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| | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = Marfan syndrome | | | Name = Marfan syndrome |
| | Image = Marfansyndrome.jpg | | | Image = Marfansyndrome2.jpg |
| | Caption = | | | Caption = |
| | DiseasesDB = 7845 | | | DiseasesDB = 7845 |
| | ICD10 = {{ICD10|Q|87|4|q|80}} | | | ICD10 = {{ICD10|Q|87|4|q|80}} |
| | ICD9 = {{ICD9|759.82}} | | | ICD9 = {{ICD9|759.82}} |
| | ICDO = | | | ICDO = |
| | OMIM = 154700 | | | OMIM = 154700 |
| | MedlinePlus = 000418 | | | MedlinePlus = 000418 |
| | eMedicineSubj = ped
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| | eMedicineTopic = 1372
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| | eMedicine_mult = {{eMedicine2|orthoped|414}}
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| | MeshID = C17.300.500 | | | MeshID = C17.300.500 |
| }} | | }} |
| {{SI}} | | {{Marfan's syndrome}} |
| {{WikiDoc Cardiology Network Infobox}}
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| {{CMG}}
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| {{Editor Help}}
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| ==Overview==
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| '''Marfan syndrome''' is an [[autosomal dominant]] genetic disorder of the [[connective tissue]] characterized by disproportionately long [[limb]]s, long thin fingers, a typically tall stature, and a predisposition to cardiovascular abnormalities, specifically those affecting the [[heart valves]] and [[aorta]]. The disorder may also affect numerous other structures and organs — including the [[lung]]s, eyes, dural sac surrounding the [[spinal cord]], and [[hard palate]].
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| ==Differential Diagnosis==
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| The following disorders have similar signs and symptoms of Marfan syndrome:
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| * [[Arachnodactyly|Congenital Contractural Arachnodactyly (CCA) or Beals Syndrome]]
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| * [[Ehlers-Danlos syndrome]]
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| * [[Homocystinuria]]
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| * [[Loeys-Dietz syndrome]]
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| * [[MASS phenotype]]
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| * [[Stickler syndrome]]
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| ==Etymology==
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| It is named after [[Antoine Marfan]], the French [[pediatrician]] who first described the condition in 1896 after noticing striking features in a 5-year-old girl.<ref>[http://www.hopkinsmedicine.org/CardiacSurgery/marfancenter/history.html Johns Hopkins Comprehensive Marfan Center.] John Hopkins Medicine. Retrieved on January 6, 2009.</ref><ref>[http://www.whonamedit.com/doctor.cfm/972.html Antoine Bernard-Jean Marfan.] Who Named It? Retrieved on January 20, 2009.</ref> The gene linked to the disease was first identified by Francesco Ramirez at the [[Mount Sinai Hospital, New York|Mount Sinai Medical Center]] in [[New York City]] in 1991.<ref>Brown P (July 27, 1991). [http://www.newscientist.com/article/mg13117793.100-science-marfan-syndrome-linked-to-gene-.html "Marfan syndrome linked to gene".] ''New Scientist''. Retrieved on August 11, 2008.</ref>
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| ==Epidemiology==
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| Marfan syndrome affects males and females equally,<ref name="marorg">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=6&menu_item_id=3|title=The role of heredity and family history|publisher=National Marfan Foundation|year=1999}}</ref> and the mutation shows no geographical bias. Estimates indicate that approximately 60 000 (1 in 5000, or 0.02% of the population)<ref name="marorg"/> to 200 000<ref name="mednet">{{Cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=63689|title=New, Deadly Relative of Marfan's Syndrome Discovered|publisher=MedicineNet.com|year=2006}}</ref> Americans have Marfan syndrome. Each parent with the condition has a 50% chance of passing it on to a child due to its [[autosomal dominant]] nature. Most individuals with Marfan syndrome have another affected family member, but approximately 15-30% of all cases are due to ''[[de novo mutation|de novo]]'' [[genetic mutation]]s<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| location=Philadelphia| id=0-7216-7335-X}}</ref> — such spontaneous mutations occur in about 1 in 20 000 births. Marfan syndrome is also an example of [[dominant negative mutation]] and [[haploinsufficiency]].<ref name="Judge_et_al_2004">{{cite journal | last = Judge | first = Daniel P. | coauthors = Nancy J. Biery, Douglas R. Keene, Jessica Geubtner, Loretha Myers, David L. Huso, Lynn Y. Sakai, Harry C. Dietz | title = Evidence for a critical contribution of haploinsufficiency in the complex pathogenesis of Marfan syndrome. | journal = The Journal of Clinical Investigation | volume = 114 | issue = 2 | pages = 172-181 | doi = 10.1172/JCI200420641 | id = PMID 15254584 | url = http://www.jci.org/cgi/content/full/114/2/172}}</ref><ref name="Judge_et_al_2005">{{cite journal | last = Judge | first = Daniel P. | coauthors = Harry C. Dietz | title = Marfan's syndrome. | journal = Lancet | volume = 366 | issue = 9501 | pages = 1965-76 | year = 2005 | doi = 10.1016/S0140-6736(05)67789-6. | id = PMID 16325700 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16325700}}</ref> It is associated with variable expressivity. [[Incomplete penetrance]], has not been definitively documented.
