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Tomás Alvarado E, Zaragoza Martínez MS, Ramirez Teran OA. Scimitar Syndrome: A Thorough Diagnosis in a Pediatric Patient. Cureus 2024; 16:e66302. [PMID: 39238762 PMCID: PMC11376682 DOI: 10.7759/cureus.66302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
Scimitar syndrome is characterized by the anomalous connection of the right pulmonary venous return to the hepatic portion of the inferior vena cava. Its name is derived from the characteristic image observed in chest X-ray, CT scan, or during pulmonary angiography in cardiac catheterization. It is more common among females and rarely affects the left lung. The importance of knowing its symptoms and presentation allows for a high diagnostic suspicion, thus avoiding the underdiagnosis of the disease. The prognosis is generally good, and timely diagnosis can prevent the occurrence of complications such as pulmonary hypertension or portal hypertension. We present the case of an eight-year-old female patient, who was previously evaluated for episodes of lower respiratory tract infections at 18 months of age, detecting only dextroposition, without any diagnostic workup. She was then sent to our office at eight years of age, with the onset of exercise-induced dyspnea. A comprehensive workup was conducted, with a diagnosis of scimitar syndrome.
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2
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Menon R, Saxena R, Pathak M, Yadav T. Hepatopulmonary fusion in congenital diaphragmatic hernia: successful management of a lethal variant. BMJ Case Rep 2024; 17:e260486. [PMID: 38926130 DOI: 10.1136/bcr-2024-260486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Congenital diaphragmatic hernia (CDH) is a congenital anomaly involving the herniation of intra-abdominal contents into the thoracic cavity. Hepatopulmonary fusion (HPF), an exceedingly rare subtype mainly associated with right-sided CDH, presents unique diagnostic and therapeutic challenges. This case report describes a male infant with right-sided CDH complicated by HPF. The intricate anatomical anomaly involved the fusion of the right lung to the liver, posing challenges during surgical separation. The patient experienced postoperative complications, including prolonged ventilation, tracheostomy and pulmonary issues, which led to a prolonged hospital stay. Intraoperative challenges stem from the absence of demarcation between lung and liver tissues and abnormal vascular structures. In summary, managing HPF in right-sided CDH necessitates a customised, multidisciplinary approach to optimise patient outcomes, highlighting the need for ongoing research to refine understanding and treatment strategies.
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Affiliation(s)
- Revathy Menon
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Paediatric Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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3
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Aristizabal AM, Guzmán-Serrano CA, Mondol-Villamil NV, Bolaños-Vallejo LM, Mejia-Quiñones V, Recio-Gómez MA, García-Pretelt EC, Mejía-González M, Alvarez WM, Gutiérrez-Gil JA. Clinical characteristics, imaging findings, management, and outcomes of patients with scimitar syndrome at a tertiary referral healthcare center in Colombia. Int J Cardiovasc Imaging 2024; 40:1319-1328. [PMID: 38634941 PMCID: PMC11213797 DOI: 10.1007/s10554-024-03102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Scimitar Syndrome is part of a complex spectrum of congenital cardiovascular anomalies related to anomalous pulmonary venous return. Depending on the extent of involvement, treatment can be either expectant or surgical. Prognosis and survival have been controversial, with some results supporting early surgical management. This research aims to disclose the outcomes and describe the management, clinical and imaging characteristics of patients diagnosed with Scimitar Syndrome treated in a tertiary referral healthcare center. Longitudinal descriptive observational study. The study included all patients diagnosed with scimitar syndrome in our institution between January/2011 and December/2022. A description of the sociodemographic and clinical characteristics, diagnostic tools used, treatment features, and patient outcomes is provided. Eleven patients were included, with a mean age at diagnosis of five years (CI 0-17), six of which were female (54.55%). Nine (81.82%) patients had evidence of a scimitar vein on the chest radiograph, six (54.55%) cardiac dextroposition, six (54.55%) pulmonary hypoplasia, five (45.45%) right pulmonary artery hypoplasia, and three (27.27%) had aortopulmonary collaterals. Four (36.36%) patients had horseshoe lungs, and four (36.36%) had bronchopulmonary sequestration. In the associations, two (18.18%) patients were found to have an atrial septal defect, three (27.27%) ventricular septal defect, and one (9%) had Tetralogy of Fallot. Pulmonary hypertension was demonstrated in two (18.18%) patients. Seven (63.64%) required surgical management to correct the scimitar vein, and two patients died due to unrelated complications. Scimitar syndrome presents diagnostic and treatment challenges, necessitating a multidisciplinary approach for timely care. Chest radiography and CT scans are primary diagnostic tools, with surgical intervention often warranted alongside other heart defects or significant hemodynamic repercussions. Medical management is effective for mild to moderate cases. Long-term patient outcomes remain uncertain due to study limitations, but improved life expectancy is anticipated with ongoing care.
