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Zhou Y, Liu S, Feng J, Xu F, Duan J, Xu F. Does this child just have an atrial septal defect? More potentiality of interventional therapy: A rare case report. Int J Surg Case Rep 2024; 120:109783. [PMID: 38795410 PMCID: PMC11143909 DOI: 10.1016/j.ijscr.2024.109783] [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: 03/31/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Partially anomalous pulmonary venous connection (PAPVC) is a rare congenital heart disease, often concomitant with atrial septal defects (ASDs). PAPVC usually tends to be treated by surgery, but the case we report will open up new perspectives for the interventional treatment of PAPVC present with ASD. CASE PRESENTATION We present a case of a 2-year-old 11 kg boy transthoracic echocardiography showed secundum-type ASD. A supracardiac-PAPVC was accidentally detected during cardiac catheterization, and an abnormal pulmonary vein connection was detected with a vertical vein (VV) opening. Ultimately, ASD and VV were both occluded. CLINICAL DISCUSSION Surgical therapy of PAPVC is the first line treatment of most centers in the world. However, the main complications after surgical repair of PAPVC raise our concerns, such as pulmonary stenosis, caval vein stenosis and sinus node dysfunction. Therefore, percutaneous closure of PAPVC can be an alternative method. This case of percutaneous interventional closure of ASD and supracardiac PAPVC through a vertical vein in the same surgery was first reported. Patients with ASD tend to have missed diagnoses of PAPVC. We can evaluate it by transesophageal echocardiography (TEE), cardiac magnetic resonance imaging (CMR) and computed tomography (CT). CONCLUSIONS This case suggests that the effect of interventional therapy is quite reliable. For children with ASD, attention should be paid to the omission of the presence or absence of PAPVC before surgery. During interventional therapy, a guide wire rather than a catheter should be preferred to explore the atrial septum and pulmonary veins to avoid a missed diagnosis of PAPVC.
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Affiliation(s)
- Yunguo Zhou
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China; JXHC Key Laboratory of Children's Cardiovascular Diseases, Nanchang, China
| | - Sijia Liu
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China
| | - Jiali Feng
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China
| | - Fang Xu
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China; JXHC Key Laboratory of Children's Cardiovascular Diseases, Nanchang, China
| | - Junkai Duan
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China; JXHC Key Laboratory of Children's Cardiovascular Diseases, Nanchang, China
| | - Fei Xu
- Jiangxi Provincial Children's Hospital, Nanchang, China; Nanchang University, Nanchang, China; JXHC Key Laboratory of Children's Cardiovascular Diseases, Nanchang, China.
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Zezular I, Hanse LC, Choe HJ, Craiem D, Lugones I. Eleven Years After Scimitar Syndrome Repair With the Lugones Technique: Usefulness of Four-Dimensional Flow Magnetic Resonance Imaging. World J Pediatr Congenit Heart Surg 2024; 15:515-518. [PMID: 38711171 DOI: 10.1177/21501351241232591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Anatomic and physiologic assessment of surgical repair of scimitar syndrome can be challenging. We evaluated the first patient who underwent the Lugones procedure in 2012 using 4D flow magnetic resonance imaging. With this technology, we demonstrate that the reconstructed right pulmonary venous return drains into the left atrium with laminar flow, just as normal pulmonary veins do.
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Affiliation(s)
- Idara Zezular
- Cardiac Surgery Unit, Hospital Provincial Neuquén "Dr. Eduardo Castro Rendón", Neuquén, Argentina
- Cardiac Surgery Unit, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Hyon Ju Choe
- Department of Cardiology, Hospital de Niños "Dr. Ricardo Gutierrez", Buenos Aires, Argentina
- Cardioimaging Section, Argus Diagnóstico Médico, Buenos Aires, Argentina
| | - Damian Craiem
- Institute of Translational Medicine, Transplantation and Bioengineering (IMeTTyB), Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | - Ignacio Lugones
- Cardiac Surgery Unit, Hospital General de Niños "Dr. Pedro de Elizalde", Buenos Aires, Argentina
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3
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Luknár M, Hlivák P, Lesný P, Goncalvesová E. Scimitar Syndrome in Adulthood: Challenges in Management and Individualized Approaches. Cureus 2024; 16:e61857. [PMID: 38975546 PMCID: PMC11227615 DOI: 10.7759/cureus.61857] [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: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Scimitar syndrome is a congenital disorder characterized by partial anomalous pulmonary venous return to the inferior vena cava (IVC). Clinical manifestation in adulthood is infrequent. The management approach has not been universally accepted and may be challenging. Individually tailored and multidisciplinary team-based decisions are often necessary. We present the case of a symptomatic patient diagnosed with complex congenital heart disease, including scimitar syndrome and atrial septal defect at the age of 50 years. Surgical repair, involving scimitar vein implantation in the left atrium using a pericardial patch, was performed. Despite surgical correction, dyspnea persisted, and hemoptysis developed. A diagnostic workup revealed a critical stenosis of the re-inserted vein. This was successfully treated by percutaneous intervention with stent implantation. The patient has remained asymptomatic since the procedure. Scimitar syndrome can be first diagnosed in adulthood, and clinical manifestations can vary. Diagnostic workup necessitates a CT angiogram, magnetic resonance scan, and catheterization in selected cases. Stenoses of re-implanted pulmonary veins (PVs) can develop years after surgical correction, and hemoptysis may serve as a warning symptom prompting further PV imaging. Percutaneous vascular intervention using a stent is warranted in symptomatic cases and can lead to long-term success.