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| == Pathogenesis ==
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| Marfan syndrome has been linked to a defect in the ''FBN1'' [[gene]] on [[chromosome]] 15,<ref>{{cite journal | author = McKusick V | title = The defect in Marfan syndrome. | journal = Nature | volume = 352 | issue = 6333 | pages = 279-81 | year = 1991 | id = PMID 1852198}}</ref> which [[Genetics|encodes]] a [[glycoprotein]] called [[fibrillin]]-1. Fibrillin is essential for the formation of the [[elastic fiber]]s found in connective tissue, as it provides the scaffolding for [[tropoelastin]].<ref name="robspath">{{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran| coauthors=Kumar, Collins| publisher=W.B Saunders Company| location=Philadelphia| id=0-7216-7335-X}}</ref> Elastic fibers are found throughout the body but are particularly abundant in the [[aorta]], [[ligament]]s and the [[Zonule of Zinn|ciliary zonule]]s of the eye, consequently these areas are among the worst affected. Without the structural support provided by fibrillin many connective tissues are weakened, which can have severe consequences for support and stability.
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| A related disease has been found in mice, and the study of mouse fibrillin synthesis and secretion, and connective tissue formation, has begun to further our understanding of Marfan syndrome in humans. It has been found that simply reducing the level of normal fibrillin-1 causes a Marfan-related disease in mice.<ref name="micefib">{{cite journal | author=Lygia Pereira, ''et al.''| title=Pathogenetic sequence for aneurysm revealed in mice underexpressing fibrillin-1| journal=Proceedings of the National Academy of Sciences| year=1999| volume=96| issue=7| page=3819-3823| url=http://www.pnas.org/cgi/content/full/96/7/3819}}</ref>
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| [[Transforming growth factor]] beta (TGFβ) plays an important role in Marfan syndrome. Fibrillin-1 binds TGFβ and inactivates it. In Marfan syndrome, reduced levels of fibrillin-1 allow activated TGFβ to damage the lungs and heart. A defect in the gene ''TGFβR2'' on [[chromosome]] 3, a [[receptor protein]] of TGFβ, has also been related to Marfan syndrome.<ref name="tgf2beta">{{Cite web|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=gene&dopt=full_report&list_uids=7048|title=TGFBR2 transforming growth factor, beta receptor II|publisher=NCBI|year=2007|author=Entrez Gene|format=Entrez gene entry}}</ref> Marfan syndrome can often be confused with [[Loeys-Dietz syndrome]], a similar connective tissue disorder resulting from mutations in the TGFβ receptor genes ''TGFβR1'' and ''TGFβR2''.<ref name="loeysdietz">{{Cite web|url=http://www.marfan.org/nmf/GetContentRequestHandler.do?menu_item_id=84|title=Related Disorders: Loeys-Dietz|publisher=National Marfan Foundation}}</ref>
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| ==Symptoms==
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| There are no signs or symptoms that are unique to Marfan syndrome. It is usually a single apparent sign or symptom that leads doctors to look for others and eventually to diagnose the syndrome, which affects connective tissue in diverse organs and systems. Even affected individuals in the same family might exhibit various combinations and severities of symptoms.
