A case of Marfan syndrome in an adolescent with aortic dissection: Should the recommendation for surgical intervention be changed?

We present a 15-year-old male patient with Marfan syndrome who died suddenl y of aortic dissection and rupture. The commonly used criteria for elective aortic root replacement are an aortic root dimension >50 mm or an aortic d imension more than twice the normal predicted value. He did not fulfill the se criteria. His ascending aortic dimension 17 days prior to his death was 48 mm and the aortic dimension to the predicted value was 1.8, although he showed progressive dilatation of the aortic root. A ratio of the ascending aortic dimension of more than 1.5 times that predicted, as proposed by Pyer itz, and a considerable increase in aortic dilatation beyond previous obser vations may lead to timely surgical repair.