France
| | - C Taillé
- Service de pneumologie, département hospitalo-universitaire FIRE, centre de compétence pour les maladies pulmonaires rares, hôpital Bichat-Claude-Bernard, 75018 Paris, France.
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Fortea-Sanchis C, Ángel Yepes V, Priego Jiménez P, Martínez-Ramos D, Escrig Sos J. Marfan syndrome and pneumothorax. Cir Esp 2014; 93:e87-8. [PMID: 24629924 DOI: 10.1016/j.ciresp.2013.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/07/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Carlos Fortea-Sanchis
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España.
| | - Vicente Ángel Yepes
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - Pablo Priego Jiménez
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - David Martínez-Ramos
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - Javier Escrig Sos
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
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Viveiro C, Rocha P, Carvalho C, Zarcos MM. Spontaneous pneumothorax as manifestation of Marfan syndrome. BMJ Case Rep 2013; 2013:bcr-2013-201697. [PMID: 24311428 DOI: 10.1136/bcr-2013-201697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors describe a 16-year-old boy, previously healthy, who was admitted to our hospital for left-sided spontaneous pneumothorax. On physical examination he presented with marfanoid habitus. Pneumothorax was managed conservatively with resolution. Four months later he had a recurrence of left-sided pneumothorax and 1 week after that he presented with contralateral pneumothorax. He underwent video-assisted thoracoscopic surgery twice for bullectomy and pleurodesis. No further recurrence was stated. Additional investigation showed a prolapsed cardiac mitral valve and Marfan syndrome was confirmed genetically.
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Affiliation(s)
- Carolina Viveiro
- Department of Pediatria, Centro Hospitalar de Leiria-Pombal, Leiria, Portugal
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Örnek D, Aydın GB, Kahveci K, Çiçek F, Dikmen B. Anesthetic management of a child with both Marfan syndrome and Turner syndrome. J Anesth 2012; 26:442-4. [DOI: 10.1007/s00540-012-1332-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 01/12/2012] [Indexed: 10/14/2022]
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Abstract
Marfan syndrome is an autosomal dominant illness of the connective tissue, with typical skeletal, ocular and cardiovascular manifestations. Less frequently, pulmonary involvement occurs, namely spontaneous pneumothorax, which generally is recurrent and occurs in 4 -11% of cases. The authors describe a 14 -year -old boy, previously healthy, admitted with a unilateral spontaneous pneumothorax, and clinical phenotype of Marfan syndrome. The subsequent investigation led to the diagnosis of mitral valve prolapse and dilatation of the root of aorta. Pneumothorax resolved through active drainage and a computerised tomography scan excluded subpleural blebs. The patient was readmitted two months later with a new spontaneous pneumothorax, with an identical localization. Surgical resection of a newly identified enfisematous bleb and pleurodesis were performed. Two years later he is asymptomatic. We highlight the importance of an early diagnosis of and a multidisciplinary approach to these patients. Monitoring illness progression and prevention of serious complications, namely cardiovascular, are essential.
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Carvalho I, Romariz J, Miranda JA, Rodrigues L. [A case of recurrent spontaneous pneumothorax]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008; 14:693-7. [PMID: 18781269 DOI: 10.1016/s0873-2159(15)30278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Spontaneous pneumothorax is a rare disease at paediatric age and in most cases is associated to predisposing factors. The authors present a case of spontaneous pneumothorax in a 9 year-old child with a history of prematurity and mechanical ventilation at neonatal stage. In spite of clinical and radiological improvement after pleural drainage, pneumothorax recurred three months later and emphysema was identified, leading to surgery. This case is important due to the rarity of the disease in this age group and its possible relation to prior neonatal medical history.
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Affiliation(s)
- Isabel Carvalho
- Serviço de Pediatria, Centro Hospitalar de Vila Nova de Gaia.
