Background
Significant mitral regurgitation (MR) could be the first manifestation in Marfan Syndrome, even before the onset of aortic dilatation or aortic regurgitation (AR). We aimed to analyse the role of simultaneous prophylactic aortic root replacement in Marfan patients presenting primarily with MR, undergoing mitral valve repair.

Material and Methods
A 4-year (2007-2010) retrospective analysis of a single surgeon’s experience included 13 Marfan patients (11 males, 2 females) aged between 12 to 60 years (mean 40.3). Pre-operative MR was Grade III or more in all patients. Mechanisms of MR were anterior leaflet prolapse in 2 patients, bi-leaflet prolapse in 11. All patients underwent mitral annuloplasty using biodegradable intra- annular ring along with other mitral valve repair techniques. No patient had significant pre- operative AR, however, the aortic root diameter was greater than the physiologic range for their corresponding BSA, hence, all patients underwent simultaneous prophylactic valve sparing aortic root replacement.

Results
Follow-up was complete in all patients, ranging from 1 to 4 years (mean 2.4). Post-operative MR at 6 months was Grade 0 in 8 patients, Grade 1 in 5. No further progression was seen during the follow-up period. No progression in AR or aortic root complications were noted. There were no post-operative deaths.

Conclusion
Marfan patients with mitral regurgitation can be successfully repaired, with good shortterm results. In patients with aortic root diameter greater than their normal physiologic range, simultaneous prophylactic aortic root replacement is safe and effective in preventing complications associated with the disease.