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Affiliation(s)
- Ana M Aristizabal
- Facultad de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Departamento materno-infantil, Fundación Valle del Lili, Cardiología pediátrica, Cali, Colombia
| | - Carlos A Guzmán-Serrano
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Av. Simón Bolívar - Carrera 98 # 18-49 Cali, Cali, Colombia.
| | | | | | - Valentina Mejia-Quiñones
- Facultad de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Av. Simón Bolívar - Carrera 98 # 18-49 Cali, Cali, Colombia
| | | | | | - Mauricio Mejía-González
- Departamento de Radiología e imágenes Diagnósticas, Fundación Valle del Lili, Cali, Colombia
| | - Walter Mosquera Alvarez
- Facultad de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Departamento materno-infantil, Fundación Valle del Lili, Cardiología pediátrica, Cali, Colombia
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Brunet-Garcia L, Zuccarino F, Prada Martínez FH, Carretero Bellon JM. Scimitar Syndrome in a Pediatric Cohort. World J Pediatr Congenit Heart Surg 2024:21501351241247512. [PMID: 38772700 DOI: 10.1177/21501351241247512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND Scimitar syndrome is a rare form of congenital heart disease (CHD) characterized by anomalous pulmonary venous drainage of the right lung to the inferior vena cava. We describe the presentation, diagnosis, therapeutic management and long-term follow-up of 10 pediatric patients with Scimitar Syndrome. METHODS We performed a retrospective observational study of all pediatric patients from our institution with scimitar syndrome (March 1996-July 2023). Patients underwent systematic evaluation including medical and family history, chest x-ray, 12-lead electrocardiogram, echocardiogram, angiography and/or computed tomography; or magnetic resonance angiography. RESULTS Ten patients with scimitar syndrome were included. The median age at diagnosis was 10.4 [0.1-150.2] months and the median follow-up time was 7.7 [1.3-15.3] years. Eight patients presented with aortopulmonary collateral arteries which were embolized. Two patients had dual connections to the inferior vena cava and left atrium; embolization of the inferior vena cava connection was only feasible in one of them. No patients underwent surgery of the scimitar vein. Three patients had surgical correction of CHDs. There were no deaths related to scimitar syndrome during follow-up. CONCLUSIONS All patients with scimitar syndrome need prompt cardiovascular evaluation and follow-up. Our study demonstrates that a conservative approach with aortopulmonary collateral artery embolization, scimitar vein embolization when dual drainage to the left atrium is identified, along with correction of concomitant CHDs might have good results in patients with scimitar syndrome in order to postpone surgical correction of the anomalous pulmonary venous return to an older age when clinically or hemodynamically indicated. Further studies with longer-term follow-up and a larger sample size are needed to more effectively determine treatment strategy.
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Affiliation(s)
- Laia Brunet-Garcia
- Department of Paediatric Cardiology, Consorci Sanitari del Maresme, Hospital de Mataró, Barcelona, Spain
| | - Flavio Zuccarino
- Department of Radiology, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Radiology, Hospital del Mar, Barcelona, Spain
| | | | - Juan Manuel Carretero Bellon
- Department of Paediatric Cardiology, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Paediatric Cardiology, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
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5
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Shamal G, Khan AI, Ali A, James N, Ghulam M. Unveiling a Unique Case of Scimitar Syndrome: Clinical Significance and Multidisciplinary Management Challenges in Pakistan. Cureus 2024; 16:e53874. [PMID: 38465183 PMCID: PMC10925003 DOI: 10.7759/cureus.53874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Scimitar syndrome, a rare congenital cardiac anomaly, involves abnormal pulmonary vein drainage into systemic veins, leading to distinct imaging features resembling a curved-blade sword. This case report presents a unique instance of scimitar syndrome in Pakistan, emphasizing its clinical importance and the challenges of management. A 26-year-old female with a history of recurrent pulmonary infections and respiratory symptoms since childhood was diagnosed with scimitar syndrome. Radiological assessments, including chest X-rays, computed tomography pulmonary angiograms (CTPA), and transthoracic echocardiography, confirmed the presence of a curved vessel originating from the right hemidiaphragm and connecting with the inferior vena cava (IVC). The patient and her medical team opted for conservative management, involving multidisciplinary care, tailored treatment for infections, and regular monitoring. The rarity of Scimitar syndrome necessitates careful diagnosis and management decisions. While surgical intervention is often recommended, this case demonstrates the complexities of choosing conservative management based on patient preferences and the evolving clinical course. A literature review reveals varied outcomes of surgical and conservative approaches, emphasizing the need for personalized strategies. Radiological techniques, such as CTPA and MRI, play pivotal roles in diagnosis and monitoring. This case report underscores the clinical significance of scimitar syndrome, particularly in regions with limited reported cases, like Pakistan. The multidisciplinary management approach, the decision-making process regarding conservative treatment, and the unique radiological findings contribute to the medical community's understanding of this rare condition.
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Affiliation(s)
- Gulalay Shamal
- Internal Medicine, Rehman Medical Institute, Peshawar, PAK
| | | | - Ahsan Ali
- Internal Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Neha James
- General Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Moula Ghulam
- Medicine, Rehman Medical Institute, Peshawar, PAK
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Jeffs E, Lee H, Beckert L. Scimitar syndrome, bronchiectasis, haemoptysis and a pneumonectomy. Respirol Case Rep 2024; 12:e01265. [PMID: 38074923 PMCID: PMC10709992 DOI: 10.1002/rcr2.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/23/2023] [Indexed: 10/16/2024] Open
Abstract
Scimitar syndrome is a rare condition characterized by partial or complete anomalous pulmonary venous drainage of the lung to the inferior vena cava, right lung hypoplasia and dextroposition of the heart. Haemoptysis is uncommon in adults, although the clinical spectrum is wide. We report a case of a 38-year-old male with scimitar syndrome who had low grade haemoptysis persisting over several years secondary to bronchiectatic changes in his hypoplastic right lung. Conservative measures to manage haemoptysis were unsuccessful and the patient proceeded to bronchial artery embolization. The post-procedure course was complicated by lung infarction and the patient ultimately required pneumonectomy. Deformities of the blood vessels and lungs are complex in scimitar syndrome. Bronchial artery embolization should be approached cautiously to protect pulmonary perfusion.
