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Kolck J, Trippel TD, Philipp K, Gehle P, Geisel D, Beetz NL. Updated 2022 ACC/AHA Guideline Improves Concordance Between TTE and CT in Monitoring Marfan Snydrome and Related Disorders, but Relevant Measurement Differences Remain Frequent. Glob Heart 2024; 23:28. [PMID: 38737456 PMCID: PMC11086607 DOI: 10.5334/gh.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/16/2024] [Indexed: 05/14/2024] Open
Abstract
Background Patients diagnosed with Marfan syndrome or a related syndrome require frequent aorta monitoring using imaging techniques like transthoracic echocardiography (TTE) and computed tomography (CT). Accurate aortic measurement is crucial, as even slight enlargement (>2 mm) often necessitates surgical intervention. The 2022 ACC/AHA guideline for Aortic Disease Diagnosis and Management includes updated imaging recommendations. We aimed to compare these with the 2010 guideline. Methods This retrospective study involved 137 patients with Marfan syndrome or a related disorder, undergoing TTE and ECG-triggered CT. Aortic diameter measurements were taken based on the old 2010 guideline (TTE: inner edge to inner edge, CT: external diameter) and the new 2022 guideline (TTE: leading edge to leading edge, CT: internal diameter). Bland-Altman plots compared measurement differences. Results Using the 2022 guideline significantly reduced differences outside the clinical agreement limit from 49% to 26% for the aortic sinus and from 41% to 29% for the ascending aorta. Mean differences were -0.30 mm for the aortic sinus and +1.12 mm for the ascending aorta using the 2022 guideline, compared to -2.66 mm and +1.21 mm using the 2010 guideline. Conclusion This study demonstrates for the first time that the 2022 ACC/AHA guideline improves concordance between ECG-triggered CT and TTE measurements in Marfan syndrome patients, crucial for preventing life-threatening aortic complications. However, the frequency of differences >2 mm remains high. Clinical Relevance/Application Accurate aortic diameter measurement is vital for patients at risk of fatal aortic complications. While the 2022 guideline enhances concordance between imaging modalities, frequent differences >2 mm persist, potentially impacting decisions on aortic repair. The risk of repeat radiation exposure from ECG-triggered CT, considered the 'gold standard', continues to be justified.
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Affiliation(s)
- Johannes Kolck
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
| | - Tobias Daniel Trippel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Karla Philipp
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Petra Gehle
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Internal Medicine –Cardiology, Charitéplatz 1, 10117 Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geisel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nick Lasse Beetz
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
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Ma Z, Zhou Y, Li P, He W, Li M. Clinical application of four-dimensional flow cardiovascular magnetic resonance in Marfan syndrome: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102177. [PMID: 37913934 DOI: 10.1016/j.cpcardiol.2023.102177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
This study aims to fill this gap by assessing the application of 4D flow CMR in MFS through a systematic review and meta-analysis. We conducted a comprehensive search of databases from their inception to May 1, 2023. Eligibility criteria were established based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS), with studies scoring above five deemed high quality. Meta-analyses were performed using Stata 15.1 software. Nine studies were analyzed. Findings indicate MFS patients had increased vortex flow in the descending aorta (DAo), larger aortic root diameter (ARD) and Z-scores, lower inner wall shear stress (WSS) in the proximal descending aorta (pDAo), reduced in-plane rotational flow (IRF) in the aortic arch and proximal descending aorta (pDAo), and increased pulse wave velocity (PWV) in the ascending aorta (AAo) and DAo compared to healthy subjects. No significant difference in systolic flow reversal ratio was observed. Sensitivity analysis showed no heterogeneity and Egger's test revealed no publication bias. This meta-analysis underscores the effectiveness of 4D flow CMR in detecting MFS, particularly through indicators such as vortex flow, WSS, IRF, ARD, and PWV. The findings provide insights into diagnosing cardiovascular diseases and predicting cardiovascular events in MFS patients. Further case-control studies are needed to establish measurement standards and explore potential indicators for improved diagnosis and treatment of MFS.
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Affiliation(s)
- Zixuan Ma
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Yuanxin Zhou
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Pengpu Li
- College of Pharmacy, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Wenkai He
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
| | - Mingyan Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
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Gietzen C, Pennig L, von Stein J, Guthoff H, Weiss K, Gertz R, Thürbach I, Bunck AC, Maintz D, Baldus S, Ten Freyhaus H, Hohmann C, von Stein P. Thoracic aorta diameters in Marfan patients: Intraindividual comparison of 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography. Int J Cardiol 2023; 390:131203. [PMID: 37480997 DOI: 10.1016/j.ijcard.2023.131203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. MATERIAL AND METHODS This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. RESULTS Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95-0.98) and modified REACT (ICC = 0.99-1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. CONCLUSIONS Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients.
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Affiliation(s)
- Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henning Guthoff
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Roman Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Iris Thürbach
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christopher Hohmann
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Beetz NL, Trippel TD, Philipp K, Maier C, Walter-Rittel T, Shnayien S, Gehle P. Discrepancy of echocardiography and computed tomography in initial assessment and 2-year follow-up for monitoring Marfan syndrome and related disorders. Sci Rep 2022; 12:15333. [PMID: 36097197 PMCID: PMC9468173 DOI: 10.1038/s41598-022-19662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with Marfan syndrome and related disorders are at risk for aortic dissection and aortic rupture and therefore require appropriate monitoring. Computed tomography (CT) and transthoracic echocardiography (TTE) are routinely used for initial diagnosis and follow-up. The purpose of this study is to compare whole-heart CT and TTE aortic measurement for initial work-up, 2-year follow-up, and detection of progressive aortic enlargement. This retrospective study included 95 patients diagnosed with Marfan syndrome or a related disorder. All patients underwent initial work-up including aortic diameter measurement using both electrocardiography-triggered whole-heart CT and TTE. Forty-two of these patients did not undergo aortic repair after initial work-up and were monitored by follow-up imaging within 2 years. Differences between the two methods for measuring aortic diameters were compared using Bland-Altman plots. The acceptable clinical limit of agreement (acLOA) for initial work-up, follow-up, and progression within 2 years was predefined as < ± 2 mm. Bland-Altman analysis revealed a small bias of 0.2 mm with wide limits of agreement (LOA) from + 6.3 to - 5.9 mm for the aortic sinus and a relevant bias of - 1.6 mm with wide LOA from + 5.6 to - 8.9 mm for the ascending aorta. Follow-up imaging yielded a small bias of 0.5 mm with a wide LOA from + 6.7 to - 5.8 mm for the aortic sinus and a relevant bias of 1.1 mm with wide LOA from + 8.1 to - 10.2 mm for the ascending aorta. Progressive aortic enlargement at follow-up was detected in 57% of patients using CT and 40% of patients using TTE. Measurement differences outside the acLOA were most frequently observed for the ascending aorta. Whole-heart CT and TTE measurements show good correlation, but the frequency of measurement differences outside the acLOA is high. TTE systematically overestimates aortic diameters. Therefore, whole-heart CT may be preferred for aortic monitoring of patients with Marfan syndrome and related disorders. TTE remains an indispensable imaging tool that provides additional information not available with CT.
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Affiliation(s)
- Nick Lasse Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Tobias Daniel Trippel
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Karla Philipp
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Maier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Petra Gehle
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Tuttolomondo D, De Filippo M, Sartorio D, Nicolini F, Niccoli G, Gaibazzi N. Peri-vascular adipose tissue attenuation on chest computed tomography in patients with Marfan Syndrome: a case series. Acta Biomed 2021; 92:e2021468. [PMID: 34747387 PMCID: PMC10523050 DOI: 10.23750/abm.v92is1.11669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Marfan Syndrome is a genetic disorder that determines histopathological alterations of the aortic vascular wall leading to increased inflammatory component. The peri-vascular adipose tissue attenuation is a method able to capture localized vascular inflammation by mapping spatial changes of perivascular tissue attenuation on computed tomography. METHODS We measured peri-vascular adipose tissue attenuation around the ascending aorta in three consecutive subjects with confirmed genetic diagnosis of Marfan Syndrome. All subjects received the genetic diagnosis of fibrillin-1 gene mutation as part of the family screening of patients with known Marfan Syndrome. Chest computed tomography was performed in such asymptomatic subjects after genetic confirmation of Marfan Syndrome. None of these subjects showed aortic aneurysms or suffered from chronic inflammatory/infectious disease. RESULTS In the three subjects identified with Marfan Syndrome the value of aortic peri-vascular adipose tissue attenuation measured at chest computed tomography was higher than normal and the volume of aortic peri-vascular adipose tissue was lower. CONCLUSION These preliminary observations suggest that peri-vascular adipose tissue attenuation is unexpectedly high in patients with Marfan Syndrome, notwithstanding the normal aortic diameter at the time of computed tomography. Whether this observation may find a clinical use in suspected Marfan Syndrome or in predicting aortic complications in Marfan Syndrome is worth to be assessed in prospective studies.
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Affiliation(s)
- Domenico Tuttolomondo
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
| | - Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiologic Science, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
| | - Daniele Sartorio
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
| | - Francesco Nicolini
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
| | - Giampaolo Niccoli
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43125, Parma, Italy..
