2012, Número 2
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Rev Cubana Pediatr 2012; 84 (2)
Consideraciones cardiovasculares del síndrome de Marfán en edades pediátricas
Serrano RG, Marcano SLE, Bacallao CD
Idioma: Español
Referencias bibliográficas: 45
Paginas:
Archivo PDF: 82.03 Kb.
RESUMEN
El síndrome de Marfán es una enfermedad hereditaria del tejido conectivo, que se describe en niños y en adultos, causada por una mutación en el gen que codifica la glicoproteína fibrilina tipo 1. Afecta múltiples órganos y sistemas, fundamentalmente cardiovascular, esquelético, oftalmológico, piel y tegumentos. Se presenta una revisión de los aspectos más actuales del diagnóstico, y la atención multidisciplinaria para lograr una reducción de la morbilidad y mortalidad en los pacientes pediátricos. Se concluye que el uso precoz de betabloqueadores e inhibidores del receptor AT-1 de la angiotensina II (losartán), constituyen actualmente los pilares fundamentales de la terapéutica farmacológica, pues disminuyen la frecuencia de complicaciones cardiovasculares, las cuales determinan el pronóstico de la enfermedad. La cirugía programada de la raíz aórtica, especialmente con preservación valvular, permite mejorar la expectativa de vida al evitar la alta mortalidad de los eventos agudos. Alternativas prometedoras son los procederes híbridos y el intervencionismo endovascular.
REFERENCIAS (EN ESTE ARTÍCULO)
Judge DP, Dietz HC. Marfan's syndrome. Lancet. 2005;366:1965-76.
Marfan A. Un cas de déformation congénitale des quatres membres, plus prononcée aux extremités, caractérisée par l'allongement des os avec un certain degré d'amincissement. Bull Mem Soc Med Hop. 1896;13:220-6.
Callewaert B, Malfait F, Loeys B, De Paepe A. Ehlers-Danlos syndromes and Marfan syndrome. Best Practice & Research Clinical Rheumatology. 2008;22:165-89.
Ramirez F, Dietz HC. Marfan syndrome: from molecular pathogenesis to clinical treatment. Current Opinion in Genetics & Development. 2007;17:252-8.
Salamanca FG. Nuevos hallazgos moleculares en el síndrome de Marfán. Gac Med Mex. 2008;144:349-50.
Gao LG, Luo F, Hui RT, Zhou XL. Recent molecular biological progress in Marfan syndrome and Marfan-associated disorders. Ageing Research Reviews. 2010;9:363-8.
Oliva PN, Moreno RA, Toledo MG, Montecinos AO, Molina JP. Síndrome de Marfán. Rev Med Chil. 2006;134:1455-64.
Kainulainen K, Pulkkinen L, Savolainen A. Location on chromosome 15 of the gene defect causing Marfan syndrome. N Engl J Med. 1990;323:152-9.
Dietz HC, Cutting GR, Pyeritz RE, Maslen CL, Sakai LY, Corson GM, et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature. 1991;352:337-9.
Faivre L, Masurel-Paulet A, Collod-Beroud G, Callewaert BL, Child AH, Stheneur C, et al. Clinical and molecular study of 320 children with Marfan syndrome and related type I fibrillinopathies in a series of 1009 probands with pathogenic FBN1 mutations. Pediatrics. 2009;123:391-8.
De Paepe A, Deveraux RB, Dietz HC, Hannekam RCM, Pyeritz RE. Revised diagnostic criteria for the Marfan Syndrome. Am J Med Genet. 1996;62:417-26.
Loeys B, Dietz HC, Braverman AC, Callewaert BL, De Backer J, Devereux RB, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet. 2010;47:476-85.
Kemna MS, Murphy DJ, Silverman NH. Screening for aortic root dilation in Marfan syndrome using the ratio of the aortic root to descending aortic diameters in children. J Am Soc Echocardiogr. 2009;22:1109-3.
Espinola NZ, Casanova MG, Muñoz LC, Ibáñez F, Keirns C, Amezcua LG, et al. Echocardiometric evaluation of cardiovascular abnormalities in Marfan syndrome. Arch Cardiol Mex. 2005;75:133-40.
Geva T, Sanders SP, Diogenes MS Rockenmacher S, Van Praagh R. Two-dimensional and doppler echocardiografic and pathologic characteristics of the infantile Marfan syndrome. Am J Cardiology. 1990;65:1230-7.
Keane MG, Pyeritz RE. Medical management of Marfan Syndrome. Circulation. 2008;117:2802-13.
Ammash NM, Sundt TM, Connolly HM. Marfan Syndrome. Diagnosis and management. Curr Probl Cardiol. 2008;33:3-7.
Ades L. Guidelines for the diagnosis and management of Marfan syndrome. Heart Lung Circ. 2007;16:28-30.
Milewicz D, Dietz H, Miller C. Aortic disease in patients with Marfan syndrome. Circulation. 2005;111:150-7.