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Affiliation(s)
- Emma Jeffs
- Department of Respiratory MedicineTe Whatu Ora Waitaha Canterbury PānuiChristchurchNew Zealand
| | - Hyukjoon Lee
- Department of RadiologyTe Whatu Ora Waitaha Canterbury PānuiChristchurchCanterburyNew Zealand
| | - Lutz Beckert
- Department of Respiratory MedicineTe Whatu Ora Waitaha Canterbury PānuiChristchurchNew Zealand
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7
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Liu Y, Ruan W, Li Z, Wang H, Chen S, Ding Y, Jin J. A rare case of scimitar syndrome with pulmonary arterial hypertension in an adult female. Pulm Circ 2024; 14:e12332. [PMID: 38174160 PMCID: PMC10762869 DOI: 10.1002/pul2.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
Scimitar syndrome is a rare congenital anomaly characterized by partial or total anomalous pulmonary venous drainage of the right lung to the inferior vena cava. We report a case of a 67-year-old female who presented with cough and dyspnea and was diagnosed with scimitar syndrome and pulmonary arterial hypertension based on comprehensive imaging and hemodynamic evaluation. This case highlights the importance of considering scimitar syndrome as a cause of pulmonary hypertension even in adult patients.
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Affiliation(s)
- Yang Liu
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
| | - Weiliang Ruan
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
| | - Ziye Li
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
| | - Hua Wang
- Special Inspection DepartmentShaoxing City Keqiao District Hospital of traditional Chinese MedicineShaoxingChina
| | - Shenghai Chen
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
| | - Yuhong Ding
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
| | - Jianfeng Jin
- Respiratory DepartmentShaoxing City Keqiao District Hospital of Traditional Chinese MedicineShaoxingChina
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8
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Akingbade O, Nelson A, Earing M, Ganigara M, Nouhossi JN, Subashchandran V, Slivnick JA. The Sword and the Crown: Echocardiography for the Detection of a Rare Combination of Congenital Heart Disease. CASE (PHILADELPHIA, PA.) 2023; 7:433-437. [PMID: 38028385 PMCID: PMC10679536 DOI: 10.1016/j.case.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
•Unexplained right heart enlargement should always prompt evaluation for shunts. •Scimitar syndrome occurs when the right pulmonary veins drain into the IVC. •Coronary sinus dilation should prompt suspicion for PLSVC. •PLSVC can be diagnosed with a bubble study through left-sided IV.
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Affiliation(s)
| | - Alma Nelson
- University of Chicago Medicine, Chicago, Illinois
| | - Michael Earing
- UChicago Medicine Comer Children’s Hospital, Chicago, Illinois
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9
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Gładki M, Bednarek PR, Owecki W. Case report: A unique quadruple coexisting anomaly-scimitar syndrome, atrial septal defect, vascular ring, and pulmonary sequestration. Front Pediatr 2023; 11:1214900. [PMID: 37534199 PMCID: PMC10392937 DOI: 10.3389/fped.2023.1214900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
The article describes a successful clinical outcome in the case of a 5-month old female with a diagnosis of incomplete vascular ring of aberrant right subclavian artery and ostium secundum atrial septal defect associated with partial anomalous pulmonary venous return of scimitar syndrome type, coexisting with right pulmonary sequestration. During hospitalization, surgical correction of the heart defect and resection of the lung sequestration were performed. To the best of our knowledge, described constellation of defects is a unique phenomenon, posing a challenge for complex treatment and disease management.
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Affiliation(s)
- Marcin Gładki
- Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł R. Bednarek
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Owecki
- Scientific Group of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznań, Poland
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10
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Yadav R, Sharma A, Pathak S. Successful Surgical Management of Incidentally Diagnosed Scimitar Syndrome With Anomalous Connection of the Left Hepatic Vein to Coronary Sinus and Persistent Left Superior Vena Cava. Cureus 2023; 15:e38367. [PMID: 37265891 PMCID: PMC10230267 DOI: 10.7759/cureus.38367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Scimitar syndrome is a rare congenital heart pathology that presents at birth, and it is a type of partial anomalous pulmonary venous return (PAPVR). In one in three people with scimitar syndrome, the right pulmonary vein is shaped like a scimitar (a Turkish sword) and can be easily visualized on radiographic imaging. This syndrome is not a simple and benign disease, and associated cardiac anomalies play a role in long-term outcomes, and the presence of pulmonary hypertension contributes to high mortality. The present case is the rarest of rare entities, scimitar syndrome, anomalous vascular connections between the left hepatic vein and coronary sinus, and persistent left superior vena cava in a single patient with no such case report published before.