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| ===Skeletal system===
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| The most readily visible signs are associated with the skeletal system. Many individuals with Marfan Syndrome grow to above average height. Some have long slender limbs with fingers and toes that are also abnormally long and slender ([[arachnodactyly]]). An individual's arms may be disproportionately long. In addition to affecting height and limb proportions, Marfan syndrome can produce other skeletal signs. Abnormal curvature of the [[Vertebral column|spine]] ([[scoliosis]]) is common, as is abnormal indentation ([[pectus excavatum]]) or protrusion ([[pectus carinatum]]) of the [[sternum]]. Other signs include abnormal joint flexibility, a high [[palate]], [[malocclusions]], flat feet, stooped shoulders, and unexplained [[stretch marks]] on the skin. Some people with Marfans have [[speech disorder|speech disorders]] resulting from symptomatic high palates and small jaws.
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| ===Eyes===
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| Marfan syndrome can also seriously affect the eyes and vision. [[myopia|Nearsightedness]] and [[astigmatism]] are common, but farsightedness can also result. Periodic eye exams can lead to an [[ophthalmologist]] or [[optometrist]] discovering dislocation, or [[subluxation]], of the crystalline [[lens (anatomy)|lens]] in one or both eyes ([[ectopia lentis]]) by carefully observing these structures using a [[Slit lamp|slit-lamp]] biomicroscope. This can be differentiated from the similar condition [[homocystinuria]], where the dislocation is inferonasal; in Marfan's the dislocation is superotemporal. Sometimes eye problems appear only after the weakening of connective tissue has caused [[retinal detachment|detachment of the retina]].<ref name="mayo-gen">{{Cite web|url=http://www.mayoclinic.com/health/marfan-syndrome/DS00540/DSECTION=2|title=Marfan Syndrome|publisher=Mayo Clinic}}</ref> Early onset [[glaucoma]] can be another complication.
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| ===Cardiovascular system===
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| The most serious conditions associated with Marfan syndrome involve the cardiovascular system. Undue fatigue, shortness of breath, [[heart palpitations]], [[tachycardia|racing heartbeats]], or [[Angina pectoris|pain in the left chest, back, shoulder, or arm]], can bring an individual into the doctor's office. A [[heart murmur]] heard on a [[stethoscope]], an abnormal reading on an [[electrocardiogram]], or symptoms of [[Angina pectoris|angina]] can lead a doctor to order an [[echocardiogram]]. This can reveal signs of leakage or [[prolapse]] of the mitral or aortic [[heart valve|valves]] that control the flow of blood through the heart. (See [[mitral valve prolapse]].) However, the major sign that would lead a doctor to consider an underlying condition is a dilated aorta or an [[aortic aneurysm]]. Sometimes, no heart problems are apparent until the weakening of the connective tissue in the [[aorta|ascending aorta]] causes an [[aortic aneurysm]] or even [[aortic dissection]].
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| Because of the underlying connective tissue abnormalities that cause Marfan syndrome, there is an increased incidence of dehiscence of prosthetic mitral valve.<ref name="Braunwald-2005">{{cite book | coauthors=Zipes, Libby Bonow Braunwald | title=Braunwald's Heart Disease ~ A Textbook of Cardiovascular Medicine, Seventh Edition | publisher=Elseview Saunders | date=2005 | location=United States of America | pages=1894 | id=ISBN 0-7216-0509-5}}</ref> Care should be taken to attempt repair of damaged heart valves rather than replacement.
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| During pregnancy, even in the absence of preconceived cardiovascular abnormality, women with Marfan syndrome are at significant risk of acute [[aortic dissection]], which can be lethal if untreated. For this reason, women with Marfan syndrome should receive a thorough assessment prior to conception, and [[echocardiography]] should be performed every 6-10 weeks during pregnancy, to assess the aortic root diameter. Most women however tolerate pregnancy well and safe vaginal delivery is possible.<ref name="emed">{{Cite web|url=http://www.emedicine.com/ped/fulltopic/topic1372.htm#section~Miscellaneous|title=Marfan Syndrome, special concerns}}</ref>
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| *A typical aortic root in Marfan's syndrome.
