Systemic management of Marfan's syndrome during dental treatment: a case report

Marfan's syndrome is a dominantly inherited connective tissue disorder characterized by skeletal, ocular, and cardiovascular abnormalities, such as arachnodactyly, dolichostenomelia, kyphosis, scoliosis, pectus excavatum, ectopia lentis, aortic aneurysm and dissection, aortic valve incompetence, and mitral valve prolapse. This report describes the systemic management during dental treatment of a 26-year-old man with Marfan's syndrome. Blood pressure, electrocardiogram, echocardiography, systolic time intervals, and aortic pulse wave velocity were monitored. Nitrous oxide inhalational sedation was employed. In contrast to the vasopressin, felypressin (contained in prilocaine), epinephrine (contained in lidocaine) caused an acceleration of cardiac function--increased heart rate, cardiac output, 1/pre-ejection period (PEP), and aortic pulse wave velocity and decreased PEP and left ventricular ejection time. This experience suggests that the use of anesthetics containing epinephrine in dental patients with Marfan's syndrome needs to be carefully managed.