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Affiliation(s)
- Rajeshwar Yadav
- Cardiac/Thoracic/Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Aditya Sharma
- General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Swati Pathak
- Cardiac/Thoracic/Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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11
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Dangoni GD, Teixeira ACB, Aguiar TF, Sugayama SMM, Filho VO, Bertola DR, Krepischi ACV. A rare case of hepatoblastoma in a syndromic child with a de novo germline JAG1 mutation. Pediatr Blood Cancer 2023; 70:e30311. [PMID: 36965188 DOI: 10.1002/pbc.30311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Gustavo Dib Dangoni
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
| | - Anne Caroline Barbosa Teixeira
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Talita Ferreira Aguiar
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sofia Mizuho Miura Sugayama
- Faculty of Medicine, Department of Pediatrics, Instituto de Tratamento do Câncer Infantil (ITACI), University of São Paulo, São Paulo, SP, Brazil
| | - Vicente Odone Filho
- Faculty of Medicine, Department of Pediatrics, Instituto de Tratamento do Câncer Infantil (ITACI), University of São Paulo, São Paulo, SP, Brazil
| | - Débora Romeo Bertola
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
- Genetics Unit, Instituto da Criança, Hospital das Clinicas Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ana Cristina Victorino Krepischi
- Department of Genetics and Evolutionary Biology, Human Genome and Stem Cell Research Center, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
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12
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Seymour E, Mallory G, Morales-Demori R. Surgical and Cardiac Catheterization Outcomes of Scimitar Syndrome Patients: A Three Decade Single-Center Experience. Pediatr Cardiol 2023; 44:579-586. [PMID: 35804238 DOI: 10.1007/s00246-022-02965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
Scimitar syndrome (SS) is a rare congenital condition which includes partial anomalous pulmonary venous return (PAPVR) and a variable degree of pulmonary hypoplasia. We describe the clinical features, therapeutic approach and outcomes of patients who underwent cardiac catheterization and/or surgical repair of the scimitar vein at a single institution in the United States. This retrospective cohort study included all patients with SS who underwent scimitar vein surgical repair or cardiac catheterization from October 1989 through August 2021 in a tertiary care center. A total of 84 patients with SS were included and median follow-up time was 74 months. Patients diagnosed with SS under the age of one year had a significantly greater incidence of congenital heart defects (CHD) (p < 0.001), non-cardiac anomalies (p = 0.02), pulmonary hypertension (p = 0.02), and mortality (p = 0.04) compared to those diagnosed over the age of 1 year. Twenty-eight patients underwent surgical repair of the scimitar vein. Overall, eight (10%) patients died. Compared to surviving patients, deceased patients had a significantly higher incidence of pulmonary hypertension (PH), neonatal SS diagnosis, and extracorporeal membrane oxygenation (ECMO) support. Median scimitar vein pressure (20 mmHg) of deceased patients was significantly higher compared to pressures in surviving patients (11 mmHg; p = 0.02). PH, CHD, neonatal SS diagnosis, ECMO support, and markedly elevated scimitar vein pressure are associated with mortality. Scimitar vein surgical repair during infancy is commonly associated with PH and restenosis that requires re-intervention.
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Affiliation(s)
- Emma Seymour
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC. E1420, Houston, TX, USA.
| | - George Mallory
- Department of Pediatrics, Division of Pulmonology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St., Houston, TX, USA
| | - Raysa Morales-Demori
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC. E1420, Houston, TX, USA
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13
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Aron-Said C, Opel MM, Alkon J. Fetal Diagnosis of Scimitar Syndrome in the Presence of Complex Congenital Heart Disease. Pediatr Cardiol 2023; 44:549-555. [PMID: 36241899 DOI: 10.1007/s00246-022-03026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022]
Abstract
Fetal diagnosis of scimitar syndrome requires a high index of suspicion. We present two fetal cases of complex congenital heart disease associated with scimitar syndrome, one of them is diagnosed with scimitar syndrome in utero. We emphasize prenatal echocardiographic findings that may assist with arriving at the correct prenatal diagnosis. We also discuss potential challenges in suspecting the presence of scimitar syndrome in utero. The postnatal echocardiographic findings and course are described for both patients. We reviewed the available literature on prenatal diagnosis of scimitar syndrome in the presence of complex congenital heart disease. We describe a new association of VACTERL, imperforate anus, scimitar syndrome, and double-outlet right ventricle all on the same patient, as well as the first prenatal diagnosis of scimitar syndrome associated with hypoplastic left heart syndrome with restrictive atrial septum. Advanced imaging modalities such as a fetal lung Magnetic Resonance Imaging is suggested as a confirmatory test when scimitar syndrome is suspected in utero in the presence of complex congenital heart disease.
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Affiliation(s)
- Catalina Aron-Said
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mariam M Opel
- Division of Pediatric Cardiology, Department of Pediatrics, Leonard M. Miller School of Medicine, Jackson Memorial Hospital/Holtz Children's Hospital, University of Miami, 1611 NW 12th Avenue. East Tower 7A, Miami, FL, 33136, USA
| | - Jaime Alkon
- Division of Pediatric Cardiology, Department of Pediatrics, Leonard M. Miller School of Medicine, Jackson Memorial Hospital/Holtz Children's Hospital, University of Miami, 1611 NW 12th Avenue. East Tower 7A, Miami, FL, 33136, USA.
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14
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Romberg EK, Stanescu AL, Bhutta ST, Otto RK, Ferguson MR. Computed tomography of pulmonary veins: review of congenital and acquired pathologies. Pediatr Radiol 2022; 52:2510-2528. [PMID: 34734315 DOI: 10.1007/s00247-021-05208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
Newer-generation CT scanners with ultrawide detectors or dual sources offer millisecond image acquisition times and significantly decreased radiation doses compared to historical cardiac CT and CT angiography. This technology is capable of nearly freezing cardiac and respiratory motion. As a result, CT is increasingly used for diagnosing and monitoring cardiac and vascular abnormalities in the pediatric population. CT is particularly useful in the setting of pulmonary vein evaluation because it offers evaluation of the entire pulmonary venous system and lung parenchyma. In this article we review a spectrum of congenital and acquired pulmonary venous abnormalities, including potential etiologies, CT imaging findings and important factors of preoperative planning. In addition, we discuss optimization of CT techniques for evaluating the pulmonary veins.
