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Patient ID 1-II:1 2-II:1 3-III:1 4-I:2 4-II:1 4-II:3 4-III:1 5-II:2 5-III:1 5-III:2 6-II:6 6-III:5 6-III:6 7-III:1 8-II:3 Mutation del del p.R330C p.P366H p.R327W p.Y369Cfs*26 p.A100_Y104 del p.Y99* Sex M M F M M M M M F M M M M F M Age 46 9 13 61 32 32 3 44 21 7 43 10 7 28 50 Craniofacial Eye myopia hyperopia lens opacities myopia excav. papil myopia nl retinal detach nl nl astigm nl nl nl myopia Downslant palpebral fissures - + + - + + - + + - + + + + - Hypertelorism + - + - - - - - - - + + - + - High arched palate + + + + + + + + + - - + - - - Uvula nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis torticollis plagiocep. spondylosis subluxation C7 over T1 Skeletal Stature (cm or percentile if child) 193 P95 P9 171 200 196 >P95 184 173 P95 196 P95 P95 177 167 Armspan ratio 1.02 0.96 1.08 0.95 1.04 1.01 1.02 1.03 Pectus Deformity + + + + + + + - - - - - + + - Scoliosis + - - + + + - - - - - - - - + Arachnodactyly + + + + + + - + - - - - - + - Club feet + + + - - - - + - - - - - + - Pes planus - + - + + + + + + - - - - + - Hypermobility (Beighton > 5/9) - - + + + + + - - - - - - + + Other Claw toes Claw toes Knee disloc ation Cardiovascular Aortic root Z-score 2.8 3 + 2 2.4 4.3 3 4* 3.7 6 3.4 2.4 2.6 7* 8.4* Ao dissection/repair Type B age 42 VSARR (45 mm) VSARR (48 mm) VSARR (56 mm) Aortic valve TAV TAV TAV TAV TAV TAV TAV AVR TAV TAV TAV BAV BAV TAV TAV Mitral valve MVP - - MV-S MVP MVP MV-S MVP with MR MR - Nature Genetics: doi:10.1038/ng.2349

Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

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Page 1: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Patient ID 1-II:1 2-II:1 3-III:1 4-I:2 4-II:1 4-II:3 4-III:1 5-II:2 5-III:1 5-III:2 6-II:6 6-III:5 6-III:6 7-III:1 8-II:3

Mutation del del p.R330C p.P366H p.R327W p.Y369Cfs*26 p.A100_Y104del

p.Y99*

Sex M M F M M M M M F M M M M F M

Age 46 9 13 61 32 32 3 44 21 7 43 10 7 28 50

Craniofacial Eye myopia hyperopia lens

opacities myopia excav.

papil myopia nl retinal

detach nl nl astigm nl nl nl myopia

Downslant palpebral fissures

- + + - + + - + + - + + + + -

Hypertelorism + - + - - - - - - - + + - + -

High arched palate

+ + + + + + + + + - - + - - -

Uvula nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid

Retrognathia + + + + + + + + - + + - - + -

Other torticollis ptosis ptosis torticollis plagiocep.

spondylosis subluxation C7 over T1

Skeletal Stature (cm or percentile if child)

193 P95 P9 171 200 196 >P95 184 173 P95 196 P95 P95 177 167

Armspan ratio 1.02 0.96 1.08 0.95 1.04 1.01 1.02 1.03

Pectus Deformity + + + + + + + - - - - - + + -

Scoliosis + - - + + + - - - - - - - - +

Arachnodactyly + + + + + + - + - - - - - + -

Club feet + + + - - - - + - - - - - + -

Pes planus - + - + + + + + + - - - - + -

Hypermobility (Beighton > 5/9)

- - + + + + + - - - - - - + +

Other Claw toes Claw toes Knee dislocation

Cardiovascular Aortic root Z-score 2.8 3 + 2 2.4 4.3 3 4* 3.7 6 3.4 2.4 2.6 7* 8.4*

Ao dissection/repair

Type B age 42

VSARR (45 mm)

VSARR (48 mm)

VSARR (56 mm)

Aortic valve TAV TAV TAV TAV TAV TAV TAV AVR TAV TAV TAV BAV BAV TAV TAV

Mitral valve MVP - - MV-S MVP MVP MV-S MVP with MR

MR -

Nature Genetics: doi:10.1038/ng.2349

Page 2: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Other VSD MPA Tortuosity ASD

SVT

Skin Striae - - - - + + - - - - + - - - -

Hernia + - + + + + - + + + + - - - +

Easy bruising - - + - - + + + + - -

Other Thin Varicose veins

Thin Thin Dystrophic scars

soft soft soft Keloid scars

Levido reticularis

Dura ND ND ND Tarlov cyst

Tarlov cyst

- ND ND Tarlov cyst Dural ectasia

-

Other findings Cryptorchidism

Hypotonia, ataxia

Supernumeray nipple

Supplementary Table 1: Abbreviations: VSARR: valve sparing aortic root replacemant; BAV, bicuspid aortic valve; TAV, tricuspid aortic valve; MVP, mitral valve prolapse; MV-S: mitral valve surgery; ASD, atrial septal defect (surgically closed at time of VSARR); VSD, ventricular septal defect; MPA, main pulmonary artery aneurysm; SVT supraventricular tachycardia; ND not done; * Z-score at time of surgery

Nature Genetics: doi:10.1038/ng.2349

Page 3: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

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?0,&'()(*(+,-0,GFI5,E&1',<,JGFI5,?E2,<,ACI5,DC2,<,B/I5,FE2K>DF,<,B/I5,?C&1'L,&'()(*(+,%0,GFI5,D&1',<,JGFI5,DC2,<,ABI5,DC2,M<CNEI5,#%*,7+7$"2O,<,B/I5,FE2K>?F,<,

JGFI5,DC2,<,ACI5,DC2,<,B/I5,FE2K>/C,<,B/I5,?C&1',

Nature Genetics: doi:10.1038/ng.2349

Page 4: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 5: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 6: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 7: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 8: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 9: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 10: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349

Page 11: Patient ID Mutation Sex Age Craniofacial Skeletal … nl nl nl nl nl nl nl broad nl nl nl nl nl broad bifid Retrognathia + + + + + + + + - + + - - + - Other torticollis ptosis ptosis

Nature Genetics: doi:10.1038/ng.2349