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The progressive systemic deposition of GAGs results in multi\u2010organ system dysfunction that varies with the particular GAG deposited and the specific enzyme mutation(s) present. Cardiac involvement has been reported in all MPS syndromes and is a common and early feature, particularly for those with MPS I, II, and VI. Cardiac valve thickening, dysfunction (more severe for left\u2010sided than for right\u2010sided valves), and hypertrophy are commonly present; conduction abnormalities, coronary artery and other vascular involvement may also occur. Cardiac disease emerges silently and contributes significantly to early mortality.<\/jats:p>\n                  <jats:p>The clinical examination of individuals with MPS is often difficult due to physical and, sometimes, intellectual patient limitations. The absence of precordial murmurs does not exclude the presence of cardiac disease. Echocardiography and electrocardiography are key diagnostic techniques for evaluation of valves, ventricular dimensions and function, which are recommended on a regular basis. The optimal technique for evaluation of coronary artery involvement remains unsettled.<\/jats:p>\n                  <jats:p>Standard medical and surgical techniques can be modified for MPS patients, and systemic therapies such as hematopoietic stem cell transplantation and enzyme replacement therapy (ERT) may alter overall disease progression with regression of ventricular hypertrophy and maintenance of ventricular function. Cardiac valve disease is usually unresponsive or, at best, stabilized, although ERT within the first few months of life may prevent valve involvement, a fact that emphasizes the importance of early diagnosis and treatment in MPS.<\/jats:p>","DOI":"10.1007\/s10545-011-9359-8","type":"journal-article","created":{"date-parts":[[2011,7,8]],"date-time":"2011-07-08T13:32:21Z","timestamp":1310131941000},"page":"1183-1197","source":"Crossref","is-referenced-by-count":265,"title":["Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management"],"prefix":"10.1002","volume":"34","author":[{"given":"Elizabeth A.","family":"Braunlin","sequence":"first","affiliation":[{"name":"Pediatric Cardiology University of Minnesota 420 Delaware St. Minneapolis MN 55455 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Harmatz","sequence":"additional","affiliation":[{"name":"Children's Hospital &amp; Research Center Oakland Oakland CA 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