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Affiliation(s)
- Erin K Romberg
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - A Luana Stanescu
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sadaf T Bhutta
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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15
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Wang K, Xu X, Liu T, Gao W, Guo Y. Treatment and prognosis of Scimitar syndrome: A retrospective analysis in a single center of East China. Front Cardiovasc Med 2022; 9:973796. [PMID: 36093138 PMCID: PMC9449312 DOI: 10.3389/fcvm.2022.973796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Scimitar syndrome is a rare congenital cardiovascular malformation; its optimal management remains controversial. This study aims to present the clinical experience of this disease in our center. Methods We undertook a retrospective review of 34 patients with Scimitar syndrome documented at our institution between January 2013 and December 2018. The patients' clinical characteristics, management, and prognosis data were collected and analyzed. Results Thirty-four patients, including 16 males and 18 females, were enrolled with a median age at diagnosis of 7 months and a follow-up period of 22.5 months. The infantile form of Scimitar syndrome presents more tendency for pulmonary hypertension (PH), pulmonary vein stenosis (PVS), and mortality than the adult form. Of the 15 patients who underwent surgical correction of the Scimitar vein, four had post-operation PVS. There was no significant difference in the stenosis incidence between baffle repair and Scimitar vein reimplantation groups. Eight patients received interventional catheter therapy, including occlusion of aortopulmonary collateral arteries (APCs) and other intracardiac malformations, without the following surgery. The overall mortality rate was 20.5% (7 of 34) over the study period. High-risk factors of death included age at diagnosis (p = 0.000), PH (p = 0.007) and PVS (p = 0.014). Conclusions Infantile Scimitar syndrome needs intense suspicion for early diagnosis and multidisciplinary treatment. Interventional treatment of Scimitar syndrome alleviates pulmonary artery pressure and progression during infancy. Baffle repair and direct reimplantation of the Scimitar vein used in the surgical treatment of Scimitar syndrome are safe and have similar effects. Age at diagnosis, PH, and PVS are high-risk factors for death in Scimitar syndrome.
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Affiliation(s)
- Kai Wang
- Department of Cardiology, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Pediatrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, China
| | - Xinyi Xu
- Department of Cardiology, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tingliang Liu
- Department of Cardiology, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Guo
- Department of Cardiology, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Ying Guo
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Henning RE, Segar DE, Frommelt PC. Obstruction of the Anomalous Pulmonary Venous Connection in Scimitar Syndrome: Progression to Spontaneous Anomalous Pulmonary Vein Atresia during Infancy without Intervention. CASE 2022; 6:183-186. [PMID: 35818494 PMCID: PMC9270664 DOI: 10.1016/j.case.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infantile scimitar syndrome can progress from pulmonary venous obstruction to atresia. Echo evidence of RPA diastolic flow reversal can be a sign of venous obstruction. Despite development of atresia, this infant was asymptomatic, with normal PA pressure.
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Affiliation(s)
- Rachel E. Henning
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David E. Segar
- Department of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter C. Frommelt
- Department of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Correspondence: Peter C. Frommelt, MD, Children’s Wisconsin, 9000 West Wisconsin, Mail station 713, Milwaukee, WI 53226
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El-Ali AM, Strubel NA, Lala SV. Congenital lung lesions: a radiographic pattern approach. Pediatr Radiol 2022; 52:622-636. [PMID: 34716454 DOI: 10.1007/s00247-021-05210-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Congenital lung malformations represent a spectrum of abnormalities that can overlap in imaging appearance and frequently coexist in the same child. Imaging diagnosis in the neonatal period can be challenging; however, the recognition of several archetypal radiographic patterns can aid in narrowing the differential diagnosis. Major radiographic archetypes include (1) hyperlucent lung, (2) pulmonary cysts, (3) focal opacity and (4) normal radiograph. Here we review the multimodality imaging appearances of the most commonly seen congenital lung malformations, categorized by their primary imaging archetypes. Along with the congenital lung malformations, we present several important imaging mimickers.
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Affiliation(s)
- Alexander Maad El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA.
| | - Naomi A Strubel
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
| | - Shailee V Lala
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 550 First Ave., New York, NY, 10016, USA
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18
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Bonnet D, Szezepanski I, Delacourt C, Malkezadeh-Milani S, Lévy M. Multifactorial pulmonary hypertension in infantile scimitar syndrome. Arch Cardiovasc Dis 2022; 115:142-150. [DOI: 10.1016/j.acvd.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
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Provenci B, Sales RKBD, Fonseca EKUN, Chate RC. Scimitar syndrome: a rare disease. EINSTEIN-SAO PAULO 2021; 19:eAI6683. [PMID: 35019035 PMCID: PMC8687649 DOI: 10.31744/einstein_journal/2021ai6683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
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20
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Diaphragmatic eventration as a first sign of Scimitar syndrome. Cardiol Young 2021; 31:1870-1872. [PMID: 33941297 DOI: 10.1017/s1047951121001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diaphragmatic eventration is an anomaly of the diaphragm. In Scimitar syndrome, a curved-shaped anomalous pulmonary venous drainage is seen. Association between these conditions is rare. We present a newborn with diaphragmatic eventration, whose diagnosis of Scimitar syndrome was made after surgical repair. Scimitar syndrome is a congenital disorder often associated with other heart and lungs anomalies. Diagnosis can be fortuitous but with important prognostic features.