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Waseem M, Ganti S. Chest pain in an adolescent with Marfan syndrome. J Emerg Med 2007; 35:449-51. [PMID: 17919874 DOI: 10.1016/j.jemermed.2007.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 09/01/2006] [Accepted: 11/10/2006] [Indexed: 11/27/2022]
Affiliation(s)
- Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, New York 10451, USA
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Ha HI, Seo JB, Lee SH, Kang JW, Goo HW, Lim TH, Shin MJ. Imaging of Marfan Syndrome: Multisystemic Manifestations. Radiographics 2007; 27:989-1004. [PMID: 17620463 DOI: 10.1148/rg.274065171] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Marfan syndrome is an inherited multisystemic connective-tissue disease that is caused by a mutation of the fibrillin-1 gene. The syndrome is characterized by a wide range of clinical manifestations. Common cardiovascular manifestations, most of which are substantial contributors to mortality, include annuloaortic ectasia with or without aortic valve insufficiency, aortic dissection, aortic aneurysm, pulmonary artery dilatation, and mitral valve prolapse. Scoliosis, pectus excavatum and carinatum, arachnodactyly, and acetabular protrusion are common musculoskeletal manifestations. Dural ectasia is a characteristic central nervous system manifestation. In some patients with Marfan syndrome, there is also pulmonary and ocular involvement. Early identification and treatment of these conditions contribute to an improved quality of life and a life expectancy close to the average for the general population in the United States. Radiologists play a key role in the diagnosis of Marfan syndrome. Knowledge about the various manifestations of Marfan syndrome and awareness of their radiologic appearances permit a comprehensive diagnostic approach that allows better patient care.
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Affiliation(s)
- Hong Il Ha
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2 dong, Songpa-gu, Seoul 138-736, Korea
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Robinson PN, Arteaga-Solis E, Baldock C, Collod-Béroud G, Booms P, De Paepe A, Dietz HC, Guo G, Handford PA, Judge DP, Kielty CM, Loeys B, Milewicz DM, Ney A, Ramirez F, Reinhardt DP, Tiedemann K, Whiteman P, Godfrey M. The molecular genetics of Marfan syndrome and related disorders. J Med Genet 2006; 43:769-87. [PMID: 16571647 PMCID: PMC2563177 DOI: 10.1136/jmg.2005.039669] [Citation(s) in RCA: 276] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Marfan syndrome (MFS), a relatively common autosomal dominant hereditary disorder of connective tissue with prominent manifestations in the skeletal, ocular, and cardiovascular systems, is caused by mutations in the gene for fibrillin-1 (FBN1). The leading cause of premature death in untreated individuals with MFS is acute aortic dissection, which often follows a period of progressive dilatation of the ascending aorta. Recent research on the molecular physiology of fibrillin and the pathophysiology of MFS and related disorders has changed our understanding of this disorder by demonstrating changes in growth factor signalling and in matrix-cell interactions. The purpose of this review is to provide a comprehensive overview of recent advances in the molecular biology of fibrillin and fibrillin-rich microfibrils. Mutations in FBN1 and other genes found in MFS and related disorders will be discussed, and novel concepts concerning the complex and multiple mechanisms of the pathogenesis of MFS will be explained.
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Affiliation(s)
- P N Robinson
- Institute of Medical Genetics, Charité University Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany.
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Shinawi M, Boileau C, Brik R, Mandel H, Bentur L. Splicing mutation in the fibrillin-1 gene associated with neonatal Marfan syndrome and severe pulmonary emphysema with tracheobronchomalacia. Pediatr Pulmonol 2005; 39:374-8. [PMID: 15666366 DOI: 10.1002/ppul.20174] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neonatal Marfan syndrome is an autosomal-dominant connective tissue disease with unique clinical manifestations and mutations. We describe the clinical course of an infant with neonatal Marfan syndrome that had the novel IVS31-2A > G splice site mutation in fibrillin-1. This mutation affects the second base of the acceptor consensus splice site of intron 31, and probably leads to abnormal splicing events. The patient presented with respiratory distress and heart murmur in early neonatal life. Cardiac evaluation revealed pulmonic stenosis, atrioventricular regurgitation, and a dilated aortic root that were controlled by balloon dilatation of the pulmonic stenosis and medications for congestive heart failure. At age 3 months, he presented with severe respiratory distress caused by upper and lower airway obstruction. Imaging studies showed severe pulmonary emphysema, and a bronchoscopy demonstrated megatracheobronchomalacia, an unusual finding in this syndrome. Subsequently, the patient developed recurrent hyperinflation of the right and left lungs, with emphysematous changes and mediastinal shift. After discussing with his parents the grave prognosis for neonatal Marfan syndrome, he was discharged home with oxygen treatment and died at home at age 4.5 months. This case report demonstrates and discusses pulmonary involvement in neonatal Marfan syndrome and the difficult therapeutic challenges created by the severe cardiopulmonary abnormalities in this invariably fatal condition.
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Affiliation(s)
- Marwan Shinawi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA.
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