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Ruiz-Muñoz A, Guala A, Rodriguez-Palomares J, Dux-Santoy L, Servato L, Lopez-Sainz A, La Mura L, Granato C, Limeres J, Gonzalez-Alujas T, Galián-Gay L, Gutiérrez L, Johnson K, Wieben O, Sao-Aviles A, Ferreira-Gonzalez I, Evangelista A, Teixido-Tura G. Aortic flow dynamics and stiffness in Loeys-Dietz syndrome patients: a comparison with healthy volunteers and Marfan syndrome patients. Eur Heart J Cardiovasc Imaging 2021; 23:641-649. [PMID: 34104946 DOI: 10.1093/ehjci/jeab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess aortic flow and stiffness in patients with Loeys-Dietz syndrome (LDS) by 4D flow and cine cardiovascular magnetic resonance (CMR) and compare the results with those of healthy volunteers (HV) and Marfan syndrome (MFS) patients. METHODS AND RESULTS Twenty-one LDS and 44 MFS patients with no previous aortic dissection or surgery and 35 HV underwent non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR), and aortic diameters were obtained at 20 planes from the ascending (AAo) to the proximal descending aorta (DAo). IRF and SFRR were also quantified for aortic regions (proximal and distal AAo, arch and proximal DAo). Peak-systolic wall shear stress (WSS) maps were also estimated. Aortic stiffness was quantified using pulse wave velocity (PWV) and proximal AAo longitudinal strain. Compared to HV, LDS patients had lower rotational flow at the distal AAo (P = 0.002), arch (P = 0.002), and proximal DAo (P < 0.001) even after adjustment for age, stroke volume, and local diameter. LDS patients had higher SFRR in the proximal DAo compared to both HV (P = 0.024) and MFS patients (P = 0.015), even after adjustment for age and local diameter. Axial and circumferential WSS in LDS patients were lower than in HV. AAo circumferential WSS was lower in LDS compared to MFS patients. AAo and DAo PWV and proximal AAo longitudinal strain revealed stiffer aortas in LDS patients compared to HV (P = 0.007, 0.005, and 0.029, respectively) but no differences vs. MFS patients. CONCLUSION Greater aortic stiffness as well as impaired IRF and WSS were present in LDS patients compared to HV. Conversely, similar aortic stiffness and overlapping aortic flow features were found in Loeys-Dietz and Marfan patients.
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Affiliation(s)
- Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | | | - Luz Servato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Lucia La Mura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Advanced Biomedical Sciences, University Federico II. Naples, Naples, Italy
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Limeres
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Teresa Gonzalez-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Galián-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Kevin Johnson
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics and Radiology, University of Wisconsin, Madison, WI, USA
| | - Augusto Sao-Aviles
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- CIBER-ESP, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Instituto del Corazón. Quirónsalud-Teknon. Barcelona, Spain
| | - Gisela Teixido-Tura
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
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García-Izquierdo E, Moñivas-Palomero V, Forteza A, Martín-López C, Torres-Sanabria M, Cia-Mendioroz X, Olivo-Rodríguez C, Navarro-Rico S, Sánchez-Gómez A, Mirelis JG, Cavero MA, Mingo-Santos S. Left atrial strain in the assessment of diastolic function: providing new insights into primary myocardial dysfunction in Marfan syndrome. Int J Cardiovasc Imaging 2021; 37:2735-2745. [PMID: 33871735 DOI: 10.1007/s10554-021-02247-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 01/28/2023]
Abstract
Previous studies using conventional echocardiographic measurements have reported subclinical left ventricular (LV) diastolic abnormalities in patients with Marfan syndrome (MFS). Left atrial (LA) strain allows an accurate categorization of LV diastolic dysfunction. We aimed to characterize LV myocardial performance in a cohort of MFS patients using STE-derived measurements (LV and LA strain) along with conventional echocardiographic parameters. We studied 127 adult patients with MFS (no prior cardiac surgery or significant valvular regurgitation) and 38 healthy controls. We performed detailed echocardiograms and selected left atrial reservoir strain (LASr) as a surrogate of impaired relaxation. Additionally, we searched for possible determinants of LASr in patients with MFS, with a special focus on the elastic properties of the aorta. In spite of lower E-wave, septal and lateral e' velocities and average E/e' ratio in MFS patients, all participants had normal diastolic function according to current guidelines. MFS patients exhibited reduced LV global longitudinal strain (19.3 ± 2.6 vs 21.6 ± 2.1%, p < 0.001) and reduced LASr (32.9 ± 8.5 vs 43.3 ± 7.8%, p < 0.001) compared to controls. In the MFS cohort, we found weak significant (p < 0.05) correlations between LASr and certain parameters: E/A ratio (R = 0.258), E wave (R = 0.226), aortic distensibility (R = 0.222), stiffness index (R = - 0.216), LV ejection fraction (R = 0.214), lateral e' (R = 0.210), LV end-systolic volume index (R = - 0.210), LV global longitudinal strain (R = 0.201), septal e' (R = 0.185). After multivariate analysis, only LV end-systolic volume index and E/A ratio maintained a weak independent association with LASr (R = - 0.220; p = 0.017 and R = 0.199; p = 0.046, respectively). In conclusion, LASr is reduced in patients with MFS, which may represent an early stage of LV diastolic dysfunction. LASr is not determined by the elastic properties of the aorta, suggesting that impaired myocardial relaxation is a primary condition in MFS.
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Affiliation(s)
- Eusebio García-Izquierdo
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain.
| | - Vanessa Moñivas-Palomero
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Carlos Martín-López
- Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Mario Torres-Sanabria
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Xabier Cia-Mendioroz
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Consuelo Olivo-Rodríguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Sara Navarro-Rico
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Andrés Sánchez-Gómez
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Jesús G Mirelis
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Miguel A Cavero
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
| | - Susana Mingo-Santos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 1, 28222, Madrid, Spain
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8
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Di Marino M, Cesareo M, Aloe G, Nucci C, Giannini C, Martucci A, Aiello F, Pisano C, Ruvolo G, Mancino R. Retinal and Choroidal Vasculature in Patients with Marfan Syndrome. Transl Vis Sci Technol 2020; 9:5. [PMID: 32879762 PMCID: PMC7442862 DOI: 10.1167/tvst.9.9.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To assess the retinal and choroidal vasculature in patients with genetically confirmed Marfan syndrome (MfS). Methods This prospective, case-control, observational study included 48 eyes of 24 patients with a genetic diagnosis of MfS and compared them with 52 eyes of 26 healthy controls. Best-corrected visual acuity, choroidal and retinal thickness measured by spectral domain-optical coherence tomography, retinal and choroidal vasculature characterized by optical coherence tomography angiography, were collected. A genetic counseling was carried out. A transthoracic echocardiogram was performed to evaluate the dimension of the aortic root, the ascending aorta and the left ventricle function and dimensions. Results A significant decrease in the superficial and deep retinal capillary plexi vessel density (VD) was evident, such as a decrease in the choriocapillaris plexus VD. In patients with MfS, a negative correlation between left ventricular diameter and the VD of the superficial and deep plexi was observed. Patients with MfS with greater posterior wall and interventricular septum dimensions had lower VD in both plexi (P < 0.05). Moreover, there was a negative correlation between the dimension of the ascending aorta and foveal choriocapillary VD. In patients with MfS, increasing diameter of the ascending aorta was associated with a lower foveal choriocapillary VD (P < 0.05). Conclusions The severity of MfS correlates with the impairment of the retinal and choroidal vasculature. Translational Relevance Optical coherence tomography angiography may be a reproducible and noninvasive tool to study retinal blood flow in patients with MfS, with potential diagnostic and prognostic value.
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Affiliation(s)
- Matteo Di Marino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Aloe
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Clarissa Giannini
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Martucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Calogera Pisano
- Department of Cardiac Surgery, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Giovanni Ruvolo
- Department of Cardiac Surgery, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Mullen M, Jin XY, Child A, Stuart AG, Dodd M, Aragon-Martin JA, Gaze D, Kiotsekoglou A, Yuan L, Hu J, Foley C, Van Dyck L, Knight R, Clayton T, Swan L, Thomson JDR, Erdem G, Crossman D, Flather M. Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial. Lancet 2019; 394:2263-2270. [PMID: 31836196 PMCID: PMC6934233 DOI: 10.1016/s0140-6736(19)32518-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Irbesartan, a long acting selective angiotensin-1 receptor inhibitor, in Marfan syndrome might reduce aortic dilatation, which is associated with dissection and rupture. We aimed to determine the effects of irbesartan on the rate of aortic dilatation in children and adults with Marfan syndrome. METHODS We did a placebo-controlled, double-blind randomised trial at 22 centres in the UK. Individuals aged 6-40 years with clinically confirmed Marfan syndrome were eligible for inclusion. Study participants were all given 75 mg open label irbesartan once daily, then randomly assigned to 150 mg of irbesartan (increased to 300 mg as tolerated) or matching placebo. Aortic diameter was measured by echocardiography at baseline and then annually. All images were analysed by a core laboratory blinded to treatment allocation. The primary endpoint was the rate of aortic root dilatation. This trial is registered with ISRCTN, number ISRCTN90011794. FINDINGS Between March 14, 2012, and May 1, 2015, 192 participants were recruited and randomly assigned to irbesartan (n=104) or placebo (n=88), and all were followed for up to 5 years. Median age at recruitment was 18 years (IQR 12-28), 99 (52%) were female, mean blood pressure was 110/65 mm Hg (SDs 16 and 12), and 108 (56%) were taking β blockers. Mean baseline aortic root diameter was 34·4 mm in the irbesartan group (SD 5·8) and placebo group (5·5). The mean rate of aortic root dilatation was 0·53 mm per year (95% CI 0·39 to 0·67) in the irbesartan group compared with 0·74 mm per year (0·60 to 0·89) in the placebo group, with a difference in means of -0·22 mm per year (-0·41 to -0·02, p=0·030). The rate of change in aortic Z score was also reduced by irbesartan (difference in means -0·10 per year, 95% CI -0·19 to -0·01, p=0·035). Irbesartan was well tolerated with no observed differences in rates of serious adverse events. INTERPRETATION Irbesartan is associated with a reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome and could reduce the incidence of aortic complications. FUNDING British Heart Foundation, the UK Marfan Trust, the UK Marfan Association.