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21
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Cruz-Galbán A, Ruiz-Cantador J, González-García AE. Atypical presentation of scimitar syndrome with severe hepatomegaly: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab280. [PMID: 34423245 PMCID: PMC8374964 DOI: 10.1093/ehjcr/ytab280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022]
Abstract
Background Scimitar syndrome is a rare congenital disease characterized by partial or total anomalous pulmonary venous return from the right lung into the systemic venous system, and accounts for 0.5-2% of all congenital heart disease. Severe forms of the disease are diagnosed in childhood. However, because of the benign form of the syndrome in adults, many are asymptomatic, or present only mild symptoms including exertional dyspnoea, arrhythmias, and respiratory infections. We report an atypical presentation with hepatomegaly. Case summary A 24-year-old woman was evaluated for abdominal discomfort. Physical examination revealed a remarkable hepatomegaly. Chest X-ray revealed dextroversion, enlargement of the right cavities, and a curvilinear opacity known as 'scimitar sign'. A transthoracic echocardiography demonstrated right ventricular dilation and a venous collector draining into right suprahepatic vein, which was severely dilated, with large hepatomegaly. Scimitar syndrome was confirmed by magnetic resonance imaging (MRI). Therefore, the patient underwent surgery, redirecting the pulmonary venous return to left atrium. Three months later, the patient remained asymptomatic and both the hepatomegaly and the right chamber volumes normalized. Discussion Abdominal discomfort, as in our clinical case, is a highly atypical presentation of scimitar syndrome. It is important for physicians to be aware that diagnostic suspicion can be established from a chest X-ray, on which the scimitar sign can be distinguished in many cases. The diagnosis must be confirmed with other imaging modalities, such as echocardiography, MRI, or computed tomography. Corrective surgery may relieve the symptoms related to liver congestion at follow-up.
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Affiliation(s)
- Alba Cruz-Galbán
- Cardiology Department, University Hospital of Salamanca, Paseo de San Vicente, 182, Salamanca, Spain
| | - José Ruiz-Cantador
- Cardiology Department, Congenital Heart Disease, "La Paz" Hospital, Paseo de la Castellana, 261, Madrid, Spain
| | - Ana Elvira González-García
- Cardiology Department, Congenital Heart Disease, "La Paz" Hospital, Paseo de la Castellana, 261, Madrid, Spain
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22
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Chowdhury UK, Anderson RH, Sankhyan LK, George N, Pandey NN, Chauhan AS, Arora Y, Goja S. Surgical management of the scimitar syndrome. J Card Surg 2021; 36:3770-3795. [PMID: 34396590 DOI: 10.1111/jocs.15857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM We sought to address the varied anatomical details, the diagnostic challenges, associated cardiopulmonary anomalies, the techniques, and outcomes of management, including re-interventions of scimitar syndrome. METHODS A total of 92 published investigations of scimitar syndrome were reviewed. Diagnostic information was provided by clinical presentations, radiographic findings, transthoracic and transesophageal echocardiography, computed-tomographic angiography, magnetic resonance imaging, angiocardiography, and ventilation/perfusion scans. These investigations served to elucidate the origin, course, and termination of the scimitar vein, the intracardiac anatomy, the presence of associated defects, and the patterns of any accompanying pulmonary lesions prior to surgical intervention. RESULTS Of the patients described, up to four-fifths presented during infancy, with cardiac failure, increased pulmonary flow, and pulmonary hypertension. Associated cardiac and extracardiac defects, particularly hypoplasia of the right lung, are present in up to three-quarters of cases. Overall operative mortality has been cited between 4.8% and 5.9%. Mortality was highest in patients with preoperative pulmonary hypertension, and those undergoing surgery in infancy. Despite timely surgical intervention, post-repair obstruction of the scimitar vein, intra-atrial baffle obstruction, or stenosis of the inferior caval vein were reported in up to two-thirds of cases. The venous obstruction could not be related to any particular surgical technique. On long term follow-up, one sixth of patients reported persistent dyspnoea and recurrent respiratory infections. CONCLUSIONS Any infants presenting with heart failure, right-sided heart, and hypoplastic right lung should be evaluated to exclude the syndrome. An increased appreciation of variables will contribute to improved surgical management.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lakshmi K Sankhyan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav S Chauhan
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Identifying partial anomalous pulmonary venous connection in the superior vena cava before pulmonary resection. Gen Thorac Cardiovasc Surg 2021; 69:1313-1319. [PMID: 33900520 DOI: 10.1007/s11748-021-01639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There are only limited reports on pulmonary resection complicated with partial anomalous pulmonary venous connection. Preoperative partial anomalous pulmonary venous connection was overlooked in approximately 50% of these reports, while most cases of were located on the same side as the pulmonary resection. We examined the prevalence of overlooked partial anomalous pulmonary venous connection and determined appropriate measures to avoid misdiagnosis. METHODS We retrospectively reviewed the records and computed tomography data of consecutive patients who underwent pulmonary resection at the University of Yamanashi Hospital between 2006 and 2019. We re-evaluated the computed tomography images in horizontal and coronal views, focusing on the four common sites of partial anomalous pulmonary venous connection. Further, we conducted a literature review of studies that reported partial anomalous pulmonary venous connection cases. RESULTS Among the 1389 patients who underwent pulmonary resection, 1205 were enrolled. There were five partial anomalous pulmonary venous connection cases (0.41%). Two were diagnosed through re-evaluation. The partial anomalous pulmonary venous connection was located between the right upper lobe and the superior vena cava in four patients (80%). All patients underwent left superior segmentectomy, and none experienced postoperative heart failure or hypoxia. In the literature, the incidence rates of partial anomalous pulmonary venous connection observed by computed tomography (0.1-0.25%) were lower than those observed by autopsy (0.62%) and angiography (0.82%). CONCLUSION There may be a considerable number of overlooked partial anomalous pulmonary venous connection cases. Therefore, particularly the superior vena cava should be carefully monitored in preoperative computed tomography examinations.
