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Hunter-Adamson L, Tierney S. Echogenomics: Echocardiography in Heritable Aortopathies. Curr Cardiol Rep 2024; 26:179-189. [PMID: 38372858 DOI: 10.1007/s11886-024-02024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the current echocardiographic considerations in the diagnosis and monitoring of patients with inherited aortopathies. RECENT FINDINGS Aortic dilation is a key feature in heritable aortopathies, and dissection is a leading cause of morbidity and mortality. New genetic and histopathologic findings are helpful in better understanding these conditions. Non-invasive imaging modalities, including echocardiogram, computerized tomography, and magnetic resonance imaging, are essential in monitoring these patients, as well as providing new prognostic factors of arterial stiffness that may help with risk stratification in the future. Diagnosis of heritable aortopathies should be considered with identification of aortic root dilation, particularly in children and young adults, or when there is a family history of aortic disease. Recent adult consensus guidelines highlight the importance of underlying genotype and phenotypic features when considering prophylactic surgical intervention. There are currently no consensus pediatric guidelines.
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Affiliation(s)
- Lyndsey Hunter-Adamson
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA
| | - Seda Tierney
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Palo Alto, CA, 94304, USA.
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杨 书, 罗 芳. [Latest advances in the diagnosis and treatment of Marfan syndrome]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:826-831. [PMID: 35894201 PMCID: PMC9336618 DOI: 10.7499/j.issn.1008-8830.2203099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Marfan syndrome (MFS) is a multisystem connective tissue disease with autosomal dominant inheritance. It is mainly caused by FBN1 gene mutation and often has different clinical manifestations. Neonatal MFS is especially rare with severe conditions and a poor prognosis. At present, there is still no radical treatment method for MFS, but early identification, early diagnosis, and early treatment can effectively prolong the life span of patients. This article reviews the latest advances in the diagnosis and treatment of MFS.
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Stark VC, Olfe J, Pesch J, Tahir E, Weinrich JM, Wiegand P, Kozlik‐Feldmann R, Kodolitsch Y, Mir TS. Tricuspid valve prolapse as an early predictor for severe phenotype in children with Marfan syndrome. Acta Paediatr 2022; 111:1261-1266. [PMID: 35194851 DOI: 10.1111/apa.16307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
AIM In Marfan syndrome, various cardiovascular pathologies, such as aortic dilatation and mitral valve pathologies, already occur in childhood and determine course of the disease. This study aimed to establish additional cardiovascular risk markers for severe Marfan phenotypes. We investigated tricuspid valve prolapse (TVP) and its predictive value for outcome of paediatric Marfan disease. METHODS In this retrospective, observational cohort study, we identified 130 paediatric Marfan patients (10.7 ± 4.8 years) with FBN1 variants. We divided patients into two groups based on TVP presence and performed a cross-sectional analysis to investigate the association of TVP with other cardiovascular, ocular and systemic pathologies, at first and last visit. A longitudinal analysis was performed with follow-up data. RESULTS At baseline, patients with TVP had higher incidence of aortic root dilatation (p = 0.013), mitral valve prolapse (p = 0.0001) and systemic manifestations (p = 0.025) than patients without TVP. At follow-up, previous presence of TVP predicted higher probability of aortic root dilatation (p = 0.002), mitral valve prolapse (p = 0.0001) and systemic manifestations (p = 0.002). CONCLUSION This shows that TVP is linked to both cardiac and extracardiac Marfan manifestations and TVP is an important marker for a disease severity in these children. Therefore, TVP should be assessed routinely using echocardiography in paediatric Marfan patients.