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Affiliation(s)
- Michael Mullen
- Barts Heart Centre, Barts Health NHS Trust, London, UK; Department of Cardiovascular Medicine and Devices, Queen Mary University, London, UK
| | - Xu Yu Jin
- Core Echo Lab, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anne Child
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | - Matthew Dodd
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Gaze
- Department of Life Sciences, University of Westminster, London UK
| | - Anatoli Kiotsekoglou
- Core Echo Lab, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Li Yuan
- Core Echo Lab, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Ultrasound Department, Wuhan Children's Hospital, Tongji Medical School, Huazhong University of Science and Technology, Hubei, China
| | - Jiangting Hu
- Core Echo Lab, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Laura Van Dyck
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosemary Knight
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Tim Clayton
- Clinical Trials Unit, Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Lorna Swan
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Toronto Congenital Cardiac Centre for Adults, Toronto, Canada
| | | | - Guliz Erdem
- Department of Cardiology, Acibadem International Hospital Istanbul, Turkey; School of Medicine, Acibadem University, Istanbul, Turkey
| | - David Crossman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norfolk, Norwich, UK; Cardiology Department, Norfolk and Norwich University Hospital, Norwich, UK.
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Carvajal-Juarez I, Alexanderson-Rosas E, Meave-Gonzalez A, Ortega-Silva S, Espinola-Zavaleta N. Non-invasive assessment of endarteritis in Marfan syndrome with aortic dissection after surgical treatment. J Nucl Cardiol 2019; 26:1759-1760. [PMID: 30094597 DOI: 10.1007/s12350-018-1370-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Isabel Carvajal-Juarez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
- PET/CT-Cyclotron Unit, Medicine Faculty, Universidad Nacional Autónoma de México (UNAM), SN, Ciudad Universitaria, Coyoacan, 04360, Mexico, Mexico
| | - Aloha Meave-Gonzalez
- Department of Magnetic Resonance Imaging, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Susana Ortega-Silva
- Department of Education in Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico.
- Department of Echocardiography, ABC Medical Center I.A.P., Sur 136 No. 116, Colonia Las Américas, Alvaro Obregon, 01120, Mexico, Mexico.
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11
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Karur GR, Pagano JJ, Bradley T, Lam CZ, Seed M, Yoo SJ, Grosse-Wortmann L. Diffuse Myocardial Fibrosis in Children and Adolescents With Marfan Syndrome and Loeys-Dietz Syndrome. J Am Coll Cardiol 2019; 72:2279-2281. [PMID: 30360836 DOI: 10.1016/j.jacc.2018.07.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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13
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Nicolo F, Romeo F, Lio A, Bovio E, Scafuri A, Bassano C, Polisca P, Pellegrino A, Nardi P, Chiariello L, Ruvolo G. Long-Term Results of Aortic Root Surgery in Marfan Syndrome Patients: A Single-Center Experience. J Heart Valve Dis 2017; 26:397-404. [PMID: 29302938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to compare long-term results of Marfan syndrome (MFS) patients affected by aortic root disease undergoing aortic root replacement with the Bentall or David operation. METHODS Since 1994, a total of 59 patients has been followed at the authors' Marfan Center, having undergone either a Bentall operation (Bentall group, n = 30) or a David operation (David group, n = 29). RESULTS No operative mortality was recorded. After 20 years (mean follow up 97 ± 82 months; range 1 to 369 months) no prosthesis-related major bleeding or thromboembolic events had been observed; the 20-year survival was 94 ± 6% in the Bentall group, and 100% in the David group (p = 0.32). Freedom from reintervention for aortic valve dysfunction was 100% in the Bentall group, and 75 ± 13% in the David group (p = 0.04). This inter-group difference became relevant after the first eight-year period of follow-up, and was mainly associated with a particular familiar genetic phenotype involving three out of four reoperated patients. Freedom from all-cause death, myocardial infarction, stroke, prosthetic valve-related complications, and reintervention on any aortic segment was 69 ± 12% in the Bentall group, and 67 ± 14% in the David group (p = 0.33). CONCLUSIONS The Bentall and David operations are both associated with satisfactory long-term results in MFS patients. The low rate of valve prosthesis-related complications suggested that the Bentall operation would continue to be a standard surgical treatment. The reimplantation technique, adopted for less-dilated aortas, provides satisfactory freedom from reoperation. Careful attention should be paid to the reimplantation technique in patients affected by a serious familiar genetic phenotype.
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Affiliation(s)
- Francesco Nicolo
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy. Electronic correspondence:
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University Policlinic, Rome, Italy
| | - Antonio Lio
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Emanuele Bovio
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Antonio Scafuri
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Carlo Bassano
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Patrizio Polisca
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Antonio Pellegrino
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | - Paolo Nardi
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
| | | | - Giovanni Ruvolo
- Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
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14
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Nam HK, Nam MH, Ha KS, Rhie YJ, Lee KH. A Novel Fibrillin-1 Gene Mutation Leading to Marfan Syndrome in a Korean Girl. Ann Clin Lab Sci 2017; 47:221-225. [PMID: 28442527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Marfan syndrome is an autosomal dominant genetic disorder caused by a connective tissue defect. A nine-year-old girl was referred to our pediatric endocrinology clinic for tall stature. Physical examination revealed a lens dislocation with strabismus, high palate, positive wrist and thumb signs, joint hypermobility, and pes planus. Transthoracic echocardiography revealed dilatation of the aortic root. She was diagnosed with Marfan syndrome based on the revised Ghent diagnostic criteria. Molecular investigation identified a heterozygous c.2810G >A variation in the FBN1 gene in the patient, but not in her parents. To our knowledge, this sequence variant has been reported as a polymorphism (rs113602180), but it is the first report identifying it as the genetic cause of Marfan syndrome. We hypothesize that this de novo novel missense FBN1 mutation disrupts fibrillin-1 function and is probably involved in the development of Marfan syndrome in this patient.
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Affiliation(s)
- Hyo-Kyoung Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Myung-Hyun Nam
- Department of Laboratory Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kee-Soo Ha
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young-Jun Rhie
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea
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15
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Abstract
We describe 2 surgical cases of acute aortic type A dissection during pregnancy in women with Marfan syndrome. Both of them underwent emergency aortic root replacement under deep hypothermia; one patient was in her 21st week of pregnancy and the other was treated 1 day after a normal delivery. The patients experienced fair postoperative courses, but intrauterine fetus death was confirmed in the first case.
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Affiliation(s)
- Hidetaka Wakiyama
- Department of Cardiovascular Surgery, Kobe General Hospital, Minatojima, Naka-Machi 4-6, Chuo-Ku, Kobe 650-0046, Japan.
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16
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Chun KJ, Yang JH, Jang SY, Lee SH, Gwag HB, Chung TY, Huh J, Ki CS, Sung K, Choi SH, Kim SM, Choe YH, Kim DK. Analysis of Protrusio Acetabuli Using a CT-based Diagnostic Method in Korean Patients with Marfan Syndrome: Prevalence and Association with Other Manifestations. J Korean Med Sci 2015; 30:1260-5. [PMID: 26339165 PMCID: PMC4553672 DOI: 10.3346/jkms.2015.30.9.1260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/13/2015] [Indexed: 11/20/2022] Open
Abstract
A new CT-based diagnostic method of protrusio acetabuli (PA) was introduced. However, prevalence of PA by this method and correlation between PA and other manifestations of Marfan syndrome (MFS) is unknown in Korean MFS patients. This study aimed to investigate the prevalence of PA diagnosed by a CT-based method in Korean patients with MFS, the association of PA with other manifestations of MFS, and the contribution of PA to MFS diagnosis. We retrospectively reviewed the records of 146 MFS patients with the presence of a causative FBN1 mutation and 146 age- and sex-matched controls from a single tertiary care center. All MFS patients underwent a complete assessment of criteria based on the revised Ghent nosology. PA was assessed quantitatively using a CT-based circle-wall distance (CWD) method. PA was diagnosed in 77.4% of patients in the MFS group and in 11.0% of the control group. CWD was significantly different between the two groups (1.50 mm vs. -0.64 mm, P<0.001). The presence of PA did not correlate with the presence of ectopia lentis, aortic root diameter, or history of aortic dissection. The presence of PA did not have a significant impact on the final diagnosis of MFS. Even though the presence of PA does not related to the cardinal clinical features of MFS or influence MFS diagnosis, its presence may be helpful for the suspicion of MFS when aortic dissection or aneurysm is found on CT angiography of the aorta because of the high frequency of PA in MFS patients.