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24
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Bonilla-Ramirez C, Salciccioli KB, Qureshi AM, Adachi I, Imamura M, Heinle JS, McKenzie ED, Caldarone CA, Allen HD, Binsalamah ZM. Smaller right pulmonary artery is associated with longer survival time without scimitar vein repair. J Card Surg 2021; 36:1352-1360. [PMID: 33604954 DOI: 10.1111/jocs.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 01/29/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The optimal management of scimitar syndrome remains incompletely defined. We (1) evaluated the impact of aortopulmonary collateral (APC) occlusion, (2) compared outcomes according to surgical approach for patients who underwent surgery, and (3) identified anatomic factors associated with longer survival time without scimitar vein repair. METHODS We conducted a single center, retrospective study of 61 patients diagnosed with scimitar syndrome between 1995 and 2019. Right pulmonary artery to total pulmonary artery cross-sectional area (RPA:PA CSA) quantitatively assessed right pulmonary artery size. Anatomical features were analyzed for association with longer survival time without scimitar vein repair. RESULTS Median follow-up time was 6 years (Q1-Q3, 2-12), with 96% 5-year survival. Twenty-three patients underwent APC occlusion, which significantly decreased symptoms of overcirculation (100%-46%; p = .001) and systolic pulmonary artery pressure (median, 34-29 mmHg; p = .004). Twenty-three patients underwent scimitar vein repair; 5-year freedom from scimitar vein stenosis was 90% among patients who underwent a reimplantation compared with 42% in patients with baffle repair (p = .1). Three patients underwent surgery before the first year of age, with lower 5-year freedom from scimitar vein stenosis (0% vs. 84%; p < .001). On multivariate analysis, a lower RPA:PA CSA was associated with longer survival time without scimitar vein repair (p = .003). CONCLUSIONS APC occlusion improves the clinical status of young and hemodynamically unstable patients. Repair at an early age is associated with an increased risk of scimitar vein stenosis. Scimitar vein repair might be avoided in patients with a smaller right pulmonary artery.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Athar M Qureshi
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Iki Adachi
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michiaki Imamura
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - E Dean McKenzie
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Hugh D Allen
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ziyad M Binsalamah
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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25
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Arora Y, Kar T, Sharma S, Devagourou V. Surgical correction of rare anomaly of scimitar syndrome with tetralogy of Fallot. J Card Surg 2021; 36:2130-2132. [PMID: 33586195 DOI: 10.1111/jocs.15429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
We present a 9-year-old male with a history of cyanosis diagnosed as scimitar syndrome with tetralogy of Fallot with left anterior descending coronary artery crossing right ventricle outflow tract. He underwent reimplantation of scimitar vein into right atrium baffled into left atrium along with intracardiac repair for tetralogy of Fallot. Postoperative recovery was uneventful and the patient was discharged on postoperative Day 8 and was asymptomatic at follow-up at 6 months.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Sharma
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
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26
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D'Angelo T, Blandino A, Saitta MB, Agati S, Romeo P, Mazziotti S. A Rare Variant of Hypogenetic Lung Syndrome Mimicking Scimitar Vein. Ann Thorac Surg 2021; 112:e173-e176. [PMID: 33497669 DOI: 10.1016/j.athoracsur.2021.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
Hypogenetic lung syndrome, also known as scimitar syndrome, is a rare and well-known congenital condition that includes hypoplastic right pulmonary artery and lung, right displacement of the heart, anomalous systemic arterial supply to the lung, and a characteristically curved anomalous right pulmonary vein draining into the inferior vena cava. In exceptional cases, the anomalous pulmonary vein may drain into left atrium. We here report a case of a 17-year-old girl with a rare variant of hypogenetic lung syndrome diagnosed by means of multimodality imaging and treated with percutaneous occlusion of the aortopulmonary collateral.
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Affiliation(s)
- Tommaso D'Angelo
- Section of Radiology, Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy.
| | - Alfredo Blandino
- Section of Radiology, Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
| | - Michele B Saitta
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, Taormina, Italy
| | - Salvatore Agati
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Children's Hospital, Taormina, Italy
| | - Placido Romeo
- Department of Radiology, S. Vincenzo Hospital, Taormina, Italy
| | - Silvio Mazziotti
- Section of Radiology, Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
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Najm HK, Ahmad M, Salam Y, Klein J, Hasan SM, Majdalany D, Stewart RD, Pettersson G, Karamlou T. Early Outcomes for In Situ Pericardial Roll Repair for Distant Anomalous Pulmonary Venous Return. Ann Thorac Surg 2021; 111:169-175. [DOI: 10.1016/j.athoracsur.2020.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022]
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Al Qasimi N, AL QASSIMI AHMEDM. Respiratory Distress in Neonate With Scimitar Syndrome. Cureus 2020; 12:e12299. [PMID: 33520501 PMCID: PMC7837649 DOI: 10.7759/cureus.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Scimitar syndrome is a relatively uncommon association of congenital cardiopulmonary anomalies characterized by partial or complete anomalous pulmonary venous drainage from the right lung. It can present in the neonatal period, as well as later in life. In this paper, we present a case of a 15-day-old Saudi boy diagnosed with scimitar syndrome who presented with a chest infection and respiratory distress, along with a brief review of the literature. Key diagnoses, such as chest x-ray, echocardiography, and computerized tomography of the chest, led to the conclusion that the patient was a rare scimitar syndrome case. Understanding that scimitar syndrome usually presents with variable symptoms, we had to perform several diagnostic tests before concluding this was a scimitar syndrome case. Infantile scimitar syndrome requires a high degree of suspicion for early referral and management, so we needed to conduct a special diagnostic test. Our literature review of scimitar syndrome has supported our findings and encouraged us to share this rare scimitar syndrome case.
