Optimal treatment of pneumothorax in adolescents with Marfan syndrome

•Our study revealed a low response and high relapse rate of when pneumothorax in adolescents with Marfan syndrome were subjected to the conservative treatment modality.•The relapse rate of the surgical treatment in pneumothorax in adolescents with Marfan syndrome was low and similar to that observed in the general pediatric population.•We recommend surgical intervention as the first line of therapy to treat pneumothorax in adolescents diagnosed with Marfan syndrome. Pneumothorax often develops in patients with Marfan syndrome (MFS). Here, we examined the effects of conservative and surgical pneumothorax treatments in children with MFS. In this study, 23 patients, less than 20 years old, diagnosed with both MFS and pneumothorax between 1999 and 2019 were included. All data were collected retrospectively from patients’ medical records. In total, 18 of 23 patients (78%) had relapsed pneumothorax either on the ipsilateral or contralateral side. Among these 18 patients, 6 (26%) patients had multiple relapses. Conservative and surgical treatments of pneumothorax were attempted in 33 and 29 lungs, respectively. The conservative treatment was attempted as a definitive therapy in 21 lungs. Twelve conservative treatments (57%) failed, which required surgical intervention. In 9 lungs (43%) with successful conservative treatment, 6 (67%) had ipsilateral relapses. In contrast to the above findings, only 4 (13%) ipsilateral relapses were observed in 29 surgical treatments. Our study revealed a low response and high relapse rate when MFS adolescents who diagnosed pneumothorax were subjected to the conservative treatment modality. Thus, we recommend surgical intervention as the first line of therapy to treat pneumothorax in adolescents diagnosed with MFS. Ⅲ (Treatment Study)