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Affiliation(s)
- Kwang Jin Chun
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hwa Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Bin Gwag
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular and Stroke Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular and Stroke Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sabnis GR, Patil DV, Phadke MS, Lanjewar CP, Nabar AA, Kerkar PG. Classical Cardiovascular Manifestations of Marfan Syndrome. J Assoc Physicians India 2015; 63:65-67. [PMID: 26731833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Presence of multiple cardiovascular manifestations of the Marfan syndrome in the same patient is not commonly encountered. We present a 49 year-old lady with this syndrome who presented with decompensated heart failure. Evaluation revealed presence of extensive Stanford type A aortic dissection alongwith severe aortic and mitral incompetence. However, the patient declined surgery and was discharged on medical management. At a year's follow-up, she had dyspnea of NYHA class II with persistent cardiovascular findings.
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18
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Abd El Rahman M, Haase D, Rentzsch A, Olchvary J, Schäfers HJ, Henn W, Wagenpfeil S, Abdul-Khaliq H. Left ventricular systolic dysfunction in asymptomatic Marfan syndrome patients is related to the severity of gene mutation: insights from the novel three dimensional speckle tracking echocardiography. PLoS One 2015; 10:e0124112. [PMID: 25901601 PMCID: PMC4406686 DOI: 10.1371/journal.pone.0124112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/26/2015] [Indexed: 11/18/2022] Open
Abstract
Background In asymptomatic Marfan syndrome (MFS) patients we evaluated the relationship between the types of fibrillin-1 (FBN1) gene mutation and possible altered left ventricular (LV) function as assessed by three-dimensional speckle tracking echocardiography (3D-STE). Methods and Results Forty-five MFS patients (mean age 24±15 years) and 40 age-matched healthy controls were studied. Genetic evaluation for the FBN1 gene was carried on 32 MFS patients. Gene mutation (n = 15, 47%) was classified as mild when the mutation resulted in nearly normally functioning protein, while mutations resulting in abnormally function protein were considered to be severe (n = 17, 53%). All patients and controls underwent 3D-STE for evaluation of LV function by an echocardiographer blinded to the results of the genetic testing. Compared to controls, MFS patients had significantly lower 3D-STE derived LV ejection fraction (EF, 57.43±7.51 vs. 62.69±4.76%, p = 0.0001), global LV longitudinal strain (LS, 14.85±2.89 vs. 17.90±2.01%, p = 0.0001), global LV circumferential strain (CS, 13.93±2.81 vs. 16.82±2.17%, p = 0.0001) and global LV area strain (AS, 25.76±4.43 vs. 30.51±2.61%, p = 0.0001). Apart from the global LV LS all these parameters were significantly lower in patients with severe gene mutation than in those with mild mutation (p<0.05). In the multivariate linear regression analysis only the type of mutation had a significant influence on the 3D-STE derived LVEF (p = 0.017), global CS (p = 0.005) and global AS (p = 0.03). Conclusions In asymptomatic MFS patients latent LV dysfunction can be detected using 3D STE. The LV dysfunction is mainly related to the severity of gene mutation, suggesting possible primary cardiomyopathy in MFS patients.
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Affiliation(s)
- Mohamed Abd El Rahman
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
- Department of Pediatric Cardiology, Cairo University, Cairo, Egypt
| | - Denise Haase
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Axel Rentzsch
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Julia Olchvary
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfram Henn
- Department of Human Genetics, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
- * E-mail:
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Groth KA, Greisen JR, Nielsen BB, Andersen NH. [High-risk pregnancy in a woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus]. Ugeskr Laeger 2015; 177:82-83. [PMID: 25612980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 29-year-old woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus (5.2 cm) presented herself in clinic 14 weeks pregnant. She was advised to discontinue the pregnancy due to risk of dissection; however, she decided to continue. She was treated with labetalol (300 mg/day) to reduce blood pressure and was admitted for bed rest from week 30. Her aortic diameter was assessed by echocardiography every 2nd week and remained unchanged. She was treated with betamethason at week 26 and the child was born by a caesarean section in week 35. The post-operative course was uneventful.
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Affiliation(s)
| | | | | | - Niels Holmark Andersen
- Hjertemedicinsk Afdeling B, Aarhus Universitetshospital, Brendstrupgaardsvej 100, 8200 Aarhus N.
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20
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Affiliation(s)
- Sanitra Anuwutnavin
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (S.A.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (L.L., N.S.), Division of Pediatric Cardiology, Department of Pediatrics (M.S.), David Geffen School of Medicine, Los Angeles, California USA, Center for Fetal Medicine and Women's Ultrasound, Los Angeles, California USA (N.S.)
| | - Lydia Lee
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (S.A.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (L.L., N.S.), Division of Pediatric Cardiology, Department of Pediatrics (M.S.), David Geffen School of Medicine, Los Angeles, California USA, Center for Fetal Medicine and Women's Ultrasound, Los Angeles, California USA (N.S.)
| | - Neil Silverman
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (S.A.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (L.L., N.S.), Division of Pediatric Cardiology, Department of Pediatrics (M.S.), David Geffen School of Medicine, Los Angeles, California USA, Center for Fetal Medicine and Women's Ultrasound, Los Angeles, California USA (N.S.)
| | - Mark Sklansky
- Division of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (S.A.), Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (L.L., N.S.), Division of Pediatric Cardiology, Department of Pediatrics (M.S.), David Geffen School of Medicine, Los Angeles, California USA, Center for Fetal Medicine and Women's Ultrasound, Los Angeles, California USA (N.S.)
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Mesfin A, Ahn NU, Carrino JA, Sponseller PD. Ten-year clinical and imaging follow-up of dural ectasia in adults with Marfan syndrome. Spine J 2013; 13:62-7. [PMID: 23218825 DOI: 10.1016/j.spinee.2012.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 06/29/2012] [Accepted: 10/13/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dural ectasia in the lumbosacral spine is a common feature of Marfan syndrome and is associated with low back pain and surgical complications, but its natural history is unknown. PURPOSE To evaluate the natural history of dural ectasia in adults with Marfan syndrome by determining if, over time, symptoms associated with dural ectasia worsen, dural ectasia imaging findings worsen, or spondylolisthesis/spondylolysis develops or worsens. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE For our prospective follow-up study, we enrolled 20 patients with Marfan syndrome and dural ectasia who, from 1998 through 1999, had undergone magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbosacral spine and had completed the Oswestry Disability Index (ODI) questionnaire. Of the 20, five did not meet the inclusion criterion of a completed 2009 ODI questionnaire and were excluded. The remaining 15 patients (mean age, 49.6 years; mean follow-up, 10.5 years) formed our study group. OUTCOME MEASURES The ODI, MRI-based qualitative and quantitative measurements, CT-based quantitative measurements. METHODS We performed matched-pair analyses via Student t test and Wilcoxon signed-rank test of the ODI scores (15 pairs), dural volume of L5-S2 (eight pairs), dural sac ratio (DSR) of L4-S2 (nine pairs), development/progression of spondolysthesis/spondylolysis (11 pairs), and Fattori qualitative grading of dural ectasia size (10 pairs). Significance was set at p<.05. RESULTS We found no statistical differences in the 1998/1999 and 2009 ODI scores (25.8 vs. 22.2 points), dural volume (70.4 vs. 73.9 cm(3)), or DSR (0.68, 0.78, 2.04, and 58.1 vs. 0.69, 0.83, 2.30, and 70.20). There was also no development or progression of spondylolisthesis/spondylolysis and no increase in dural ectasia size. CONCLUSIONS During this 10-year period, the natural history of dural ectasia in adults with Marfan syndrome was not associated with a significant increase in ODI scores, dural ectasia size, or with the development/progression of spondylolisthesis or spondylolysis.
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Affiliation(s)
- Addisu Mesfin
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline St, Baltimore, MD 21287, USA
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22
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Angtuaco MJ, Vyas HV, Malik S, Holleman BN, Gossett JM, Sachdeva R. Early detection of cardiac dysfunction by strain and strain rate imaging in children and young adults with marfan syndrome. J Ultrasound Med 2012; 31:1609-1616. [PMID: 23011624 DOI: 10.7863/jum.2012.31.10.1609] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Strain and strain rate imaging have been reported to detect cardiac dysfunction more accurately than conventional methods in adults with Marfan syndrome, but their utility has not been proven in younger patients. We sought to determine whether strain and strain rate imaging would allow early detection of cardiac dysfunction in children and young adults with Marfan syndrome. METHODS Unoperated patients (<30 years) with Marfan syndrome and healthy control participants were prospectively enrolled. Patients with greater than mild mitral or aortic insufficiency were excluded. Left ventricular systolic function was assessed by standard M-mode imaging. The strain and strain rate values were obtained from apical 4-chamber (longitudinal) and parasternal short-axis views at basal and midventricular levels (radial and circumferential). Data from the two groups were compared by a t test. RESULTS Sixteen patients with Marfan syndrome (mean age ± SD, 14.4 ± 6.4 years; range, 5.8-28.9 years) and 26 controls (mean age, 12.4 + 4.4 year; range, 4.1-18.1 years) were enrolled. Demographics and left ventricular end-diastolic dimensions were similar between the patients with Marfan syndrome and the controls. The M-mode-derived shortening fraction was significantly lower in the patients with Marfan syndrome compared to the controls, even though the values were within normal limits. The patients with Marfan syndrome had lower regional radial and circumferential strain rates, but there were no significant difference in strain between the groups. CONCLUSIONS Strain rate imaging may be useful in detection of subclinical changes in cardiac function in patients with Marfan syndrome when conventional echocardiographic parameters are within normal limits. These findings may be clinically important and warrant closer follow-up of these patients to monitor for cardiac dysfunction.