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Hepatopulmonary fusion: A rare variant of congenital diaphragmatic hernia. J Pediatr Surg 2020; 55:1903-1907. [PMID: 31708208 DOI: 10.1016/j.jpedsurg.2019.09.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hepatopulmonary fusion (HPF), a rare anomaly associated with right congenital diaphragmatic hernia (CDH), is characterized by a fibrovascular fusion between herniated liver and lung parenchyma. We aimed to clarify patient characteristics, management strategies, and outcomes in HPF. METHODS Data on infants with HPF were obtained from the Congenital Diaphragmatic Hernia Registry (CDHR). Patient characteristics, management, and outcomes were compared with the results of a literature review. RESULTS Ten cases of HPF were identified in the CDHR. Five patients survived. The median estimated gestational age was 38 weeks (range 36-40). Median birth weight was 2.7 kg (range 2.0-3.8 kg), but non-survivors had a lower median birth weight (2.3 kg vs. 3.5 kg). All patients had at least 1 congenital anomaly in addition to CDH. Operative approach varied, but most surgeons performed only partial separation of the liver and lung (n = 6). The 2 patients who underwent complete separation both ultimately died, 1 due to significant postoperative complications and 1 due to severe pulmonary hypertension with multiple vascular anomalies. CONCLUSION Partial separation of liver and lung appears to be the wisest surgical approach in HPF, as complete separation has resulted in catastrophic complications due to frequent underlying vascular anomalies. LEVEL OF EVIDENCE IV.
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Sha JM, Zhao H, Lin ZB. Anomalous Systemic Arterial Supply to the Lung: To Which Category Should This Belong? Heart Lung Circ 2020; 29:1292-1300. [PMID: 32349946 DOI: 10.1016/j.hlc.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/23/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The nomenclature of both intralobar pulmonary sequestration (ILS) and aortic origin of a pulmonary artery (AOPA) remains controversial. According to this review, both ILS and AOPA have an anomalous systemic arterial supply to all or part of the lung with venous drainage into the pulmonary veins, which leads to pulmonary hypertension, congestive heart failure, and fatal pulmonary haemorrhage. The purpose of this review was to consider whether these two rare congenital anomalies have similar anatomical, clinical and pathological characteristics. METHODS This review was conducted by researching relevant literature using PubMed and MEDLINE databases to January 2019. All researched literature was related to the anatomical, associated anomalies, pathophysiology and clinical features of the extralobar pulmonary sequestration (ELS), ILS, and AOPA, and the therapeutic method for ILS and AOPA. RESULTS Through research literature, it was found that ILS and AOPA may differ in terms of embryonic origin, but some of the anatomical, histopathological, physiological and clinical features of these two congenital malformations are similar. However, ELS and ILS have significant differences in their anatomical, histopathological, physiological, and clinical features. CONCLUSIONS This study proposes that ILS and AOPA could be classified as one single condition - systemic arterialisation of the lung - and further divided into three subtypes, namely: types I, II and III. This new classification nomenclature permits the appropriate change of novel surgical techniques, which obviate the need for lobectomy or segmentectomy in specific cases, thereby minimising fatal postoperative complications.
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Affiliation(s)
- Ji-Ming Sha
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
| | - Hui Zhao
- Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Ze-Bang Lin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
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Tirado FP, Faconi NPF, Corso RB, Silva IA. A Very Rare Combination: two Scimitar Veins and a Myocardial Bridge. Braz J Cardiovasc Surg 2020; 35:229-231. [PMID: 32369305 PMCID: PMC7199994 DOI: 10.21470/1678-9741-2018-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Scimitar syndrome is a rare congenital anomaly characterized by partial or complete anomalous pulmonary venous drainage of the right (rarely left) lung into the inferior vena cava. This anomalous vein resembles the curved Turkish sword “scimitar”[1]. Only few cases were reported with two scimitar veins[2]. “Myocardial bridge” constitutes a portion of the myocardial tissue that bridges a segment of the coronary artery, mostly the left anterior descending coronary artery . For the first time, a combination of double scimitar vein and a myocardial bridge was described in this study.
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Affiliation(s)
- Freddy Ponce Tirado
- Clinica Delgado Auna - Cardiac Surgery Lima Peru Clinica Delgado Auna - Cardiac Surgery, Lima, Peru
| | | | - Ricardo Barros Corso
- Cardiovascular Associados Brasília Distrito Federal Brazil Cardiovascular Associados, Brasília, Distrito Federal, Brazil
| | - Isaac Azevedo Silva
- Cardiovascular Associados Brasília Distrito Federal Brazil Cardiovascular Associados, Brasília, Distrito Federal, Brazil
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Vida VL, Guariento A. A sword threatening the heart: The scimitar syndrome. JTCVS Tech 2020; 1:75-80. [PMID: 34317722 PMCID: PMC8288726 DOI: 10.1016/j.xjtc.2020.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/21/2019] [Accepted: 01/03/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alvise Guariento
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
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Computed Tomography Angiography and Magnetic Resonance Angiography of Congenital Anomalies of Pulmonary Veins. J Comput Assist Tomogr 2019; 43:399-405. [DOI: 10.1097/rct.0000000000000857] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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