Scimitar syndrome

Scimitar syndrome is a relatively uncommon constellation of cardio-pulmonary anomalies, its typical feature being partial anomalous pulmonary venous connection. It can present in the neonatal period as well as later in life. We present the case of a girl diagnosed in the newborn period, along with a brief review of literature.

Magnetic resonance angiographic and three-dimensional computerized tomographic identification of scimitar syndrome in an 8-month-old infant

Scimitar syndrome is a rare congenital abnormality. Clear anatomic definition is an important issue before operation. We report definition of both abnormal pulmonary venous drainage and anomalous systemic arterial supply by gadolinium-enhanced magnetic resonance angiography and three-dimensional computerized tomography in an eight month-old infant with scimitar syndrome. The presented case study confirms that these noninvasive diagnostic tools can successfully be used to provide valuable information about vascular anatomy in infants with scimitar syndrome.

Scimitar syndrome: imaging by magnetic resonance angiography and Doppler echocardiography

We report magnetic resonance angiographic demonstration of both an anomalous pulmonary venous drainage and an anomalous systemic arterial supply in a patient with scimitar syndrome. Contrast-enhanced magnetic resonance angiography provides an excellent non-invasive diagnostic tool for demonstrating this complex congenital lesion in detail. A two-dimensional and colour Doppler echocardiography was also performed to show the anomalous venous drainage and to analyse the anomalous flow velocity pattern.

Bilateral scimitar syndrome

Scimitar syndrome is a rare congenital anomaly that affects classically the right lung and the heart. We present a rare variant that involves both lungs in association with totally anomalous pulmonary venous connection, horseshoe lung, and right pulmonary cyst.

Scimitar syndrome: complete anatomical and functional diagnosis with gadolinium-enhanced and velocity-encoded cine MRI

We report an asymptomatic 8-year-old girl with anomalous pulmonary venous connection to the IVC and systemic arterial supply (scimitar syndrome). We present for the first time a description of gadolinium-enhanced 3D MR angiography that provided concurrent non-invasive complete anatomical (arterial and venous supply) and 'functional' (calculation of left-to-right shunt using phase-contrast-MRI performed in the ascending aorta, main pulmonary artery and anomalous pulmonary vein) diagnosis, avoiding the need for more traditional invasive techniques. As the shunt quantification was less than 2:1, conservative management was decided upon.

A novel operative approach to scimitar syndrome

Scimitar syndrome is a rare congenital cardiac anomaly defined by an anomalous right pulmonary vein draining the right lung to the inferior vena cava. We describe a unique operative approach performed on 2 patients with infantile scimitar syndrome.

A case series of five infants with scimitar syndrome

Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies consisting of a partial anomalous pulmonary venous connection of the right lung to the inferior vena cava, right lung hypoplasia, dextroposition of the heart, and anomalous systemic arterial supply to the right lung. To date, this syndrome has not been reported or discussed in the nursing literature. In this article, 5 patients are presented to illustrate the variable presentation of this syndrome, ranging from infants who are asymptomatic to those with heart failure and severe pulmonary hypertension. The clinical signs and symptoms, diagnostic dilemmas, and medical and surgical management are discussed. The triad of respiratory distress, right lung hypoplasia, and dextroposition of the heart should alert the clinician to the possibility of this syndrome.

MRI of partial anomalous pulmonary venous return (scimitar syndrome)

We report a case of anomalous pulmonary venous drainage into the inferior vena cava (scimitar syndrome). Cine MRI and 3-D contrast-enhanced MR angiography provides an non-invasive diagnostic technique in the evaluation of anomalous pulmonary venous return.

Surgical management of scimitar syndrome: an alternative approach

OBJECTIVE

The scimitar syndrome is a congenital anomaly that consists in part of total or partial anomalous venous drainage of the right lung to the inferior vena cava. Surgical approaches to the scimitar syndrome have varied according to the anatomic and pathologic features presented in each case. The aim of this study was to present an alternative approach to the surgical correction of scimitar syndrome.

METHODS

Nine patients with the scimitar syndrome were operated on between 1990 and 2000. They comprised 1 male and 8 female patients (mean age 11.5 +/- 17.6 years). All patients had symptoms, with recurrent pneumonia or respiratory tract infections and pulmonary/systemic flow ratios greater than 1.5:1.0. None of the patients had pulmonary hypertension or an atrial septal defect. All patients underwent repair of the anomalous scimitar vein by direct reimplantation into the left atrium without cardiopulmonary bypass. Two patients underwent concomitant resection of a right lower lobe sequestration. Follow-up was complete in all cases.

