The recommendations concerning which sports are safe in these often young patients can be difficult. Children and adolescents with Marfan syndrome are at significant risk for physical injury and medical complications with physical activity and of particular concern are contact sports, activities with "burst" exertion (such as sprinting) and intense isometric exertion such as weight lifting.[3]Tinkle BT, Lacro RV, Burke LW, et al. Health supervision for children and adolescents with Marfan syndrome. Pediatrics. 2023 Apr 1;151(4):e2023061450.
http://www.ncbi.nlm.nih.gov/pubmed/36938616?tool=bestpractice.com
In patients with significant aortic disease guidance should be provided to avoid intense isometric exercises, burst exertion, and collision sports.[19]Isselbacher EM, Preventza O, Black JH 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-482.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001106
http://www.ncbi.nlm.nih.gov/pubmed/36322642?tool=bestpractice.com
Patients without aortic dilatation, significant valve regurgitation or ventricular dysfunction can be encouraged to participate in recreational physical activity but this is still limited by the intensity of the activity.[3]Tinkle BT, Lacro RV, Burke LW, et al. Health supervision for children and adolescents with Marfan syndrome. Pediatrics. 2023 Apr 1;151(4):e2023061450.
http://www.ncbi.nlm.nih.gov/pubmed/36938616?tool=bestpractice.com
The American Heart Association provides recommendations for Marfan syndrome and physical activity which grades individual sports and their suitability.[92]Maron BJ, Chaitman BR, Ackerman MJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004 Jun 8;109(22):2807-16.
https://www.ahajournals.org/doi/10.1161/01.CIR.0000128363.85581.E1?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/15184297?tool=bestpractice.com
Patients are instructed to seek immediate ocular examination if they develop ophthalmologic symptoms such as the perception of floaters (myodesopsia), flashing lights (photopsia), glare, or visual-field defect.
Women who are planning a pregnancy should be offered preconception counseling; this would ideally be provided by a geneticist or cardiologist familiar with Marfan syndrome, a genetic counselor, and a perinatologist.[3]Tinkle BT, Lacro RV, Burke LW, et al. Health supervision for children and adolescents with Marfan syndrome. Pediatrics. 2023 Apr 1;151(4):e2023061450.
http://www.ncbi.nlm.nih.gov/pubmed/36938616?tool=bestpractice.com
Based on a known causative fibrillin-1 mutation in either parent, prepregnancy counseling should include advice regarding options of antenatal diagnosis by chorionic villus biopsy at 11 weeks' gestation, or preimplantation genetic diagnosis to ensure an unaffected fetus.[38]Child AH, Aragon-Martin JA, Sage K. Genetic testing in Marfan syndrome. Br J Hosp Med (Lond). 2016 Jan;77(1):38-41.
http://www.ncbi.nlm.nih.gov/pubmed/26903455?tool=bestpractice.com
[93]Thornhill AR, Handyside AH, Ottolini C, et al. Karyomapping - a comprehensive means of simultaneous monogenic and cytogenetic PGD: comparison with standard approaches in real time for Marfan syndrome. J Assist Reprod Genet. 2015 Mar;32(3):347-56.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363232
http://www.ncbi.nlm.nih.gov/pubmed/25561157?tool=bestpractice.com