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Affiliation(s)
- Veronika C. Stark
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jakob Olfe
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Jannis Pesch
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Julius M. Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Peter Wiegand
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Rainer Kozlik‐Feldmann
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Yskert Kodolitsch
- Department of Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Thomas S. Mir
- Paediatric Cardiology University Heart and Vascular Center University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Abstract
Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye. Up to 25% of individuals with MFS have de novo variants. The most prominent manifestations of MFS are asymptomatic aortic root aneurysms, aortic dissections, dislocation of the ocular lens (ectopia lentis) and skeletal abnormalities that are characterized by overgrowth of the long bones. MFS is diagnosed based on the Ghent II nosology; genetic testing confirming the presence of a FBN1 pathogenetic variant is not always required for diagnosis but can help distinguish MFS from other heritable thoracic aortic disease syndromes that can present with skeletal features similar to those in MFS. Untreated aortic root aneurysms can progress to life-threatening acute aortic dissections. Management of MFS requires medical therapy to slow the rate of growth of aneurysms and decrease the risk of dissection. Routine surveillance with imaging techniques such as transthoracic echocardiography, CT or MRI is necessary to monitor aneurysm growth and determine when to perform prophylactic repair surgery to prevent an acute aortic dissection.
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Lidal IB, Bathen T, Johansen H, Velvin G. A scoping review presenting a wide variety of research on paediatric and adolescent patients with Marfan syndrome. Acta Paediatr 2020; 109:1758-1771. [PMID: 31977115 PMCID: PMC7496935 DOI: 10.1111/apa.15186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
AIM The present study aimed to map and summarise the research on children, aged 0-18 years, with Marfan syndrome, identify research gaps and point to research agendas. METHODS A scoping review was systematically performed by searching multiple databases from January 1996 to April 2019. Primary studies presenting results on at least six individuals aged 0-18 years with Marfan syndrome, diagnosed according to the Ghent nosology, were selected. RESULTS From 2341 de-duplicated records, 92 papers were included, mapped and described. Their topics were diagnostics (12%), cardiovascular matters (50%), skeletal matters (22%), ocular matters (9%), other medical aspects (5%) and psychosocial perspectives (2%). Most studies were from Europe and North America and published between 1999 and 2019 in subject-specific or paediatric journals, while a few were published in genetics journals. All studies had quantitative designs, and very few were multicentre studies. Each study had six to 608 subjects for a total of approximately 5809. CONCLUSION A wide range of research topics on adolescent and paediatric Marfan syndrome was found, but qualitative studies and a focus on psychosocial matters were lacking. Future investigations addressing noncardiovascular consequences and patient experiences are needed, as well as studies reaffirming or replicating existing intervention study results.
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Affiliation(s)
| | - Trine Bathen
- TRS Resource Centre for Rare DisordersSunnaas Rehabilitation HospitalOsloNorway
| | - Heidi Johansen
- TRS Resource Centre for Rare DisordersSunnaas Rehabilitation HospitalOsloNorway
| | - Gry Velvin
- TRS Resource Centre for Rare DisordersSunnaas Rehabilitation HospitalOsloNorway
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von Kodolitsch Y, Demolder A, Girdauskas E, Kaemmerer H, Kornhuber K, Muino Mosquera L, Morris S, Neptune E, Pyeritz R, Rand-Hendriksen S, Rahman A, Riise N, Robert L, Staufenbiel I, Szöcs K, Vanem TT, Linke SJ, Vogler M, Yetman A, De Backer J. Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease. Expert Rev Cardiovasc Ther 2020; 17:883-915. [DOI: 10.1080/14779072.2019.1704625] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yskert von Kodolitsch
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Anthony Demolder
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
| | - Evaldas Girdauskas
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Katharina Kornhuber
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Laura Muino Mosquera
- Department of Pediatric Cardiology and Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Shaine Morris
- Department of Pediatrics-Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reed Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svend Rand-Hendriksen
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Alexander Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Nina Riise