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Affiliation(s)
- Michael J Angtuaco
- Department of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, USA
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23
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Schmidtke C, Karluss A, Sier H, Hüppe M, Brauer K, Sievers HH. Mid-term results of different aortic valve-sparing procedures in Marfan syndrome. J Heart Valve Dis 2012; 21:195-202. [PMID: 22645855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Marfan patients with aortic root aneurysm are typically treated with the Bentall procedure, though aortic valve-sparing procedures (AVSPs) are also possible. The study aim was to compare the authors' experience with two such techniques performed at their institution, namely a reimplantation according to David (David I) and remodeling according to Yacoub. METHODS Between 1996 and 2009, a total of 37 Marfan patients underwent an AVSP at the authors' institution. Of these patients, 25 (mean age 32 +/- 14.9 years) underwent surgery according to David (group D), and 12 (mean age 35 +/- 10.9 years) according to Yacoub (group Y). The patients underwent both clinical and echocardiographic follow up examinations at a mean of 42.0 +/- 36.4 months after surgery. RESULTS One patient from each group had moved abroad and was lost to follow up. The remaining 35 patients were alive at follow up, and none presented with any major neurological or bleeding complications. In addition, no significant differences were noted between the groups in terms of NYHA classification, left ventricular function, or left ventricular diameter. At follow up, aortic valve function was also comparable between groups, with a peak/mean gradient of 9.4 +/- 6.4/5.3 +/- 3.5 mmHg and 5.1 +/- 3.3/2.8 +/- 1.5 mmHg for groups D and Y, respectively (p = 0.081/0.058). The measured mean grades of aortic valve regurgitation were comparable in groups D and Y (0.6 +/- 0.7 and 1.1 +/- 0.6, respectively; p = 0.055). However, aortic root dimensions obtained via M-mode were smaller in group D patients (29.6 +/- 2.3 mm) than in group Y patients (36.1 +/- 6.6 mm) (p = 0.027). Only three patients from group Y required reoperation on the aortic valve due to valvular regurgitation (p = 0.028); two of these had presented with aortic dissection at the first operation. CONCLUSION Both types of AVSP can be performed with comparably good interim clinical results, and also low mortality and morbidity, in patients with Marfan syndrome.
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Affiliation(s)
- Claudia Schmidtke
- Klinik für Herz- und thorakale Gefaesschirurgie, Universitaet zu Lübeck, Lübeck, Germany.
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Goya M, Alvarez M, Teixido-Tura G, Merced C, Pineda V, Evangelista A. Abdominal aortic dilatation during pregnancy in Marfan syndrome. Rev Esp Cardiol 2011; 65:288-9. [PMID: 22137470 DOI: 10.1016/j.recesp.2011.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/26/2011] [Indexed: 11/15/2022]
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25
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Seliger C, Turmanidze N, Schmid E, Wiethölter H, Boy S, Bogdahn U, Kaiser B, Schlachetzki F. Three cases of stroke in patients with atypical presentation of type a aortic dissection--potential of neurosonography in the early diagnosis of atypical stroke. Ultraschall Med 2011; 32:619-621. [PMID: 21894602 DOI: 10.1055/s-0031-1281718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
MESH Headings
- Adult
- Aged
- Aortic Aneurysm, Thoracic/classification
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/surgery
- Blood Vessel Prosthesis Implantation
- Carotid Artery, Internal, Dissection/diagnostic imaging
- Carotid Artery, Internal, Dissection/surgery
- Diagnosis, Differential
- Echocardiography
- Emergencies
- Humans
- Male
- Marfan Syndrome/diagnostic imaging
- Sensitivity and Specificity
- Stroke/diagnostic imaging
- Stroke/surgery
- Subclavian Artery/diagnostic imaging
- Subclavian Artery/surgery
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Transcranial
- Vertebral Artery Dissection/diagnostic imaging
- Vertebral Artery Dissection/surgery
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26
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Williams-Phillips S. Post Ross procedure aortic right sinus of Valsalva fistula to right ventricle. W INDIAN MED J 2011; 60:669-673. [PMID: 22512227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Post Ross procedure complications have been limited predominantly to neoaortic valvular dilatation (10-30%) and insufficiency, right ventricular prosthetic deterioration or right ventricular pulmonary artery conduit obstruction. Arrhythmia has been documented to occur in a third of these patients. This is the first time that neoaortic right sinus of valsalva dissection and rupture to the right ventricle with a fistulous communication has occurred and been described, as far as the author is aware.
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Affiliation(s)
- S Williams-Phillips
- Adolescent Cardiac Clinic, Cardiology Unit, Department of Medicine, University Hospital of the West Indies, Kingston 7, Jamaica, West Indies.
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27
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Geiger J, Markl M, Herzer L, Hirtler D, Loeffelbein F, Stiller B, Langer M, Arnold R. Aortic flow patterns in patients with Marfan syndrome assessed by flow-sensitive four-dimensional MRI. J Magn Reson Imaging 2011; 35:594-600. [PMID: 22095635 DOI: 10.1002/jmri.23500] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 10/17/2011] [Indexed: 01/05/2023] Open
Affiliation(s)
- Julia Geiger
- Department of Radiology, Medical Physics, University Hospital Freiburg, Germany.
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28
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Gao L, Mao Q, Wen D, Zhang L, Zhou X, Hui R. The effect of beta-blocker therapy on progressive aortic dilatation in children and adolescents with Marfan's syndrome: a meta-analysis. Acta Paediatr 2011; 100:e101-5. [PMID: 21443687 DOI: 10.1111/j.1651-2227.2011.02293.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM To assess the effect of beta-blockade therapy on progressive aortic dilatation and on clinical outcome in children and adolescents with Marfan's syndrome (MFS). METHODS The meta-analysis was instituted, which included studies identified by a systematic review of MEDLINE of peer-reviewed publications. Echocardiogram measurements of the aortic root dimension and outcome measures of mortality and major morbidity were compared between patients who were treated and untreated with beta-blockade therapy. RESULTS Five studies were included. A total of 224 young patients treated with beta-blocker therapy and 168 patients did not accept medical management. Compared with non-beta-blockade treatment, beta-blockade therapy significantly decreased the rate of aortic dilatation (SMD = -1.30 with 95% CI -2.11 to -0.49). A tendency of clinical outcome beneficial was observed in the beta-blocker treatment group when compared with no beta-blocker treatment group (odds ratio = 0.87 with 95% CI 0.37-2.04). CONCLUSION There is evidence that beta-blockade therapy can slow down the rate of dilatation of the aorta and has clinical benefits on children and adolescents with MFS.
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Affiliation(s)
- Linggen Gao
- Department of Cardiology, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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29
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Fleig A, Seitz K. Thoracic aortic aneurysms. Ultraschall Med 2010; 31:122-143. [PMID: 20306379 DOI: 10.1055/s-0029-1245288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- A Fleig
- Innere Medizin, Kreiskrankenhaus Sigmaringen.
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30
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Zhao X, Chang Q, Zhu JM, Liu YM, Yu CT, Zhang HT, Zheng J, Li B, Sun LZ. [Chronic Debakey I aortic dissection in Marfan syndrome and hypertensive patients with modified stented elephant trunk surgery: a post-operative CT assessment]. Zhonghua Yi Xue Za Zhi 2010; 90:830-833. [PMID: 20450623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the outcome of stented elephant trunk surgery for chronic DebakeyIaortic dissection in Marfan syndrome and hypertension patients by CT. METHODS Between 2003 and 2008, 54 patients underwent the modified stented elephant trunk procedure and total arch replacement for chronic DebakeyIaortic dissection. Twenty-two patients were made a diagnosis of Marfan syndrome and the other 32 patients of hypertension. Aortic evolvement was evaluated with CT angiography by calculating the diameter ratios between the stent graft/true lumen and the aorta at the same level. RESULTS CT study one year after discharge showed no difference in the diameter ratios of the stent and aorta at the carina level between groups (0.84 +/- 0.16 vs 0.80 +/- 0.23, P = 0.472), but had significant difference before and after surgery (0.29 +/- 0.16 vs 0.72 +/- 0.21, P < or = 0.001). And significant difference occurred at the different periods after discharge (0.72 +/- 0.21 vs 0.81 +/- 0.20, 0.81 +/- 0.20 vs 0.77 +/- 0.20, P < or = 0.001). The residual false lumen in the proximal descending aorta reached complete thrombosis in 59% of Marfan and 78% of hypertension. CONCLUSION The modified stented elephant trunk technique is effective for closing the false lumen in the proximal descending aorta of chronic DebakeyIaortic dissection in Marfan syndrome and hypertension patients.
