How Is Marfan Syndrome Treated?

Marfan syndrome has no cure. However, treatments can help delay or prevent complications (especially when started early).

Marfan syndrome can affect many parts of your body, including your heart, bones and joints, eyes, nervous system, and lungs. The type of treatment you receive will depend on your signs and symptoms.

Heart Treatments

Aortic dilation, or aortic aneurysm, is the most common and serious heart problem in people who have Marfan syndrome. In this condition, the aorta-the main artery that carries oxygen-rich blood to your body-stretches and weakens.

Medicines are used to try to slow the rate of aortic dilation. Surgery is used to replace the dilated segment of aorta before it tears.

Medicines

Beta blockers are medicines that help your heart beat slower and with less force. These medicines may help relieve strain on your aorta and slow the rate of aortic dilation.

Some people have side effects from beta blockers, such as tiredness and nausea (feeling sick to your stomach). If side effects occur, your doctor may prescribe a calcium channel blocker or ACE inhibitor instead of a beta blocker. Both medicines help relieve stress on the aorta.

Lab studies suggest that blocking a protein called TGF-beta may help prevent some of the effects of Marfan syndrome. Research shows that the medicine losartan may block the protein in other conditions.

The National Heart, Lung, and Blood Institute is currently sponsoring a study comparing losartan to a beta blocker in children and adults who have Marfan syndrome. The study aims to find out which medicine, if either, is best at slowing the rate of aortic enlargement.

Surgery

If your aorta stretches, it's more likely to tear (aortic dissection). To prevent this, your doctor may recommend surgery to repair or replace part of your aorta.

Surgery may involve:

• A composite valve graft. For this surgery, part of the aorta and the aortic valve are removed. The aorta is replaced with a man-made tube called a graft. A man-made valve replaces the original valve.
• Aortic valve-sparing surgery. If your aortic valve is working well, your doctor may recommend valve-sparing surgery. For this surgery, your doctor replaces the enlarged part of your aorta with a graft. Your aortic valve is left in place.

After aortic surgery, you may need certain medicines or followup tests. For example, after a composite valve graft, your doctor will prescribe anticoagulants, or "blood thinners."

Blood thinners help prevent blood clots from forming on your man-made aortic valve. You will need to take these medicines for the rest of your life. If you've had valve-sparing surgery, you'll only need to take blood thinners for a short time, as your doctor prescribes.

If you've had a composite valve graft, you're at increased risk for endocarditis (EN-do-kar-DI-tis)-an infection of the valve. Your doctor may recommend that you take antibiotics before certain medical or dental procedures that may raise your risk for the heart infection.

Your doctor also may advise you to continue taking beta blockers or other medicines after either type of aortic surgery.

After surgery, you may have routine cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT) scans to check your aorta.

Cardiac MRI is a safe test that uses radio waves and magnets to created detailed pictures of your organs and tissues. Cardiac CT is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart.

Bone and Joint Treatments

If you have scoliosis (a curved spine), your doctor may suggest a brace or other device to prevent the condition from getting worse. More severe cases of scoliosis may require surgery.

Some people who have Marfan syndrome need surgery to repair a chest that sinks in or sticks out. This surgery is done to prevent the chest from pressing on the lungs and heart.

Eye Treatments

Marfan syndrome can lead to several eye problems, such as a dislocated lens, nearsightedness, early glaucoma (high pressure in the fluid in the eyes), and cataracts (clouding of an eye's lens).

Glasses or contact lenses can help with some of these problems. In some cases, surgery is needed.

Nervous System Treatments

Marfan syndrome can lead to dural ectasia. In this condition, a substance called the dura (which covers the fluid around your brain and spinal cord) weakens and stretches. This can cause the bones of the spine to wear away. Dural ectasia usually is treated with pain medicines.

Lung Treatments

Marfan syndrome may cause pneumothorax, or collapsed lung. In this condition, air or gas builds up in the space between the lungs and the chest wall.

If the condition is minor, it may go away on its own. However, you may need to have a tube placed through your skin and chest wall to remove the air. Sometimes surgery is required.