Ultimately, even treated individuals suffer from aortic dilation, so that surgical repair of the dilated aortic root is definitive in MFS. Elective surgery carries a low mortality and has significantly improved life expectancy; in contrast, emergency surgery for aortic root dissection or rupture carries a much higher mortality. Our earlier clinical studies and more recent work in a Marfan mouse model study suggest that aortic root dilation is a later stage in the disease process, which has involved cellular mechanisms (perhaps related to TGF beta) before aortic root dilation occurs. This suggests that, through research, one might enable clinicians to identify individuals who are in the early stages of vessel dilation and/or who are at risk for aortic rupture. If we could improve our capacity for early diagnosis of aortic root dilation, we could intervene in the pre-clinical stages and minimize the incidence of emergency surgery or sudden death.