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Affiliation(s)
- Xin Zhao
- Department of Cardiovascular Surgery, Cardiovascular Institute & Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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31
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Altman A, Uliel L, Caspi L. Dural ectasia as presenting symptom of Marfan syndrome. Isr Med Assoc J 2008; 10:194-195. [PMID: 18494231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Arie Altman
- Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
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32
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Avivi E, Arzi H, Paz L, Caspi I, Chechik A. Skeletal manifestations of Marfan syndrome. Isr Med Assoc J 2008; 10:186-188. [PMID: 18494229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Eran Avivi
- Department of Orthopedics, Sheba Medical Center, Tel Hashomer, Israel.
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Türk UO, Alioğlu E, Nalbantgil S, Nart D. Catastrophic cardiovascular consequences of weight lifting in a family with Marfan syndrome. Turk Kardiyol Dern Ars 2008; 36:32-34. [PMID: 18453784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Marfan syndrome primarily involves the musculoskeletal, cardiovascular, and ocular systems. Isometric exercises such as weight lifting lead to significant stress along the aortic wall and predispose patients to dissection and rupture. A 30-year-old male patient presented with a complaint of back pain. He had a history of two operations for recurrent inguinal hernia. His father and elder brother died on separate occasions following loss of consciousness after weight lifting. He also had a brother who had undergone an emergency operation for De Bakey type I acute aortic dissection after presentation with acute back pain following weight lifting. The patient was 180 cm tall, had elongated limbs and arachnodactyly. On auscultation, there was a diastolic murmur of 1-2/6 over the aortic area. A chest roentgenogram demonstrated mild cardiomegaly and mediastinal widening. Transthoracic echocardiography showed moderate aortic insufficiency with dilatation of the aortic root and ascending aorta. He was diagnosed as having Marfan syndrome and underwent complete replacement with a composite aortic valve-ascending aortic conduit. Histologic sections of the ascending aortic wall showed medial cystic and myxoid degeneration and loss of nuclei in the media. Von Gieson staining showed elastic fragmentation and loss of elastic lamellae. Screening of other family members showed Marfan syndrome in his sister and in one of his nephews. His other two brothers had Marfanoid habitus without findings of systemic involvement.
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Affiliation(s)
- Likurgos Kolilekas
- The Second Pulmonary Department, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
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Ahimastos AA, Aggarwal A, D'Orsa KM, Formosa MF, White AJ, Savarirayan R, Dart AM, Kingwell BA. Effect of perindopril on large artery stiffness and aortic root diameter in patients with Marfan syndrome: a randomized controlled trial. JAMA 2007; 298:1539-47. [PMID: 17911499 DOI: 10.1001/jama.298.13.1539] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Aortic stiffness is increased in Marfan syndrome contributing to aortic dilatation and rupture, the major cause of premature death in this population. Angiotensin-converting enzyme inhibitors have been shown to reduce arterial stiffness. OBJECTIVE To determine whether perindopril therapy reduces aortic stiffness and attenuates aortic dilatation in patients with Marfan syndrome. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled trial of 17 patients with Marfan syndrome (mean [SD], 33 [6] years) taking standard beta-blocker therapy, initiated in January 2004 and completed in September 2006, at Alfred Hospital Marfan Syndrome Clinic, Melbourne, Australia. INTERVENTION Patients were administered 8 mg/d of perindopril (n = 10) or placebo (n = 7) for 24 weeks. MAIN OUTCOME MEASURES Indices of arterial stiffness were assessed via systemic arterial compliance, and central and peripheral pulse wave velocities. Aortic root diameters were assessed at 4 sites via transthoracic echocardiography. RESULTS Perindopril reduced arterial stiffness as indicated by increased systemic arterial compliance (mean [SEM], 0.33 [0.01] mL/mm Hg at baseline to 0.54 [0.04] mL/mm Hg at 24 weeks in perindopril group vs 0.30 [0.01] mL/mm Hg to 0.29 [0.01] mL/mm Hg in placebo group, P = .004), and reduced central (7.6 [0.4] m/s to 5.9 [0.3] m/s in perindopril group, P < .001 vs placebo) and peripheral (10.9 [0.4] m/s to 8.7 [0.4] m/s in perindopril group, P < .001 vs placebo) pulse wave velocities. In addition, perindopril significantly reduced aortic root diameters relative to placebo in both end-systole and end-diastole (P<.01 to P < .001 for all comparisons between groups). Although perindopril marginally reduced mean arterial pressure (from 81 [2] mm Hg to 80 [1] mm Hg in perindopril group vs 83 [2] mm Hg to 84 [3] mm Hg in placebo group, P = .004), the observed changes in both stiffness and left ventricular outflow tract diameter remained significant when mean arterial pressure was included as a covariate. Transforming growth factor beta (TGF-beta), which contributes to aortic degeneration in Marfan syndrome, was reduced by perindopril compared with placebo in both latent (59 [6] ng/mL to 45 [3] ng/mL in perindopril group, P = .01 vs placebo) and active (46 [2] ng/mL to 42 [1] ng/mL in perindopril group, P = .02 vs placebo) forms. CONCLUSIONS Perindopril reduced both aortic stiffness and aortic root diameter in patients with Marfan syndrome taking standard beta-blocker therapy, possibly through attenuation of TGF-beta signaling. Large clinical trials are needed to assess the clinical benefit of angiotensin II blockade in Marfan syndrome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00485368.
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Affiliation(s)
- Anna A Ahimastos
- Alfred and Baker Medical Unit, Baker Heart Research Institute, Central Melbourne, Victoria, Australia
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Redruello HJ, Cianciulli TF, Rostello EF, Recalde B, Lax JA, Picone VP, Belforte SM, Prezioso HA. Monozygotic twins with Marfan's syndrome and ascending aortic aneurysm. European Journal of Echocardiography 2007; 8:302-6. [PMID: 16781196 DOI: 10.1016/j.euje.2006.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 04/16/2006] [Accepted: 04/23/2006] [Indexed: 11/25/2022]
Abstract
Marfan's syndrome is a hereditary connective tissue disease, in which cardiovascular abnormalities (especially aortic root dilatation) are the most important cause of morbidity and mortality. In this report, we describe two 24-year-old twins, with a history of surgery for lens subluxation and severe cardiovascular manifestations secondary to Marfan's syndrome. One of the twins suffered a type A aortic dissection, which required replacement of the ascending aorta, and the other twin had an aneurysmal dilatation of the ascending aorta (46mm) and was prescribed medical treatment with atenolol and periodic controls to detect the presence of a critical diameter (50mm) that would indicate the need for prophylactic surgery.
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Affiliation(s)
- Héctor Jorge Redruello
- Division of Cardiology and Cardiovascular Surgery, Hospitales del Gobierno de la Ciudad de Buenos Aires Bernardino Rivadavia and Cosme Argerich, Buenos Aires, Argentina.
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Abstract
PURPOSE Marfan syndrome is an autosomal dominant disorder historically defined by well-characterized features in the cardiovascular, ocular, and skeletal systems. To date, there have been no reports concerning abdominal visceral findings in this disorder. The purpose of this study was to determine the prevalence of abdominal visceral findings in patients with Marfan syndrome. METHODS Computed tomography or magnetic resonance studies of 69 patients with Marfan syndrome and an age- and sex-matched cohort of control subjects were reviewed. The presence of abdominal visceral findings was noted. Chi-square and Student t tests were used to determine significance of differences between the patient and control groups. This retrospective study was approved by the local institutional review board and determined to be exempt from Health Insurance Portability and Accountability Act reporting requirements. RESULTS Renal cysts were present in 41 Marfan patients (59.4%) versus 21 control subjects (30.4%), P=0.001. The average number of renal cysts was greater in Marfan patients than controls (2.4 vs. 0.9, P=0.005). Hepatic cysts were present in 24 Marfan patients (34.8%) versus 12 control patients (17.3%), P=0.02. The average number of hepatic cysts was also greater in Marfan patients than controls (0.9 vs. 0.3, P=0.027). Cholelithiasis was present in 12 Marfan patients (18.1%) versus one control patient (1.5%), P<0.001. CONCLUSIONS Marfan syndrome patients have liver and renal cysts more often, in increased number, and at an earlier age than controls, in addition to an increased prevalence of cholelithiasis. Further study will be needed to relate these findings to recent developments concerning the underlying molecular genetics of this disorder.
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Affiliation(s)
- Kira Chow
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA
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Stadié R, Geipel A, Heep A, Herberg U, Welker B, Gembruch U, Berg C. Prenatal diagnosis of Marfan syndrome. Ultrasound Obstet Gynecol 2007; 30:119-21. [PMID: 17546605 DOI: 10.1002/uog.4011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Kato Y, Ohashi H, Tsutsumi Y, Kawai T. Emergent David-V operation for a ruptured aortic root aneurysm in a 9-year-old child. Eur J Cardiothorac Surg 2007; 31:744-6. [PMID: 17292616 DOI: 10.1016/j.ejcts.2007.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 01/05/2007] [Accepted: 01/15/2007] [Indexed: 11/24/2022] Open
Abstract
Ruptured aortic root aneurysm is very rare in children less than 10 years of age. Isolated dilatation of the ascending aorta and/or aortic root in a child is mostly associated with Marfan's syndrome, and the standard surgical treatment is aortic root replacement with a composite valve graft or homograft. We report here a successful emergent T. David-V operation using two grafts of different sizes for a ruptured aortic root aneurysm in a 9-year-old child with Marfan's syndrome.
