Natural history of cardiovascular manifestations in Marfan syndrome.
OBJECTIVE
To investigate the natural history of mitral valve and aortic abnormalities in patients with Marfan syndrome during childhood and adolescence.


METHODS
Fifty two patients with Marfan syndrome were followed for a mean of 7.9 years. Occurrence of adverse cardiovascular outcomes was measured clinically and by ultrasound examination.


RESULTS
Mitral valve prolapse (MVP) was diagnosed in 46 patients at a mean age of 9.7 years, more than 80% of whom presented as "silent MVP". Mitral regurgitation (MR) occurred in 25 patients, aortic dilatation in 43, and aortic regurgitation (AR) in 13. Both MVP and aortic dilatation developed at a constant rate during the age period 5-20 years. In 23 patients MVP was diagnosed before aortic dilatation, in 18 the reverse occurred, and in 11 patients the two abnormalities were diagnosed simultaneously. During follow up, 21 patients showed progression of mitral valve dysfunction; progression of aortic abnormalities occurred in 13. Aortic surgery was performed in 10; two died of subsequent complications. Mitral valve surgery was performed in six. In sporadic female Marfan patients the age at initial diagnosis of MVP, MR, aortic dilatation, and AR was lowest, the grade of MR and AR most severe, the time lapse between the occurrence of MVP and subsequent MR as well as between dilatation and subsequent AR shortest, and the risk for cardiovascular associated morbidity and mortality highest.


CONCLUSIONS
During childhood and adolescence in Marfan syndrome, mitral valve dysfunction as well as aortic abnormalities develop and progress gradually, often without symptoms, but may cause considerable morbidity and mortality by the end of the second decade, especially in female sporadic patients.
van Karnebeek
C D
CD
Department of Paediatrics H3-150, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Naeff
M S
MS
Mulder
B J
BJ
Hennekam
R C
RC
Offringa
M
M
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000209:etiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis