Skip to main content

Advertisement

Log in

Diagnosis and treatment of cardiovascular disease in patients with heritable connective tissue disorders or heritable thoracic aortic diseases

  • Invited Review Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Patients with heritable connective tissue disorders (HCTDs), represented by Marfan syndrome, can develop fatal aortic and/or arterial complications before age 50. Therefore, accurate diagnosis, appropriate medical treatment, and early prophylactic surgical treatment of aortic and arterial lesions are essential to improve prognosis. Patients with HCTDs generally present with specific physical features due to connective tissue abnormalities, while some patients with heritable thoracic aortic diseases (HTADs) have few distinctive physical characteristics. The development of genetic testing has made it possible to provide accurate diagnoses for patients with HCTDs/HTADs. This review provides an overview of the diagnosis and treatment of HCTDs/HTADs, including current evidence on cardiovascular interventions for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

In writing this review article, all data were taken from published articles and no original datasets were used.

References

  1. Milewicz DM, Braverman AC, De Backer J, Morris SA, Boileau C, Maumenee IH, et al. Marfan syndrome. Nat Rev Dis Prim. 2021;7:64.

    Article  PubMed  Google Scholar 

  2. Chiu HH, Wu MH, Chen HC, Kao FY, Huang SK. Epidemiological profile of Marfan syndrome in a general population: a national database study. Mayo Clin Proc. 2014;89:34–42.

    Article  PubMed  Google Scholar 

  3. Groth KA, Hove H, Kyhl K, Folkestad L, Gaustadnes M, Vejlstrup N, et al. Prevalence, incidence, and age at diagnosis in Marfan syndrome rare systemic diseases. Orphanet J Rare Dis. 2015;10:1–10.

    Article  Google Scholar 

  4. Dietz HC, Cutting CR, 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.

    Article  ADS  CAS  PubMed  Google Scholar 

  5. Loeys BL, Dietz HC, Braverman AC, Callewaert BL, De BJ, Devereux RB, et al. The revised Ghent nosology for the Marfan syndrome. J Med Genet. 2010;47:476–85.

    Article  CAS  PubMed  Google Scholar 

  6. Arnaud P, Milleron O, Hanna N, Ropers J, Ould Ouali N, Affoune A, et al. Clinical relevance of genotype–phenotype correlations beyond vascular events in a cohort study of 1500 Marfan syndrome patients with FBN1 pathogenic variants. Genet Med. 2021;23:1296–304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Murdoch JL, Walker BA, Halpern BL, Kuzma JW, Mckusick VA. Life expectancy and causes of death in the Marfan syndrome. N Engl J Med. 1972;286:804–8.

    Article  CAS  PubMed  Google Scholar 

  8. Silverman DI, Burton KJ, Gray J, Bosner MS, Kouchoukos NT, Roman MJ, et al. Life expectancy in the Marfan syndrome. Am J Cardiol. 1995;75:157–60.

    Article  CAS  PubMed  Google Scholar 

  9. Gray J, Bridges A, West R, McLeish L, Stuart A, Dean J, et al. Life expectancy in British Marfan syndrome populations. Clin Genet. 1998;54:124–8.

    Article  CAS  PubMed  Google Scholar 

  10. Shores J. 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.

    Article  CAS  PubMed  Google Scholar 

  11. Groenink M, Den Hartog AW, Franken R, Radonic T, De Waard V, Timmermans J, et al. Losartan reduces aortic dilatation rate in adults with Marfan syndrome: a randomized controlled trial. Eur Heart J. 2013;34:3491–500.

    Article  CAS  PubMed  Google Scholar 

  12. Lacro RV, Dietz HC, Sleeper LA, Yetman AT, Bradley TJ, Colan SD, et al. Atenolol versus losartan in children and young adults with Marfan’s syndrome. N Engl J Med. 2014;371:2061–71.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Milleron O, Arnoult F, Ropers J, Aegerter P, Detaint D, Delorme G, et al. Marfan Sartan: a randomized, double-blind, placebo-controlled trial. Eur Heart J. 2015;36:2160–6.

    Article  PubMed  Google Scholar 

  14. Forteza A, Evangelista A, Sánchez V, Teixidó-Turà G, Sanz P, Gutiérrez L, et al. Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial. Eur Heart J. 2016;37:978–85.

    Article  CAS  PubMed  Google Scholar 

  15. Mullen M, Jin XY, Child A, Stuart AG, Dodd M, Aragon-Martin JA, et al. Irbesartan in Marfan syndrome (AIMS): a double-blind, placebo-controlled randomised trial. Lancet. 2019;394:2263–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Byers PH. Determination of the molecular basis of Marfan syndrome: a growth industry. J Clin Invest. 2004;114:161–3.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pitcher A, Spata E, Emberson J, Davies K, Halls H, Holland L, et al. Angiotensin receptor blockers and β blockers in Marfan syndrome: an individual patient data meta-analysis of randomised trials. Lancet. 2022;400:822–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Yagyu T, Noguchi T, Asano Y, Ida K, Ogata S, Nishimura K, et al. Association between genetic diagnosis and clinical outcomes in patients with heritable thoracic aortic disease. J Am Heart Assoc. 2023;12: e028625.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mizuguchi T, Collod-Beroud G, Akiyama T, Abifadel M, Harada N, Morisaki T, et al. Heterozygous TGFBR2 mutations in Marfan syndrome. Nat Genet. 2004;36:855–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Loeys BL, Chen J, Neptune ER, Judge DP, Podowski M, Holm T, et al. A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet. 2005;37(3):275–81.

    Article  CAS  PubMed  Google Scholar 

  22. Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H, et al. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med. 2006;355:788–98.

    Article  CAS  PubMed  Google Scholar 

  23. Attias D, Stheneur C, Roy C, Collod-Béroud G, Detaint D, Faivre L, et al. Comparison of clinical presentations and outcomes between patients with TGFBR2 and FBN1 mutations in Marfan syndrome and related disorders. Circulation. 2009;120:2541–9.

    Article  CAS  PubMed  Google Scholar 

  24. van de Laar IM, Oldenburg RA, Pals G, Roos-hesselink JW, de Graaf BM, Verhagen JM, et al. Mutations in SMAD3 cause a syndromic form of aortic aneurysms and dissections with early-onset osteoarthritis. Nat Genet. 2011;43:121–8.

    Article  PubMed  Google Scholar 

  25. Lindsay ME, Schepers D, Bolar NA, Doyle JJ, Gallo E, Fert-bober J, et al. Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm. Nat Genet. 2012;44:922–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Boileau C, Guo DC, Hanna N, Regalado ES, Detaint D, Gong L, et al. TGFB2 mutations cause familial thoracic aortic aneurysms and dissections associated with mild systemic features of Marfan syndrome. Nat Genet. 2012;44:916–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rienhoff HY, Yeo CY, Morissette R, Khrebtukova I, Melnick J, Luo S, et al. A mutation in TGFB3 associated with a syndrome of low muscle mass, growth retardation, distal arthrogryposis and clinical features overlapping with Marfan and Loeys–Dietz syndrome. Am J Med Genet Part A. 2013;161:2040–6.

    Article  CAS  Google Scholar 

  28. van der Linde D, van de Laar IM, Bertoli-Avella AM, Oldenburg RA, Bekkers JA, Mattace-Raso FU, et al. Aggressive cardiovascular phenotype of aneurysms-osteoarthritis syndrome caused by pathogenic SMAD3 variants. J Am Coll Cardiol. 2012;60:397–403.

    Article  PubMed  Google Scholar 

  29. MacCarrick G, Black JH, Bowdin S, El-Hamamsy I, Frischmeyer-Guerrerio PA, Guerrerio AL, et al. Loeys–Dietz syndrome: a primer for diagnosis and management. Genet Med. 2014;16:576–87.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Teixidó-tura G, Franken R, Galuppo V, García-moreno LG, Borregan M, Mulder BJM, et al. Heterogeneity of aortic disease severity in patients with Loeys–Dietz syndrome. Heart. 2016;102:626–32.

    Article  PubMed  Google Scholar 

  31. Jondeau G, Ropers J, Regalado E, Braverman A, Evangelista A, Teixedo G, et al. International registry of patients carrying TGFBR1 or TGFBR2 mutations results of the MAC (Montalcino aortic consortium). Circ Cardiovasc Genet. 2016;9:548–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease. J Am Coll Cardiol. 2022;80:e223–393.

    Article  PubMed  Google Scholar 

  33. Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, et al. The 2017 international classification of the Ehlers–Danlos syndromes. Am J Med Genet Part C Semin Med Genet. 2017;175C:8–26.

    Article  Google Scholar 

  34. Pepin M, Schwarze U, Superti-Furga A, Byers P. Clinical and genetic features of Ehlers–Danlos syndrome type IV, the vascular type. N Engl J Med. 2000;342:673–80.

    Article  CAS  PubMed  Google Scholar 

  35. Frank M, Albuisson J, Ranque B, Golmard L, Mazzella J-MM, Bal-Theoleyre L, et al. The type of variants at the COL3A1 gene associates with the phenotype and severity of vascular Ehlers–Danlos syndrome. Eur J Hum Genet. 2015;23:1657–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Renard M, Francis C, Ghosh R, Scott AF, Witmer PD, Adès LC, et al. Clinical validity of genes for heritable thoracic aortic aneurysm and dissection. J Am Coll Cardiol. 2018;72:605–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Oderich GS, Panneton JM, Bower TC, Lindor NM, Cherry KJ, Noel AA, et al. The spectrum, management and clinical outcome of Ehlers–Danlos syndrome type IV: a 30-year experience. J Vasc Surg. 2005;42:98–106.

    Article  PubMed  Google Scholar 

  38. Adham S, Legrand A, Bruno RM, Billon C, Dalens V, Boutouyrie P, et al. Assessment of arterial damage in vascular Ehlers–Danlos syndrome: a retrospective multicentric cohort. Front Cardiovasc Med. 2022;9: 953894.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Pepin MG, Schwarze U, Rice KM, Liu M, Leistritz D, Byers PH. Survival is affected by mutation type and molecular mechanism in vascular Ehlers–Danlos syndrome (EDS type IV). Genet Med. 2014;16:881–8.

    Article  CAS  PubMed  Google Scholar 

  40. Ong KT, Perdu J, De Backer J, Bozec E, Collignon P, Emmerich J, et al. Effect of celiprolol on prevention of cardiovascular events in vascular Ehlers–Danlos syndrome: a prospective randomised, open, blinded-endpoints trial. Lancet. 2010;376:1476–84.

    Article  CAS  PubMed  Google Scholar 

  41. Frank M, Adham S, Seigle S, Legrand A, Mirault T, Henneton P, et al. Vascular Ehlers–Danlos syndrome: long-term observational study. J Am Coll Cardiol. 2019;73:1948–57.

    Article  PubMed  Google Scholar 

  42. Freeman RK, Swegle J, Sise MJ. The surgical complications of Ehlers–Danlos syndrome. Am Surg. 1996;62:869–73.

    CAS  PubMed  Google Scholar 

  43. Zilocchi M, Macedo TA, Oderich GS, Vrtiska TJ, Biondetti PR, Stanson AW. Vascular Ehlers–Danlos syndrome: imaging findings. Am J Roentgenol. 2007;189:712–9.

    Article  Google Scholar 

  44. Guo DC, Pannu H, Tran-Fadulu V, Papke CL, Yu RK, Avidan N, et al. Mutations in smooth muscle α-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nat Genet. 2007;39:1488–93.

    Article  CAS  PubMed  Google Scholar 

  45. Zhu L, Vranckx R, Van Kien PK, Lalande A, Boisset N, Mathieu F, et al. Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus. Nat Genet. 2006;38:343–9.

    Article  CAS  PubMed  Google Scholar 

  46. Wang L, Guo DC, Cao J, Gong L, Kamm KE, Regalado E, et al. Mutations in myosin light chain kinase cause familial aortic dissections. Am J Hum Genet. 2010;87:701–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Mariscalco G, Debiec R, Elefteriades JA, Samani NJ, Murphy GJ. Systematic review of studies that have evaluated screening tests in relatives of patients affected by nonsyndromic thoracic aortic disease. J Am Heart Assoc. 2018;7: e009302.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Abbasciano RG, Mariscalco G, Barwell J, Owens G, Zakkar M, Joel-David L, et al. Evaluating the feasibility of screening relatives of patients affected by nonsyndromic thoracic aortic diseases: the REST study. J Am Heart Assoc. 2022;11: e023741.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Regalado ES, Guo DC, Prakash S, Bensend TA, Flynn K, Estrera A, et al. Aortic disease presentation and outcome associated with ACTA2 mutations. Circ Cardiovasc Genet. 2015;8(3):457–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Sherrah AG, Andvik S, van der Linde D, Davies L, Bannon PG, Padang R, et al. Nonsyndromic thoracic aortic aneurysm and dissection outcomes with Marfan syndrome versus bicuspid aortic valve aneurysm. J Am Coll Cardiol. 2016;67:618–26.

    Article  PubMed  Google Scholar 

  51. Regalado ES, Morris SA, Braverman AC, Hostetler EM, De Backer J, Li R, et al. Comparative risks of initial aortic events associated with genetic thoracic aortic disease. J Am Coll Cardiol. 2022;80:857–69.

    Article  CAS  PubMed  Google Scholar 

  52. Milewicz DM, Østergaard JR, Ala-Kokko LM, Khan N, Grange DK, Mendoza-Londono R, et al. De novo ACTA2 mutation causes a novel syndrome of multisystemic smooth muscle dysfunction. Am J Med Genet Part A. 2010;152 A:2437–43.

    Article  Google Scholar 

  53. Isselbacher EM, Bonaca MP, Di Eusanio M, Froehlich J, Bassone E, Sechtem U, et al. Recurrent aortic dissection: observations from the international registry of aortic dissection. Circulation. 2016;134:1013–24.

    Article  PubMed  Google Scholar 

  54. David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T. Outcomes of aortic valve-sparing operations in Marfan syndrome. J Am Coll Cardiol. 2015;66:1445–53.

    Article  PubMed  Google Scholar 

  55. Finkbohner R, Johnston D, Crawford ES, Coselli J, Milewicz DM. Marfan syndrome: long-term survival and complications after aortic aneurysm repair. Circulation. 1995;91:728–33.

    Article  CAS  PubMed  Google Scholar 

  56. Coselli JS, Volguina IV, LeMaire SA, Connolly HM, Sundt TM, Milewicz DM, et al. Midterm outcomes of aortic root surgery in patients with Marfan syndrome: a prospective, multicenter, comparative study. J Thorac Cardiovasc Surg. 2021;165:1790–9.

    Article  PubMed  Google Scholar 

  57. den Hartog AW, Franken R, Zwinderman AH, Timmermans J, Scholte AJ, van den Berg MP, et al. The risk for type B aortic dissection in Marfan syndrome. J Am Coll Cardiol. 2015;65:246–54.

    Article  Google Scholar 

  58. Curtis SL, Swan L. Aortopathy in pregnancy. Heart. 2022;108:1851–7.

    Article  CAS  PubMed  Google Scholar 

  59. Lopez-Sainz A, Mila L, Rodriguez-Palomares J, Limeres J, Granato C, La Mura L, et al. Aortic branch aneurysms and vascular risk in patients with Marfan syndrome. J Am Coll Cardiol. 2021;77:3005–12.

    Article  PubMed  Google Scholar 

  60. Henkin S, Negrotto SM, Tweet MS, Kirmani S, Deyle DR, Gulati R, et al. Spontaneous coronary artery dissection and its association with heritable connective tissue disorders. Heart. 2016;102:876–81.

    Article  PubMed  Google Scholar 

  61. Kaadan MI, MacDonald C, Ponzini F, Duran J, Newell K, Pitler L, et al. Prospective cardiovascular genetics evaluation in spontaneous coronary artery dissection. Circ Genom Precis Med. 2018;11: e001933.

    Article  CAS  PubMed  Google Scholar 

  62. Murad AM, Hill HL, Wang Y, Ghannam M, Yang ML, Pugh NL, et al. Spontaneous coronary artery dissection is infrequent in individuals with heritable thoracic aortic disease despite partially shared genetic susceptibility. Am J Med Genet Part A. 2022;188A:1448–56.

    Article  Google Scholar 

  63. Adlam D, Olson TM, Combaret N, Kovacic JC, Iismaa SE, Al-Hussaini A, et al. Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection. J Am Coll Cardiol. 2019;73:58–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Saw J, Yang ML, Trinder M, Tcheandjieu C, Xu C, Starovoytov A, et al. Chromosome 1q21.2 and additional loci influence risk of spontaneous coronary artery dissection and myocardial infarction. Nat Commun. 2020;11:4432.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  65. Tarr I, Hesselson S, Iismaa SE, Rath E, Monger S, Troup M, et al. Exploring the genetic architecture of spontaneous coronary artery dissection using whole-genome sequencing. Circ Genom Precis Med. 2022;15: e003527.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Debette S, Markus HS. The genetics of cervical artery dissection: a systematic review. Stroke. 2009;40:459–66.

    Article  Google Scholar 

  67. Adham S, Billon C, Legrand A, Domigo V, Denarié N, Charpentier E, et al. Spontaneous cervical artery dissection in vascular Ehlers–Danlos syndrome: a cohort study. Stroke. 2021;52:1628–35.