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Affiliation(s)
- Yasuyuki Kato
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Shinbo 2-228 Fukui, Japan.
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Nisanoglu V, Battaloglu B, Erdil N, Ozgur B, Kuzucu A. Surgical approach for Stanford type A aortic dissection in a patient with Marfan syndrome and pectus excavatum. Tex Heart Inst J 2007; 34:240-3. [PMID: 17622379 PMCID: PMC1894713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Acute Stanford type A aortic dissection in a patient with severe pectus excavatum constitutes a surgical emergency and presents a major challenge for the surgeon. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. Herein, we describe a case of acute aortic dissection in a patient who had Marfan syndrome with severe pectus excavatum. Combined partial upper sternotomy and left anterior thoracotomy provided excellent surgical exposure, and the aortic root and ascending aorta were completely replaced. The procedures were successful, and the patient recovered. Technical and surgical considerations led us to postpone concomitant correction of the pectus excavatum.
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Affiliation(s)
- Vedat Nisanoglu
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, 44315 Malatya, Turkey.
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Selamet Tierney ES, Feingold B, Printz BF, Park SC, Graham D, Kleinman CS, Mahnke CB, Timchak DM, Neches WH, Gersony WM. Beta-blocker therapy does not alter the rate of aortic root dilation in pediatric patients with Marfan syndrome. J Pediatr 2007; 150:77-82. [PMID: 17188619 DOI: 10.1016/j.jpeds.2006.09.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 06/23/2006] [Accepted: 09/01/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test the hypothesis that chronic beta-blocker therapy in pediatric patients with Marfan syndrome alters the rate of aortic root dilation. Beta-blockade has been advocated as preventive therapy for Marfan syndrome based on reports indicating a decreased rate of aortic root dilation in treated patients. STUDY DESIGN Patients with Marfan syndrome (n = 63) followed at Children's Hospital of Pittsburgh or Children's Hospital of New York-Presbyterian who had > or =18 months of echocardiographic follow-up were studied. All clinical data and 213 serial echocardiograms were reviewed, and aortic root dimensions were measured. Patients were divided into 2 groups for comparison: untreated (n = 34) and treated (n = 29). RESULTS At study entry, the 2 study groups were comparable in terms of age, sex, body surface area (BSA), aortic root measurements, heart rate, and corresponding z scores. Follow-up duration in each group was similar. At last follow-up, heart rates and heart rate z scores were lower in the treated group. Rates of change of aortic root measurements (P = .52) and the corresponding z scores were not statistically different between the 2 group at the study's end. CONCLUSIONS This study suggests that that beta-blocker therapy does not significantly alter the rate of aortic root dilation in children with Marfan syndrome. Based on these data, the recommendation of lifetime beta-blocker therapy instituted during childhood should be reassessed.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians & Surgeons, New York, NY, USA.
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Abstract
The Marfan's syndrome is an autosomal dominant genetic disorder resulting in a diminished strength of connective tissue. The ocular, skeletal and cardiovascular systems are mostly at risk. Principal complications of the disease are aortic dilatation and the risk of acute dissection. Pregnancy increases this risk. Based on the experience of our obstetrics department and after reviewing medical literature, we have tried to establish guidelines for obstetric care adapted to pregnant patients affected by Marfan's syndrome. Women with aortic root > 40 mm should avoid pregnancy. In all cases B-adrenergic receptor blockers must be used as soon as possible. Because there is a 50% risk that offspring will inherit the syndrome, prenatal diagnosis should be suggested. In addition to usual pregnancy monitoring, echocardiography should be performed every 3 months as well as 2 months after delivery. No increase of obstetrical complications has been shown in these patients. Route of delivery also depends on the diameter of the aortic root: vaginal delivery is warranted if the aortic root is<40; cesarean section should be performed in the other cases. Thus, with appropriate supervision, women with Marfan's syndrome will tolerate pregnancy without any adverse effect.
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Affiliation(s)
- A Lunel
- Service de Gynécologie Obstétrique, Pavillon K, Hôpital Edouard-Herriot, place d'Arsonval, 69437 Lyon Cedex 03
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Abstract
STUDY DESIGN Case report. OBJECTIVE To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation. SUMMARY OF BACKGROUND DATA Severe progressive scoliosis is a well-known feature in Marfan's disease. Although overall complication rate after surgical correction of the spinal deformity is rather high, late iatrogenic complications are less frequently identified. METHODS A 40-year-old woman with Marfan's disease reported to our outpatient clinic with dyspnoe d'effort, 20 years after anterior spinal instrumentation of a thoracolumbar scoliosis. Routine screening identified a saccular aneurysm of the descending thoracic aorta. A contrast-enhanced CT scan revealed that the most proximal screw of the construct had perforated the vessel wall and caused a false aneurysm. An endovascular approach to the problem was chosen; by a transfemoral approach, an AneuRx endovascular graft was successfully implanted. RESULTS The patient had an uneventful postoperative course and was discharged within 5 days. At 5-year follow-up, the patient still has no clinical complaints, nor radiographic leakage nor recurrence of the false aneurysm at contrast-enhanced CT screening. CONCLUSION Use of an endovascular graft is an adequate alternative for treatment of late vascular complications after anterior spinal instrumentation.
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Affiliation(s)
- Henk D Been
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Beroukhim RS, Roosevelt G, Yetman AT. Comparison of the pattern of aortic dilation in children with the Marfan's syndrome versus children with a bicuspid aortic valve. Am J Cardiol 2006; 98:1094-5. [PMID: 17027578 DOI: 10.1016/j.amjcard.2006.05.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 12/01/2022]
Abstract
Marfan's syndrome (MS) and bicuspid aortic valves (BAVs) are associated with aortic dilation. Despite their histologic similarities, the 2 diseases differ with regard to the location of maximal aortic dilation. Echocardiographic analysis of aortic dimensions was performed in children with MS, children who had aortic dilation in the setting of nonstenotic BAVs (peak gradient <16 mm Hg), and healthy controls. Data on 25 patients with MS, 31 with BAVs, and 65 controls were analyzed. Subjects with BAVs had greater dimensions at all levels of the aortic root compared with normal controls. Patients with BAVs also had greater dilation than those with MS at the level of the annulus and the ascending aorta, with dilation often extending cranially beyond the region of measurement. Conversely, patients with MS had more focal dilation at the sinuses of Valsalva compared with controls and patients with BAVs. In conclusion, despite similar histologic abnormalities, the anatomic pattern of aortic dilation differs in children with MS and BAVs.
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Affiliation(s)
- Rebecca S Beroukhim
- The Children's Hospital Heart Institute, University of Colorado Health Sciences Center, Denver, Colorado, USA
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45
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Moura B, Tubach F, Sulpice M, Boileau C, Jondeau G, Muti C, Chevallier B, Ounnoughene Y, Le Parc JM. Bone mineral density in Marfan syndrome. A large case-control study. Joint Bone Spine 2006; 73:733-5. [PMID: 17056292 DOI: 10.1016/j.jbspin.2006.01.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To measure bone mineral density (BMD) in a group of patients meeting Gand criteria for Marfan syndrome, comparatively with a group of healthy controls. METHODS Dual-energy X-ray absorptiometry (DEXA) was used to measure BMD at the hip and wrist in 130 patients seen at the Multidisciplinary Marfan Clinic, Paris, France. Results were compared to values in the database of the absorptiometry machine (Hologic QDR100) and to values in 72 healthy height-matched controls including 35 whose body mass index (BMI) values were similar to those in the patients. RESULTS A history of fractures was noted in 32 (24.6%) patients. Z-score values were significantly decreased in the patients compared to the Hologic database values at the femoral neck (-1.190+/-0.098, P<0.0001) and wrist (-1.403+/-1.06; P < 0.001). Patients had significantly lower BMD values at the femoral neck compared to the height-matched controls (0.841+/-0.15 versus 1.010+/-0.017; P<0.0001). BMD values were also significantly lower in the patients compared to the controls of similar height and BMI. BMD values did not correlate with history of fractures or acetabular protrusion. In the patients, BMD values lower than -2.5 correlated with presence of dural ectasia. CONCLUSION Men and women with Marfan syndrome have significant osteopenia independent from BMI.
