What is Marfan syndrome?
Marfan syndrome is a genetic disorder that causes the connective tissues that shape and support many parts of the body to be weaker than they should be. It can affect many parts of the body — including the heart and blood vessels, lungs, bones, joints, eyes, and skin. Marfan syndrome often weakens the aorta, the body’s largest blood vessel, putting the child at risk for heart problems.
About one out of every 5,000 Americans has Marfan syndrome. It affects males and females of all races and ethnicities.
Children who have Marfan syndrome are usually tall and thin, with long arms, long double-jointed fingers, a short torso, and very long legs. They often have an abnormally shaped chest, which increases the risk of developing lung problems.
How we care for Marfan syndrome
The Boston Children’s Hospital Cardiovascular Genetics Program cares for patients and families affected by Marfan syndrome and other genetic disorders. We also conduct research to develop better treatments for these conditions.
Patients with Marfan syndrome can develop aneurysms of the aorta, most commonly of the aortic root but also the aortic arch and descending aorta. Without treatment, these aneurysms can be life threatening.
Some patients with Marfan syndrome develop leakage of the mitral valve, which our surgeons specialize in repairing.
Because Marfan syndrome is a multi-system disorder, our program works closely with other specialists — including general surgeons, ophthalmologists, orthopedic surgeons, behavioral pediatricians, educational specialists, and mental health providers — to provide complete care for our patients with this condition.
Marfan Syndrome | Symptoms & Causes
What are the symptoms of Marfan syndrome?
Children with Marfan syndrome often have specific physical traits that may become more noticeable as a child grows. These traits can include:
- long arms, legs, fingers, and toes
- long, narrow face
- flexible joints
- short torso
- a spine that curves to one side (scoliosis)
- a chest that sinks in (pectus excavatum) or sticks out (pectus carinatum)
- eye problems, like nearsightedness or a dislocated lens
- overly crowded teeth
- flat feet
- unexplained stretch marks on the skin
Not everyone who has these traits has Marfan syndrome. If you’re concerned that your child may have Marfan syndrome, it’s important to see a doctor who’s experienced in diagnosing genetic disorders.
What causes Marfan syndrome?
The syndrome is caused by a defect in a gene known as FBN1, which controls the structure of fibrillin-1, a protein that’s an important part of the connective tissue in the body.
About 75 percent of children with Marfan syndrome have inherited the condition from a parent. In the other 25 percent of children, the gene mutates spontaneously for no apparent reason.
Marfan Syndrome | Diagnosis & Treatments
How is Marfan syndrome diagnosed?
There’s no single test to diagnose Marfan syndrome. The condition can be especially hard to diagnose in children because most symptoms don’t appear until the child is a teenager or young adult. Usually, a child with suspected Marfan syndrome will be carefully monitored, so any symptoms can be detected and treated as soon as possible.
Tests for Marfan syndrome can include:
- echocardiogram (cardiac ultrasound)
- electrocardiogram (EKG or ECG)
- cardiac magnetic resonance imaging (MRI) or computed tomography (CT)
- DNA test to locate and confirm the genetic defect
Can prenatal testing detect Marfan syndrome?
If you have Marfan syndrome and want to know if your unborn baby also has the condition, you can have prenatal testing at about 10 to 12 weeks using chorionic villus sampling. This test involves taking and examining a small sample of placenta from the womb. Amniocentesis at about 16 to 18 weeks can also test for Marfan syndrome. This involves taking and examining a small sample of amniotic fluid (the fluid that surrounds the fetus in the womb).
While these tests can show if your child has the gene defect, they can’t indicate how severe the condition will be. The severity of Marfan syndrome in a parent doesn’t predict how severe the syndrome will be in a child.
How is Marfan syndrome treated?
Marfan syndrome doesn't have a cure. But treatments can help delay or prevent complications, especially when they're started early. This is why early diagnosis is so important.
Marfan syndrome can affect many parts of your child's body, including the heart, bones and joints, and eyes. The type of treatment your child receives depends on their symptoms and related conditions.
The most common and serious heart problem in people with Marfan syndrome is aortic dilation (aneurysm), a stretching and weakening of the aorta. It can lead to a bulge, tear, or leak in the aorta, which can be life threatening.
Treatments may include:
- medication, including beta blockers, to lower the child’s blood pressure and reduce stress on the aorta, and angiotensin II blocker Losartan
- surgery to replace the affected part of the aorta or to repair the heart valve if it’s not working normally
If your child has scoliosis — a common problem in children with Marfan syndrome — your child may need to wear a brace or other device to prevent the condition from getting worse. Severe cases of scoliosis may require surgery.
Some children may also need surgery to repair a chest that sinks in (pectus excavatum) or that sticks out (pectus carinatum). Surgery to repair a concave chest is done to prevent the chest from pressing on the lungs and heart, and is generally very successful.
Glasses or contact lenses can help with some of these problems, but children may need surgery for a dislocated lens or cataracts. Treatments for glaucoma may include eye drops, medications, laser therapy, or surgery.
What is the long-term outlook for children with Marfan syndrome?
People with Marfan syndrome can lead normal lives. Treatments for Marfan syndrome are continually being refined, with long-term outcomes constantly improving. Still, those with Marfan syndrome need lifelong monitoring and possibly medication, since they will always be at some risk for other heart problems.
Your child's cardiologist will help you create a long-term care program for your child as they mature into the teen years and adulthood.
As your child becomes an adult, their treatment can be transferred to the Adult Congenital Heart Program at Boston Children’s.
Marfan Syndrome | Innovation
Our areas of innovation for Marfan syndrome
Our clinicians and scientists are at the leading edge of research and treatment for the medical prevention and management of aneurysms associated with Marfan syndrome. Our surgeons specialize in aortic valve-sparing procedures (the valve is left intact) for aneurysms associated with Marfan syndrome, with excellent results.