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Previous research found that pathogenic variants clustered in exons 24\u201332 of fibrillin-1 (<jats:italic>FBN1<\/jats:italic>) gene result in more severe clinical phenotypes. Furthermore, genotype-phenotype correlation studies suggested that more severe cardiovascular phenotypes were related to variants held responsible for haploinsufficiency. Our objective was to analyze the differences in clinical manifestations and genotypes of individuals with early-onset Marfan syndrome and to assess their impact on management strategies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We analyzed clinical and genetic data of a new patient with early-onset Marfan syndrome together with 51 previously reported ones in the PubMed database between 1991 and 2022.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Analysis showed 94% (49\/52) of pathogenic variants clustered in exons 24\u201332 of the <jats:italic>FBN1<\/jats:italic>. The most common skeletal features were arachnodactyly (98%), reduced elbow extension (48%), pectus deformity (40%), and scoliosis (39%). Haploinsufficiency variants were reported as having poor outcome in 87.5% of the cases. Among patients carrying variants that substitute a cysteine for another amino acid and those that do not change cysteine content, cardiac intervention was found to be associated with a better outcome (p\u2009=\u20090.035 vs. p\u2009=\u20090.002). Variants that create an extra cysteine residue were found to be associated with a higher risk of ectopia lentis. Additionally, children up to 36-months-old were more often reported as still alive at the time of publication compared to newborns (p\u2009&lt;\u20090.01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our findings have implications for prognosis, because different genotype groups and their resulting phenotype may require personalized care and management.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-023-04357-8","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T02:01:45Z","timestamp":1698458505000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Genotype-phenotype spectrum and prognosis of early-onset Marfan syndrome"],"prefix":"10.1186","volume":"23","author":[{"given":"Aurelija","family":"Kemezyte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruta","family":"Gegieckiene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birute","family":"Burnyte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,28]]},"reference":[{"key":"4357_CR1","doi-asserted-by":"publisher","DOI":"10.1038\/352337a0","author":"HC Dietz","year":"1991","unstructured":"Dietz HC, Cutting CR, Pyeritz RE, Maslen CL, Sakai LY, Corson GM, et al. 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The study was approved by the Vilnius Regional Biomedical Research Ethics Committee of Lithuania. Written informed consent was obtained from the patient\u2019s parents for publication. A copy of the written consent is available for review by the Editor of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"539"}}