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Leema Robert
- Department of Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ingmar Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Katalin Szöcs
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Thy Thy Vanem
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Stephan J. Linke
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Ophthalmological practice at the University Clinic Hamburg-Eppendorf, zentrumsehstärke, Hamburg, Germany
| | - Marina Vogler
- German Marfan Association, Marfan Hilfe Deutschland e.V, Eutin, Germany
| | - Anji Yetman
- Vascular Medicine, Children’s Hospital and Medical Center, Omaha, USA
| | - Julie De Backer
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
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Vanem TT, Böker T, Sandvik GF, Kirkhus E, Smith H, Andersen K, Drolsum L, Lundby R, Røe C, Krohg‐Sørensen K, Geiran OR, Paus B, Rand‐Hendriksen S. Marfan syndrome: Evolving organ manifestations—A 10‐year follow‐up study. Am J Med Genet A 2019; 182:397-408. [DOI: 10.1002/ajmg.a.61441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Thy Thy Vanem
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Cardiothoracic SurgeryOslo University Hospital (OUH) Oslo Norway
| | - Tordis Böker
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Radiology and Nuclear MedicineOUH Oslo Norway
| | - Gunhild F. Sandvik
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of OphthalmologyOUH Oslo Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear MedicineOUH Oslo Norway
| | - Hans‐Jørgen Smith
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Radiology and Nuclear MedicineOUH Oslo Norway
| | - Kai Andersen
- Department of Cardiothoracic SurgeryOslo University Hospital (OUH) Oslo Norway
| | - Liv Drolsum
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of OphthalmologyOUH Oslo Norway
| | - Rigmor Lundby
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Radiology and Nuclear MedicineOUH Oslo Norway
| | - Cecilie Røe
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Physical Medicine and RehabilitationOUH Oslo Norway
| | - Kirsten Krohg‐Sørensen
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Cardiothoracic SurgeryOslo University Hospital (OUH) Oslo Norway
| | - Odd R. Geiran
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Cardiothoracic SurgeryOslo University Hospital (OUH) Oslo Norway
| | - Benedicte Paus
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- Department of Medical GeneticOUH Oslo Norway
| | - Svend Rand‐Hendriksen
- Faculty of Medicine, University of OsloInstitute of Clinical Medicine Oslo Norway
- TRS, National Resource Centre for Rare DisordersSunnaas Rehabilitation Hospital Nesoddtangen Norway
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Progressive Pulmonary Artery Dilatation is Associated with Type B Aortic Dissection in Patients with Marfan Syndrome. J Clin Med 2019; 8:jcm8111848. [PMID: 31684091 PMCID: PMC6912475 DOI: 10.3390/jcm8111848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/16/2023] Open
Abstract
Objective: Marfan syndrome (MFS) is a connective tissue disorder associated with severe cardiovascular morbidity and mortality. It is unknown if aorta complications in MFS are associated with progressive pulmonary artery (PA) dilatation. Methods: We measured the PA diameter on routine magnetic resonance imaging in a population of MFS patients seen in our specialised centre with follow up of diameters as well as the outcome. Results: PA dilatation was defined as an increase in diameter of 2 mm or more, and 71 patients (44%) of our total cohort (n = 162) met this criterion; mean follow up between two scans was 8.6 years (standard deviation (SD) ± 2.7 years). Furthermore, 28 patients suffered from dissections, of which 14 had a type A dissection, 10 had a type B dissection, and 4 patients suffered from both. Of those who suffered from dissection, 64% (18 out of 28) had a dilatation of the PA, versus 39% (53 out of 134) in the patient group without a dissection (p < 0.05). There was a significant association between type B dissection and descending aorta diameter (OR 1.14; 95% CI 1.05–1.24 p < 0.01) and PA dilatation (OR 1.69; 95% CI 1.03–2.77 p = 0.04). In the multivariable analysis the final model for type B dissection, only systolic blood pressure (OR 1.06; 95% CI 1.01–1.11 p = 0.02) and PA dilatation were statistically significant (OR 1.85; 95% CI 1.10–3.12 p = 0.02) while descending aorta diameter was not. Conclusions: We report an association between progressive PA dilatation and type B dissection. Our findings encourage a renewed interest in PA dimensions in MFS.
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Pyeritz RE. Marfan syndrome: improved clinical history results in expanded natural history. Genet Med 2018; 21:1683-1690. [DOI: 10.1038/s41436-018-0399-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
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