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| <googlevideo>-760162053984535443&hl=en</googlevideo>
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| ===Lungs===
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| Marfan syndrome is a [[risk factor]] for spontaneous [[pneumothorax]]. In spontaneous unilateral pneumothorax, air escapes from a lung and occupies the [[pleural]] space between the chest wall and a [[lung]]. The lung becomes partially compressed or collapsed. This can cause pain, shortness of breath, [[cyanosis]], and, if not treated, death. Marfan syndrome has also been associated with [[sleep apnea]] and [[idiopathic]] obstructive lung disease.
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| ===Central nervous system===
| | '''Editors-In-Chief:''' [[William James Gibson]], [[C. Michael Gibson, M.S., M.D.]]; {{AE}} {{CZ}}; {{CA}} |
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| Another condition that can reduce the quality of life for an individual, though not life-threatening, is [[dural ectasia]], the weakening of the connective tissue of the dural sac, the membrane that encases the [[spinal cord]].
| | == [[Marfan's syndrome overview|Overview]] == |
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| Dural ectasia can be present for a long time without producing any noticeable symptoms. Symptoms that can occur are lower [[back pain]], leg pain, [[abdominal pain]], other neurological symptoms in the lower extremities, or [[headaches]]. Such symptoms usually diminish when the individual lies flat on his or her back.
| | == [[Marfan's syndrome historical perspective|Historical Perspective]] == |
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| These types of symptoms might lead a doctor to order an [[X-ray]] of the [[lumbar|lower spine]]. Dural ectasia is usually not visible on an X-ray in the early phases. A worsening of symptoms and the lack of finding any other cause should eventually lead a doctor to order an upright [[MRI]] of the lower spine.
| | == [[Marfan's syndrome pathophysiology|Pathophysiology]] == |
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| Dural ectasia that has progressed to the point of causing these symptoms would appear in an upright MRI image as a dilated pouch that is wearing away at the [[lumbar vertebrae]].<ref name="mayo-gen" /> Other spinal issues associated with Marfan include degenerative disk disease and spinal cysts.
| | == [[Marfan's syndrome differential diagnosis|Differentiating Marfan's Syndrome from other Diseases]] == |
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| ==Management== | | == [[Marfan's syndrome epidemiology and demographics|Epidemiology and Demographics]] == |
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| There is no cure for Marfan syndrome, but life expectancy has increased significantly over the last few decades, and clinical trials are underway for a promising new treatment.<ref>Freeman, Elaine (2007) "[http://www.hopkinsmedicine.org/hmn/F07/feature1.cfm A Silver Bullet for Blake]", ''Johns Hopkins Magazine'', Fall, 2007.</ref> The syndrome is treated by addressing each issue as it arises, and, in particular, considering prophylactic medication, even for young children, to slow progression of aortic dilation.
| | == [[Marfan's syndrome screening|Screening]] == |
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| Regular checkups by a [[cardiologist]] are needed to monitor the health of the heart valves and the aorta. The goal of treatment is to slow the progression of aortic dilation and damage to heart valves by eliminating [[Cardiac arrhythmia|arrythmias]], minimizing the [[heart rate]], and minimizing [[blood pressure]].
| | == [[Marfan's syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| [[Beta blocker]]s have been used to control [[Cardiac arrhythmia|arrythmias]] and slow the [[heart rate]]. Other medications might be needed to further minimize [[blood pressure]] without slowing the [[heart rate]], such as [[ACE inhibitors]] and [[angiotensin II receptor antagonist]]s, also known as angiontensin receptor blockers (ARBs).
| | == Diagnosis == |
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| If the dilation of the aorta progresses to a significant diameter [[aneurysm]], causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft [CAVG] or valve-sparing procedure) becomes necessary.