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Affiliation(s)
- Bertrand Moura
- Rheumatology Department, Ambroise-Paré Teaching Hospital, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Baril DT, Carroccio A, Palchik E, Ellozy SH, Jacobs TS, Teodorescu V, Marin ML. Endovascular Treatment of Complicated Aortic Aneurysms in Patients with Underlying Arteriopathies. Ann Vasc Surg 2006; 20:464-71. [PMID: 16779505 DOI: 10.1007/s10016-006-9091-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 05/03/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
Patients with arteriopathies including giant cell arteritis, Marfan syndrome, and Takayasu's disease are at risk for aneurysmal degeneration of the aorta. Aortic repair has been recommended for these patients to prevent rupture. The purpose of this study was to examine outcomes following endovascular stent graft (EVSG) repair of aortic aneurysms in this patient population. Over an 8-year period, 11 patients (six men, five women) with arteriopathies underwent endovascular aortic repair. The mean age was 50 (range 15-81). Diseases included Marfan syndrome (n = 6), Takayasu's disease (n = 3), and giant cell arteritis (n = 2). Success of EVSG repair was evaluated per the reporting standards of the Society for Vascular Surgery/American Association for Vascular Surgery. Follow-up was a mean of 28.9 months (range 3-68). Six patients underwent EVSG repair of the thoracic aorta, four underwent EVSG repair of the abdominal aorta, and one underwent a staged repair of the thoracic and subsequently the abdominal aorta. Six true aneurysms and six pseudoaneurysms were repaired. Eight patients had previous aortic surgery, including four with multiple aortic operations. For the 12 aneurysms treated, technical success was achieved in 11 (91.7%). One technical failure occurred due to a small iliac access vessel, requiring an eventual iliac conduit for insertion. Early complications (<30 days) occurred in three patients. Type I or III endoleak developed following two repairs (16.7%). Aneurysm expansion occurred following one repair (8.3%). No aneurysm-related deaths occurred during follow-up. EVSG repair of aortic aneurysms is feasible and can be safely performed in patients with arteriopathies. Long-term durability in this younger group of patients who carry an ongoing risk of arterial degeneration remains to be determined.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Angioplasty, Balloon
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/therapy
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/etiology
- Aortic Aneurysm, Thoracic/therapy
- Aortography
- Blood Vessel Prosthesis Implantation
- Feasibility Studies
- Female
- Follow-Up Studies
- Giant Cell Arteritis/complications
- Giant Cell Arteritis/diagnostic imaging
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Male
- Marfan Syndrome/complications
- Marfan Syndrome/diagnostic imaging
- Middle Aged
- Recurrence
- Retrospective Studies
- Stents
- Takayasu Arteritis/complications
- Takayasu Arteritis/diagnostic imaging
- Tomography, X-Ray Computed
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Affiliation(s)
- Donald T Baril
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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Meijboom LJ, Drenthen W, Pieper PG, Groenink M, van der Post JAM, Timmermans J, Voors AA, Roos-Hesselink JW, van Veldhuisen DJ, Mulder BJM. Obstetric complications in Marfan syndrome. Int J Cardiol 2006; 110:53-9. [PMID: 16236373 DOI: 10.1016/j.ijcard.2005.07.017] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 07/19/2005] [Accepted: 07/24/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the obstetric maternal and neonatal outcome of pregnancy in women with Marfan syndrome. METHODS Retrospective observational multi-center study based on congenital heart disease registry. RESULTS Sixty-three of the 122 enrolled women with Marfan syndrome had been pregnant 142 times (including 111 pregnancies>20 weeks, 28 (20%) miscarriages and 3 elective abortions). In 40% of all completed pregnancies an obstetric and/ or neonatal complication occurred. The most important complications were an increased percentage of premature deliveries (n=17, 15%) mainly due to preterm premature rupture of membranes and cervical incompetence and a markedly increased combined fetal and neonatal mortality of 7.1%. An obstetric and/or neonatal complication occurred in a similar proportion of pregnancies in women with a diagnosis of Marfan syndrome before pregnancy versus women with a diagnosis of Marfan syndrome after pregnancy (39% vs. 41%, p=0.85, respectively). CONCLUSION In addition to cardiovascular complications, pregnancy in women with Marfan syndrome is associated with a high rate of premature deliveries, preterm premature rupture of membranes and increased mortality in the offspring.
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Affiliation(s)
- Lilian J Meijboom
- Department of Cardiology, Rm B2-240, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, and Department of Cardiology, Radboud Hospital Nijmegen, The Netherlands
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48
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Garreau de Loubresse C, Mullins MM, Moura B, Marmorat JL, Piriou P, Judet T. Spinal and pelvic parameters in Marfan’s syndrome and their relevance to surgical planning. ACTA ACUST UNITED AC 2006; 88:515-9. [PMID: 16567788 DOI: 10.1302/0301-620x.88b4.17034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spinal deformities are a common feature of Marfan’s syndrome and can be a significant cause of morbidity. The morphology of the scoliosis associated with this condition was previously described by Sponseller, but no correlation with the pelvic parameters has been seen. We performed a retrospective radiological study of 58 patients with scoliosis, secondary to Marfan’s syndrome and related the findings in the thoracolumbar spine to the pelvic parameters, including pelvic version (tilt), pelvic incidence and sacral slope. Our results showed marked abnormalities in the pelvic values compared with those found in the unaffected population, with increased retroversion of the pelvis in particular. In addition we found a close correlation between the different patterns of pelvic parameters and scoliosis morphology. We found that pelvic abnormalities may partially dictate the spinal disorders seen in Marfan’s syndrome. Our results supplement the well-established Sponseller classification, as well as stressing the importance of considering the orientation of the pelvis when planning surgery.
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Affiliation(s)
- C Garreau de Loubresse
- Service de Chirurgie, Orthopédique et Traumatologique, Hôpital Raymond Poincaré, 92380 Garches, France
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Sponseller PD, Jones KB, Ahn NU, Erkula G, Foran JRH, Dietz HC. Protrusio acetabuli in Marfan syndrome: age-related prevalence and associated hip function. J Bone Joint Surg Am 2006; 88:486-95. [PMID: 16510812 DOI: 10.2106/jbjs.e.00611] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Protrusio acetabuli is known to occur in patients with Marfan syndrome, but its prevalence, its effects on hip function, and its possible association with the subsequent development of degenerative hip disease have not been studied in a large population. Nevertheless, some clinicians have recommended prophylactic hip surgery for preadolescents with Marfan syndrome and protrusio acetabuli. METHODS We performed a cross-sectional study of 173 patients (346 hips) with Marfan syndrome who were interviewed and examined for calculation of the Iowa hip score. Anteroposterior radiographs of the pelvis were made, and two radiographic indices of acetabular depth were measured: (1) the center-edge angle of Wiberg and (2) the acetabular-ilioischial distance. The presence of protrusio was defined with use of two extant definitions: (1) a center-edge angle of >50 degrees or (2) an acetabular-ilioischial distance of >/=3 mm in male patients or >/=6 mm in female patients. Linear regression analyses were performed between these radiographic indices of acetabular depth and patient age, Iowa hip scores, the magnitude of the radiographic joint space, and range of motion. RESULTS The prevalence of protrusio acetabuli was 27% according to the center-edge angle criterion and 16% according to the acetabular-ilioischial distance criterion. The prevalence of protrusio increased until the age of twenty years and remained stable after the age of twenty years. Slight but significant negative correlations were detected between the two radiographic indices of acetabular depth and both the Iowa hip score and the summed range of motion (p < 0.02 for all). No significant relationship was found between the two radiographic indices and pain scores. In patients with Marfan syndrome who were more than forty years old, the Iowa hip scores for hips with protrusio were not significantly lower than those for hips without protrusio. CONCLUSIONS In patients with Marfan syndrome, the prevalence of protrusio acetabuli increases during the first two decades of life and then plateaus in terms of both population-wide prevalence and radiographic severity. In this population, protrusio generally is not associated with severely problematic hip function but it is associated with slightly decreased range of motion of the hip. We concluded that prophylactic surgical intervention is not indicated for most patients with Marfan syndrome who have a radiographic diagnosis of protrusio.
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Affiliation(s)
- Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Johns Hopkins Outpatient Center, 5th Floor, 601 North Caroline Street, Baltimore, MD 21287, USA.
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50
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Vitarelli A, Conde Y, Cimino E, D'Angeli I, D'Orazio S, Stellato S, Padella V, Caranci F. Aortic wall mechanics in the Marfan syndrome assessed by transesophageal tissue Doppler echocardiography. Am J Cardiol 2006; 97:571-7. [PMID: 16461059 DOI: 10.1016/j.amjcard.2005.09.089] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Revised: 09/02/2005] [Accepted: 09/02/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the value of tissue Doppler imaging (TDI) using transesophageal echocardiography (TEE) in assessing the elastic properties of the thoracic aorta in patients with Marfan's syndrome. Aortic distensibility, stiffness index, and pulse-wave velocity were calculated using M-mode data in a TEE short-axis view in 31 patients with Marfan's syndrome and 22 normal controls. Acceleration time, maximum wall expansion velocity (Vmax), and wall strain were determined from TDI tracings. Indexes derived from TDI differed at a greater level of significance than M-mode-derived indexes in patients with dilated and normal aortas. Significant predictors of aortic dilation were systolic blood pressure, aortic stiffness index, Vmax, and strain. Decreased aortic strain and Vmax and increased stiffness index were predictive of aortic dissection (odds ratios 4.5, 3.3, and 2.2). In conclusion, the TDI assessment of aortic wall mechanics is complementary to standard M-mode measurements in discriminating normal subjects from patients with Marfan's syndrome and is accurate in predicting aortic dilation and dissection.
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