Yetman AT. Cardiovascular pharmacotherapy in patients with Marfan syndrome. Am J Cardiovasc Drugs. 2007;7:117-26.
Shores J, Berger KR, Murphy EA, Pyeritz RE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. N Engl J Med. 1994;330:1335-41.
Ladouceur M, Fermanian C, Lupoglazoff JM, Edouard T, Dulac Y, Acar P, et al. Effect of beta-blockade on ascending aortic dilatation in children with the Marfan syndrome. Am J Cardiol. 2007;99:406-9.
Gersony DR, McClaughlin MA, Jin Z, Gersony WM. The effect of beta-blocker therapy on clinical outcome in patients with Marfan's syndrome: a meta-analysis. Int J Cardiol. 2007;114:303-8.
Ahimastos AA, Natoli AK, Lawler A, Blombery PA, Kingwell BA. Ramipril reduces large-artery stiffness in peripheral arterial disease and promotes elastogenic remodeling in cell culture. Hypertension. 2005;45:1194-9.
Yetman AT, Bornemeier RA, McCrindle BW. Usefulness of enalapril versus propranolol or atenolol for prevention of aortic dilation in patients with the Marfan syndrome. Am J Cardiol. 2005;95:1125-7.
Ahimastos AA, Aggarwal A, D'Orsa KM, Formosa MF, White AJ, Savarirayan R, et al. Effect of perindopril on large artery stiffness and aortic root diameter in patients with Marfan syndrome: a randomized controlled trial. JAMA. 2007;298:1539-47.
Neptune ER, Frischemeyer PA, Arking DE. Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. Nat Genet. 2003;33:407-11.
Habashi JP, Judge DP, Holm TM, Cohn RD, Loeys BL, Cooper TK, et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science. 2006;312:117-21.
Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC. Angiotensin II blockade and aortic-root dilation in Marfan's syndrome. N Engl J Med. 2008;358:2787-95.
Lacro RV, Dietz HC, Wruck LM, Bradley TJ, Colan SD, Devereux RB, et al. Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J. 2007;154:624-31.
Yang HC, Moo JK, Chum E, van Breemen C, Chung AW. Effectiveness of combination of losartan potassium and doxycycline versus single-drug treatments in the secondary prevention of thoracic aortic aneurysm in Marfan syndrome. J Thorac Cardiovasc Surg. 2010;140:305-12.
Nistala H, Lee-Arteaga S, Carta L, Cook JR, Smaldone S, Siciliano G, et al. Differential effects of alendronate and losartan therapy on osteopenia and aortic aneurysm in mice with severe Marfan syndrome. Hum Mol Genet. 2010;19:4790-8.
Silverman DI, Burton KJ, Gray J. Life expectancy in the Marfan syndrome. Am J Cardiol. 1995;75:157-60.
Cameron DE, Alejo DE, Patel ND, Nwakanma LU, Weiss ES, Vricella LA, et al. Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years. Ann Thorac Surg. 2009;87:1344-50.
Everitt M, Pinto N, Hawkins J, Mitchell M, Kouretas P, Yetman A. Cardiovascular surgery in children with Marfan syndrome or Loeys-Dietz syndrome. J Thorac Cardiovasc Surg. 2009;137:1327-33.
Kallenbach K, Baraki H, Khaladj N, Kamiya H, Hagl C, Haverich A, et al. Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade? Ann Thorac Surg. 2007;83:764-8.
Miller D. Valve-sparing aortic root replacement: current state of the art and where are we headed? Ann Thorac Surg. 2007;83:736-9.
Patel N, Arnaoutakis G, George T, Allen J, Alejo D, Dietz HC, et al. Valve-sparing aortic root replacement in children: intermediate-term results. Interact Cardio Vasc Thorac Surg. 2011;12:415-9.
Bentall H, DeBono A. A technique for complete replacement of the ascending aorta. Thorax. 1968;23:338-9.
Yacoub MH, Fagan A, Stassano P, Radley-Smith R. Results of valve conserving operations for aortic regurgitation. Circulation. 1983;68:321.
David TE, Feindel C. An aortic valve-sparing operation for patients with aortic incompitence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617-22.
Susumu K, Nobuyuki U, Seiryo S, Toshiaki H. The sinus of Valsalva relieves abnormal stress on aortic valve leaflets by facilitating smooth closure. J Thorac Cardiovasc Surg. 2008;136:1528-35.
Cameron DE. Mitral valve surgery in children with the Marfan syndrome. Prog Pediatr Cardiol. 1996;5:205-10.
Cooper DG, Walsh SR, Sadat U, Hayes PD, Boyle JR. Treating the thoracic aorta in Marfan syndrome: surgery or TEVAR? J Endovasc Ther. 2009;16:60-70.
Takahashi Y, Tsutsumi Y, Shirakawa Y, Ohashi H. Total aortic repair in Marfan syndrome using stent grafting with hybrid techniques. J Vasc Surg. 2009;52:1365-6.