| | [[Marfan's syndrome diagnostic criteria|Diagnostic Criteria]] | [[Marfan's syndrome history and symptoms|History and Symptoms]] | [[Marfan's syndrome physical examination|Physical Examination]] | [[Marfan's syndrome laboratory findings|Laboratory Findings]] | [[Marfan's syndrome electrocardiogram|ECG]] | [[Marfan's syndrome chest x ray|Chest X Ray]] | [[Marfan's syndrome CT|CT]] | [[Marfan's syndrome MRI|MRI]] | [[Marfan's syndrome echocardiography or ultrasound|Echocardiography ]] | [[Marfan's syndrome other imaging findings|Other Imaging Findings]] | [[Marfan's syndrome other diagnostic studies|Other Diagnostic Studies]] |
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| Although aortic graft surgery (or any vascular surgery) is a serious undertaking it is generally successful if undertaken on an elective basis. Surgery in the setting of acute aortic dissection or rupture is considerably more problematic. Elective aortic valve/graft surgery is usually considered when aortic root diameter reaches 50 millimetres, but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common.<ref name="mayo-heart">{{Cite web|url=http://www.mayoclinic.org/marfan-syndrome/heartsurgery.html|title=Heart Surgery for Marfan Syndrome|publisher=Mayo Clinic}}</ref> As Marfan patients live longer, other vascular repairs are becoming more common, e.g. repairs of descending thoractic aortic aneurysms and aneurysms of vessels other than the aorta.
| | == Treatment == |
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| The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in the typical manner for the appropriate condition. This can also affect height, arm length, and life span. The [[Nuss procedure]] is now being offered to people with Marfan syndrome to correct 'sunken chest' or ([[pectus excavatum]]).<ref name="chkd">{{Cite web|url=http://www.chkd.org/services/nussprocedure/Overview.aspx|title=Overview of the Nuss Procedure for Pectus Excavatum|publisher=Children's Hospital of The King's Daughters}}</ref> Because Marfan may cause spinal abnormalities that are asymptomatic, any spinal surgery contemplated on a Marfan patient should only follow detailed imaging and careful surgical planning, regardless of the indication for surgery.
| | [[Marfan's syndrome medical therapy|Medical Therapy]] | [[Marfan's syndrome surgery|Surgery]] | [[Marfan's syndrome primary prevention|Primary Prevention]]| [[Marfan's syndrome secondary prevention| Secondary Prevention]] | [[Marfan's syndrome cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Marfan's syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| Clinical trials have been conducted of the drug [[acetazolamide]] in the treatment of symptoms of [[dural ectasia]]. The treatment has demonstrated significant functional improvements in some sufferers.<ref name="spine">{{Cite web|url=http://www.spineuniverse.com/displayarticle.php/article922.html|title=Dural Ectasia in the Marfan Spine: Symptoms and Treatment|publisher=Scoliosis Research Society}}</ref> Other medical treatments, as well as physical therapy, are also available.
| | == External links == |
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| Treatment of a spontaneous [[pneumothorax]] is dependant on the volume of air in the pleural space and the natural progression of the individual's condition. A small pneumothorax might resolve without active treatment in 1 to 2 weeks. Recurrent pneumothoraxes might require chest surgery. Moderately sized pneumothoraxes might need [[Chest tube|chest drain]] management for several days in hospital. Large pneumothoraxes are likely to be medical emergencies requiring emergency decompression.
| | * [http://marfanworld.org/ International Federation of Marfan Syndrome Organisations] |
| | | * [http://www.marfan.org/ National Marfan Foundation (USA)] |
| Research in laboratory mice has suggested that the [[angiotensin II receptor antagonist]] [[losartan]], which appears to block TGF-beta activity, can slow or halt the formation of aortic aneurysms in Marfan syndrome.<ref name="scimag">{{Cite journal | last = Habashi | first = Jennifer P. | coauthors = Daniel P. Judge, Tammy M. Holm, Ronald D. Cohn, Bart L. Loeys, Timothy K. Cooper, Loretha Myers, Erin C. Klein, Guosheng Liu, Carla Calvi, Megan Podowski, Enid R. Neptune, Marc K. Halushka, Djahida Bedja, Kathleen Gabrielson, Daniel B. Rifkin, Luca Carta, Francesco Ramirez, David L. Huso, and Harry C. Dietz | date = [[April 7]], [[2006]] | title = Losartan, an AT1 Antagonist, Prevents Aortic Aneurysm in a Mouse Model of Marfan Syndrome | volume = 312 | issue = 5770 | pages = 117 - 121 | doi = 10.1126/science.1124287 | url = http://www.sciencemag.org/cgi/content/full/312/5770/117 | abstract = http://www.sciencemag.org/cgi/content/abstract/sci;312/5770/117 | news = http://www.news-medical.net/?id=17249}}</ref> A large [[clinical trial]] sponsored by the [[National Institutes of Health]] comparing the effects of losartan and [[atenolol]] on the aortas of Marfan patients is scheduled to begin in early 2007, coordinated by Johns Hopkins.<ref name="trial">{{Cite web|url=http://www.marfan.org/nmf/GetSubContentRequestHandler.do?sub_menu_item_content_id=147&menu_item_id=91|title=Atenolol vs. Losartan in Individuals with Marfan Syndrome Clinial Trial|publisher=National Marfan Foundation}}</ref>
| | * [http://www.ncbi.nlm.nih.gov/disease/Marfan.html National Institute for Health Marfan syndrome page (USA)] |
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| Genetic counseling and specialized clinics are available at many academic medical centers for affected persons and family members.