RESULTS

There were no operative or late deaths, and no patients have required reoperation. At the time of follow-up (mean 55 +/- 46 months), echocardiography demonstrated a patent anastomosis in all patients without any evidence of restenosis.

CONCLUSION

This clinical experience indicates that an alternative surgical approach to scimitar syndrome is direct anastomosis of the scimitar vein to the posterior aspect of the left atrium using a right thoracotomy without cardiopulmonary bypass. This procedure is safe and effective and obviates the need for long intra-atrial baffles and the use of the extracorporeal circuit.

[Morphologic and functional assessment of vascular abnormalities of the pulmonary vasculature by breath-hold MR techniques]

PURPOSE

To evaluate breath-hold MR techniques for morphologic and functional assessment of vascular abnormalities of the pulmonary vasculature.

PATIENTS AND METHODS

13 patients aged 11 to 60 years with different vascular abnormalities of the pulmonary vasculature (5 patients with 16 arteriovenous malformations, 8 patients with partial anomalous pulmonary venous return) underwent MR imaging at 1.5 T. For morphological assessment, a contrast-enhanced 3D MR angiography (ce-MRA) was performed after a timing run. Segmented cine- and velocity-encoded GRE sequences were used for delineation of associated cardiac septal defects and for determination of systemic left-to-right or intrapulmonary shunt volumes. Selective intra arterial digital subtraction angiography, cardiac catheterization, and the intraoperative situs served as reference standards.

RESULTS

Ce-MRA allowed for detection of all vascular abnormalities and for anatomic characterization of 14/16 arteriovenous malformations. Flow measurements in the feeding arteries allowed for determination of intrapulmonary shunt volumes in 4/5 patients. Flow measurements performed in the pulmonary arteries and the ascending aorta enabled determination of systemic left-to-right shunting in patients with anomalous pulmonary venous return. Cine-sequences clearly depicted associated cardiac septal defects.

CONCLUSION

Breath-hold MR techniques allow for morphological and functional characterization of vascular anomalies of the pulmonary vasculature. Therefore, they are the non-invasive method of choice for planning further treatment.

Combined correction of an adult scimitar syndrome and coronary artery bypass grafting

Combined scimitar syndrome and coronary artery disease is a rare combination of congenital and acquired cardiac disease in adults. Hence, no guidelines for surgical correction are available. We report on the case of a 60-year-old man with coronary artery disease and scimitar syndrome. The patient underwent arterial coronary revascularization and simultaneous correction of the scimitar syndrome utilizing a new surgical approach with a modified pericardium-baffle reconstruction of the anomalous right pulmonary vein.

Meandering right pulmonary vein to the left atrium and inferior vena cava: the first case with associated anomalies

We report a case of a healthy, asymptomatic 6-year-old boy in whom an anomalous right pulmonary vein was noted to drain into both the inferior vena cava and left atrium in association with findings consistent with scimitar syndrome. The anomalous pulmonary vein took a very circuitous route through the lungs before draining into the left atrium, a condition previously termed "meandering pulmonary vein." To aid in the diagnosis, cardiovascular magnetic resonance imaging and magnetic resonance angiography were used to delineate this complex course and the connection of the anomalous pulmonary vein. To our knowledge, this is the 1st reported case of a meandering pulmonary vein with dual drainage to the inferior vena cava and left atrium in association with other anomalies.

Scimitar syndrome in neonates: report of four cases and review of the literature

Four neonates with scimitar syndrome are presented. Three of the cases had congenital cardiovascular abnormalities not usually regarded as part of the scimitar syndrome, namely, ventricular septal defect, abnormalities of the aortic arch, and abnormal relationship of the pulmonary arteries and bronchi. Review of the literature indicates that among subjects of all ages the incidence of additional congenital heart disease is 24%; in patients within the pediatric age group the incidence is about 36% and is highest (75%) among those subjects having diagnostic studies while neonates.

Gadolinium-enhanced magnetic resonance angiography in scimitar syndrome: diagnosis and postoperative evaluation

We report the 1st magnetic resonance demonstration of both an anomalous pulmonary venous drainage and systemic arterial supply in a patient with scimitar syndrome. With its superior imaging capabilities, gadolinium-enhanced magnetic resonance angiography provides a powerful diagnostic tool for this complex congenital lesion and offers the possibility of surgical repair and follow-up without conventional cardiac catheterization.

Tetralogy of Fallot associated with scimitar syndrome

We present a case of tetralogy of Fallot associated with Scimitar syndrome. The patient was an 11-month old female who underwent successfully total repair of her lesion, including rerouting of the anomalous pulmonary vein to the left atrium. The diagnosis was suspected from the chest x-ray and echocardiography, and confirmed by angiography. To the best of our knowledge only 2 additional cases have previously been reported.