• Silvia Spoto, Emanuele Valeriani, Luciana Locorriere, Giuseppina Beretta Anguissola, Angelo Lauria Pantano, Francesca Terracciani, Maria Caterina Bono, Sebastiano Costantino, Massimo Ciccozzi, and Silvia Angeletti.
• Internal Medicine Department, University Campus Bio-Medico of Rome, Rome.
• Medicine (Baltimore). 2019 Nov 1; 98 (47): e17978.

RationaleMarfan syndrome is a rare cause of heart failure due to primary or secondary cardiomyopathy. Recently, sacubitril/valsartan-an angiotensin receptor blocker-neprilysin inhibitor-has been added in clinical practice as a standard therapy for heart failure. To our knowledge, there are no data on sacubitril/valsartan's effects on cardiovascular outcomes in patients with Marfan syndrome.Patient ConcernsA 24-year-old man was admitted to our Internal Medicine Department due to dyspnea, ascites, and leg swelling. Arterial blood gas analysis revealed severe hypoxemia with respiratory and metabolic alkalosis. Hilar congestion was highlighted on chest x-ray.DiagnosesRecurrent acute decompensated heart failure with reduced ejection fraction despite optimal medical therapy in Marfan-related cardiomyopathy.Interventions And OutcomesSacubitril/valsartan was added to optimal medical therapy after hemodynamic stabilization allowing progressive clinical, laboratoristic, and echocardiographic improvement. Patient maintained a free survival from heart failure and a good quality of life until 9-month follow-up.LessonsSacubitril/valsartan should be effective on pathophysiologic mechanisms and cardiovascular outcomes of Marfan syndrome-related cardiovascular complications.

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