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| ==Related disorders==
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| The following conditions that can result from having Marfan's syndrome and may also occur in people without any known underlying disorder. what leads doctors to a diagnosis of marfan syndrome is family history and a combination of major and minor indicators of the disorder that occur in one individual which is a rare manifestation in general population. Example: four skeletal signs with one or more signs in another body system such as ocular and cardiovascular in one individual.
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| *[[Aortic aneurysm|Aortic aneurysm or dilatation]]
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| *[[Arachnodactyly]]
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| *[[Bicuspid aortic valve]]
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| *[[Cysts]]
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| *[[Craniosynostosis]]
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| *[[Cystic medial necrosis]]
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| *[[Dural ectasia]]
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| *[[Ectopia lentis]]
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| *[[Flat feet]]
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| *[[Gigantism]]
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| *[[Glaucoma]]
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| *[[Hernias]]
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| *[[Hyperflex|Hypermobility of the joints]]
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| *[[Malocclusion]]
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| *[[Mitral valve prolapse]]
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| *[[Myopia]]
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| *[[COPD|Obstructive lung disease]]
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| *[[Osteoarthritis]]
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| *[[Pectus carinatum]] or [[pectus excavatum|excavatum]]
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| *[[Pneumothorax]]
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| *[[Retinal detachment]]
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| *[[Scoliosis]]
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| *[[Sleep apnea]]
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| *[[Stretch marks]]
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| *[http://marfanworld.org/ International Federation of Marfan Syndrome Organisations] | |
| *[http://www.marfan.org/ National Marfan Foundation (USA)] | |
| *[http://www.marfan.org.za/diagnosis.html Marfan diagnosis criteria]
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| *[http://www.ncbi.nlm.nih.gov/disease/Marfan.html National Institute for Health Marfan syndrome page (USA)] | |
| *[http://www.medicinenet.com/marfan_syndrome/index.htm Marfan Syndrome Center at medicinenet.com]
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| *[http://marfansyndrome.researchtoday.net/ Marfan Syndrome Research] - recent literature on Marfan Syndrome
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| *[http://www.supportmarfan.com Marfan support]
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| *[http://www.marfan.ca/ Canadian Marfan Association]
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| *[http://www.marfan.org.uk/ Marfan Association UK]
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| *[http://www.marfan.org.mx/ Marfan de Mexico]
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| *[http://www.marfan.no/ Norwegian Marfan Organization]
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| *[http://www.marfanlife.net Marfan Life blog] - mostly links to news articles about Marfan Syndrome
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| *[http://www.marfansyndrome.info MarfanSyndrome.Info] - Findings in Marfan Syndrome and link collection
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| *[http://www.marfanlife.net/lists/ Marfan-List] - email discussion list for people and families with Marfan Syndrome
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| *[http://www.marfan.org.za/ South African Marfan Syndrome Organisation] - support group for Africa
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| *[http://www.medstudents.com.br/original/revisao/marfan/marfan.htm Eye Findings in Marfan's syndrome]
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| {{Phakomatoses and other congenital malformations not elsewhere classified}} | | {{Phakomatoses and other congenital malformations not elsewhere classified}} |
| {{SIB}}
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| [[ko:마르팡 증후군]]
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| [[nl:Syndroom van Marfan]]
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