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Pectus excavatum
Pectus excavatum


Marfan's syndrome
Marfan's syndrome


Definition:

Marfan syndrome is a disorder of connective tissue, the tissue that strengthens the body's structures. Disorders of connective tissue affect the skeletal system, cardiovascular system, eyes, and skin.



Causes, incidence, and risk factors:

Marfan syndrome is caused by defects in a gene called fibrillin-1. Fibrillin-1 plays an important role as the building block for elastic tissue in the body.

A problem with this gene leads to changes in elastic tissues, particularly in the aorta, eye, and skin. The gene defect also causes too much growth of the long bones of the body. This causes the tall height and long arms and legs seen in people with this syndrome. How this overgrowth happens is not well understood.

In most cases, Marfan syndrome is inherited, which means it is passed down through families. However, up to 30% of cases have no family history. Such cases are called "sporadic." In sporadic cases, the syndrome is believed to result from a spontaneous new gene defect.



Symptoms:

People with Marfan syndrome are usually tall with long, thin arms and legs and spider-like fingers -- a condition called arachnodactyly. When they stretch out their arms, the length of their arms is much greater than their height.

Other symptoms include:

  • Coloboma of iris
  • Flat feet
  • Funnel chest (pectus excavatum ) or pigeon breast (pectus carinatum )
  • Highly arched palate and crowded teeth
  • Hypotonia
  • Learning disability
  • Movement of the lens of the eye from its normal position (dislocation)
  • Nearsightedness
  • Scoliosis
  • Small lower jaw (micrognathia)
  • Thin, narrow face


Signs and tests:

The doctor will perform a physical exam. There may be hypermobile joints and signs of:

  • Aneurysm
  • Collapsed lung
  • Heart valve problems

An eye exam may show:

The following tests may be performed:

An echocardiogram should be done every year to look at the base of the aorta.



Treatment:

Vision problems should be treated when possible. Take care to prevent scoliosis, especially during adolescence.

Medicine to slow the heart rate may help prevent stress on the aorta. Avoid participating in competitive athletics and contact sports to avoid injuring the heart. Some people may need surgical replacement of the aortic root and valve.

People with Marfan syndrome should take antibiotics before dental procedures to prevent endocarditis . Pregnant women with Marfan syndrome must be monitored very closely because of the increased stress on the heart and aorta.



Support Groups:

National Marfan Foundation -- www.marfan.org



Expectations (prognosis):

Heart-related complications may shorten the lifespan of people with this disease. However, many patients survive well into their 60s. Good care and surgery may extend the lifespan further.



Complications:

Complications may include:



Calling your health care provider:

Experts recommend genetic counseling for couples with a history of this syndrome who wish to have children.



Prevention:

Spontaneous new gene mutations leading to Marfan (less than 1/3 of cases) cannot be prevented. If you have Marfan syndrome, see your doctor at least once every year.



References:

Pyeritz RE. Inherited Diseases of Connective Tissue. In: Goldman L, Ausiello D. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 281.

Robinson LK, Fitzpatrick E. Marfan Syndrome. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Kliegman: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 700.




Review Date: 5/15/2008
Reviewed By: Chad Haldeman-Englert, MD, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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