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Affiliation(s)
- Milan Luknár
- Department of Cardiology, Faculty of Medicine, Comenius University, Bratislava, SVK
- Department of Cardiology, Faculty of Medicine, National Cardiovascular Institute, Bratislava, SVK
| | - Peter Hlivák
- Department of Arrhythmia and Pacing, Slovak Medical University, Bratislava, SVK
- Department of Arrhythmia and Pacing, National Cardiovascular Institute, Bratislava, SVK
| | - Peter Lesný
- Department of Cardiology, Faculty of Medicine, Comenius University and National Cardiovascular Institute, Bratislava, SVK
- Department of Cardiology, Faculty of Medicine, National Cardiovascular Institute, Bratislava, SVK
| | - Eva Goncalvesová
- Department of Cardiology, Faculty of Medicine, Comenius University, Bratislava, SVK
- Department of Cardiology, Faculty of Medicine, National Cardiovascular Institute, Bratislava, SVK
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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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6
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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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Jamil SF, Alsalahi EH, Alamri AA, Alsaman MA. Bronchial Asthma With Scimitar Syndrome: A Case Report. Cureus 2024; 16:e51823. [PMID: 38192526 PMCID: PMC10772306 DOI: 10.7759/cureus.51823] [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: 01/07/2024] [Indexed: 01/10/2024] Open
Abstract
Scimitar syndrome is a rare congenital cardiopulmonary anomaly; it is also called venolobar syndrome, hypogenic lung syndrome, and Halasz syndrome. The syndrome is characterized by cardiac dextroposition, right lung and pulmonary artery hypoplasia as well as complete or partial anomalous pulmonary venous drainage of the right lung. We report a case of a 22-month-old full-term male child with a severe form of scimitar syndrome diagnosed at birth. The X-ray demonstrated dextrocardia and right lung hypoplasia, while the echocardiography clearly illustrated the scimitar vein. The patient had multiple ER visits and hospitalizations due to asthma exacerbation that was aggravated by recurrent respiratory tract infections; he responded well to asthma medications during his admissions yet compliance to his prophylactic asthma medications was poor at home.
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Affiliation(s)
- Syed F Jamil
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
- Pedaitrics, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Elham H Alsalahi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abaad A Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Majd A Alsaman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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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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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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Recker F, Weber EC, Strizek B, Herberg U, Brockmaier K, Gottschalk I, Geipel A, Gembruch U, Berg C. Prenatal Diagnosis and Outcome of Scimitar Syndrome: A Case Series of Six Patients. J Clin Med 2022; 11:jcm11061696. [PMID: 35330021 PMCID: PMC8954158 DOI: 10.3390/jcm11061696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023] Open
Abstract
Scimitar syndrome is a rare disease characterized by hypoplasia of the right lung and partial anomalous pulmonary venous drainage to the inferior vena cava. All cases with a prenatal diagnosis of scimitar syndrome with or without associated malformations in an 18-year period (2000–2018) in two large tertiary referral centers (University of Bonn and University of Cologne, Germany) were retrospectively reviewed for the intrauterine course and postnatal outcome. Six cases were diagnosed in the study period. All presented with hypoplasia of the right lung, right-sided mediastinal shift, and abnormal pulmonary venous drainage to the inferior vena cava. Systemic arterial blood supply to the right lung, albeit postnatally present in all cases, could not be detected prenatally. Major associated anomalies were present in all cases and included atrial septal defect (n = 5), coarctation (n = 3), diaphragmatic hernia (n = 2), and VACTERL association (n = 1). Half of the cohort died within 6 months after birth and all three survivors suffer from long-term pulmonary sequelae. The primary hint to the prenatal diagnosis of scimitar syndrome is the abnormal position of the heart in the chest. If searched for, abnormal venous drainage can be identified prenatally and confirms the diagnosis. The prognosis depends on the presence of associated major anomalies and the need for neonatal intervention.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
- Correspondence: ; Tel.: +49-228-28737116
| | - Eva Christin Weber
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany;
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University of Bonn, 53127 Bonn, Germany;
| | - Konrad Brockmaier
- Department of Pediatric Cardiology, University of Cologne, 50937 Cologne, Germany;
| | - Ingo Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany;
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany; (E.C.W.); (B.S.); (A.G.); (U.G.); (C.B.)
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany;
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