    Article  CAS  PubMed  Google Scholar 

  68. Grond-Ginsbach C, Brandt T, Kloss M, Aksay SS, Lyrer P, Traenka C, et al. Next generation sequencing analysis of patients with familial cervical artery dissection. Eur Stroke J. 2017;2:137–43.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Morris SA, Orbach DB, Geva T, Singh MN, Gauvreau K, Lacro RV. Increased vertebral artery tortuosity index is associated with adverse outcomes in children and young adults with connective tissue disorders. Circulation. 2011;124:388–96.

    Article  PubMed  Google Scholar 

  70. Chivulescu M, Krohg-Sørensen K, Scheirlynck E, Lindberg BR, Dejgaard LA, Lie ØH, et al. Mitral annulus disjunction is associated with adverse outcome in Marfan and Loeys–Dietz syndromes. Eur Heart J Cardiovasc Imaging. 2021;22:1035–44.

    Article  PubMed  Google Scholar 

  71. Eleshra A, Panuccio G, Spanos K, Rohlffs F, von Kodolitsch Y, Kölbel T. Safety and effectiveness of TEVAR in native proximal landing zone 2 for chronic type B aortic dissection in patients with genetic aortic syndrome. J Endovasc Ther. 2022;29:717–23.

    Article  PubMed  Google Scholar 

  72. Jiang X, Chen B, Jiang J, Shi Y, Ma T, Fu W, et al. Outcomes of endovascular therapy for Stanford type B aortic dissection in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2023;165:1999–2007.

    Article  PubMed  Google Scholar 

  73. Kölbel T, Eleshra A, Aldag M, Rohlffs F, Debus SE, Honig S, et al. Endovascular treatment of aortic pathologies in patients with Marfan syndrome: single-center experience. J Endovasc Ther. 2022;29:602–10.

    Article  PubMed  Google Scholar 

  74. Le HuuA, Olive JK, Cekmecelioglu D, Chatterjee S, Amarasekara HS, Green SY, et al. Endovascular therapy for patients with heritable thoracic aortic disease. Ann Cardiothorac Surg. 2022;11:31–6.

    Article  Google Scholar 

  75. Pellenc Q, Girault A, Roussel A, De Blic R, Cerceau P, Raffoul R, et al. Optimising aortic endovascular repair in patients with Marfan syndrome. Eur J Vasc Endovasc Surg. 2020;59:577–85.

    Article  PubMed  Google Scholar 

  76. Qato K, Conway A, Lu E, Tran NN, Giangola G, Carroccio A. Outcomes of thoracic endovascular aneurysm repair (TEVAR) in patients with connective tissue disorders. Vasc Endovasc Surg. 2020;54:676–80.

    Article  Google Scholar 

  77. Steinmetz LM, Coselli JS. Endovascular repair in patients with Marfan syndrome: concerns amid controversy. Ann Vasc Surg. 2023;94:1–7.

    Article  PubMed  Google Scholar 

  78. Klarin D, Verma SS, Judy R, Dikilitas O, Wolford BN, Paranjpe I, et al. Genetic architecture of abdominal aortic aneurysm in the million veteran program. Circulation. 2020;142:1633–46.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Pirruccello JP, Chaffin MD, Chou EL, Fleming SJ, Lin H, Nekoui M, et al. Deep learning enables genetic analysis of the human thoracic aorta. Nat Genet. 2022;54:40–51.

    Article  CAS  PubMed  Google Scholar 

  80. Tcheandjieu C, Xiao K, Tejeda H, Lynch JA, Ruotsalainen S, Bellomo T, et al. High heritability of ascending aortic diameter and trans-ancestry prediction of thoracic aortic disease. Nat Genet. 2022;54:772–82.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takeshi Yagyu.

Ethics declarations

Conflict of interest

The author has no relationships to disclose that are relevant to the contents of this article.

Consent for publication

Written consent for publication of the data, including photographs, was obtained from all patients. Approval of the institutional review board was not required, because this article did not involve clinical research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yagyu, T., Noguchi, T. Diagnosis and treatment of cardiovascular disease in patients with heritable connective tissue disorders or heritable thoracic aortic diseases. Cardiovasc Interv and Ther 39, 126–136 (2024). https://doi.org/10.1007/s12928-023-00977-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-023-00977-0

Keywords

Navigation