Scimitar syndrome

Treatment and prognosis of Scimitar syndrome: A retrospective analysis in a single center of East China

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.

Scimitar Syndrome and H-type Tracheo-esophageal Fistula in a Newborn Infant

Scimitar syndrome is a rare congenital anomaly characterized by partial anomalous pulmonary venous drainage of the right lung to the inferior vena cava (IVC) creating a tubular opacity paralleling the right cardiac border on chest radiography which resembles a curved Turkish sword or scimitar. Associated pulmonary and vascular anomalies have been reported in cases of Scimitar syndrome, most commonly hypoplasia of right lung, dextroposition of the heart, hypoplasia of the right pulmonary artery, and aberrant arterial supply from the descending aorta to the affected lobe of the right lung. To the best of our knowledge, this is the first case of Scimitar syndrome with an H-type tracheoesophageal fistula that has ever been reported.

Scimitar syndrome: A novel management approach for palliation in a sick infant

Scimitar syndrome is a rare congenital anomaly essentially requiring surgical management. Nonsurgical interventional treatments are rarely possible and are associated with poor outcome. We report a case of Scimitar syndrome with obstructed partial pulmonary venous confluence, large patent ductus arteriosus, and severe pulmonary artery hypertension, where a significant decrease in the pulmonary artery pressure was achieved by pulmonary venous stenting in combination with coiling of aberrant vascular supply to the sequestered lung segment. However, the child succumbed to lower respiratory tract infection. To the best of our knowledge, no such procedure in combination has been reported in the literature. <Learning Objective: The percutaneous approach to deal with pulmonary hypertension in a case of Scimitar syndrome is discussed. The outcome of this case suggests that interventional procedures such as pulmonary venous stenting could be done as an emergent palliative treatment to relieve pulmonary hypertension.>.

Eponym. Scimitar syndrome

Scimitar syndrome is a rare congenital anomaly, characterized by partial or complete anomalous pulmonary venous drainage of the right or left lung into the inferior vena cava. The syndrome is commonly associated with hypoplasia of the right lung, pulmonary sequestration, persisting left superior vena cava, and dextroposition of the heart. The pathogenesis of the syndrome is unclear, but it seems to originate from a basic developmental disorder of the entire lung bud early in embryogenesis. Two main forms of scimitar syndrome have been described. Signs and symptoms can start during infancy (infantile form) or beyond (childhood/adult form). The infantile form generally presents within the first 2 months of life with tachypnea, recurrent pneumonia, failure to thrive, and signs of heart failure. The diagnosis of scimitar syndrome is usually made based on the characteristic chest X-ray films and can be confirmed by angiography; however, it is now done mostly by transthoracic or transesophageal echocardiography, noninvasive computed tomography, or magnetic resonance angiography. Fetal echocardiography using three-dimensional power Doppler imaging permits prenatal diagnosis. Most frequently, patients are asymptomatic in the absence of associated abnormalities and can be followed conservatively. For patients with congestive heart failure, repeated pneumonia, or pulmonary-to-systemic blood flow ratios greater than 1.5 and pulmonary hypertension, it is important to reroute the anomalous right pulmonary veins and repair the associated cardiac defects in order to avoid progression to right ventricular failure. The triad of respiratory distress, right lung hypoplasia, and dextroposition of the heart should alert the clinician to think of scimitar syndrome.

Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing

Anomalies of the vascular system are caused by false embryogenesis and are therefore present from birth. Single-detector row spiral computed tomography angiography (CTA) and multi-detector row computed tomography angiography (MDCTA) have gained increasing importance in the non-invasive assessment of vascular pathologies and replace conventional angiography in many cases. High-resolution volumetric datasets that are acquired during a single breath-hold give the possibility of two- (2D) and three-dimensional (3D)-post-processing. Due to post-processing, even complex vascular malformations are visualized in an understandable way. Furthermore, CTA, in contrast to conventional angiography, depicts not only the vascular structures but also allows assessment of the surrounding anatomical structures. We present cases of rare congenital anomalies of the thoracic vessels using MDCT with special respect to 2D- and 3D-post-processing.

Embolization of the Systemic Arterial Supply via a Detachable Silicon Balloon in a Child with Scimitar Syndrome

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of the anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply.

A case series of five infants with scimitar syndrome

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

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

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

Scimitar syndrome: five cases examined with two-dimensional and Doppler echocardiography

Five patients with scimitar syndrome (three boys, two girls) with a mean age of 3.4 years (range 6 months to 11 years) were studied with two-dimensional and Doppler echocardiography. Four-chamber apical and parasternal short- and long-axis views were obtained, in addition to subcostal views. The anomalous drainage was seen entering the inferior vena cava below the diaphragm in three patients, and in two cases the inferior vena cava was considered normal (both patients had supradiaphragmatic drainage). The anomalous flow velocity pattern was monophasic without reverse flow at atrial contraction. The peak velocity ranged from 0.6 to 1.0 m/s (mean 0.8 m/s). In one case an ostium secundum atrial septal defect was detected. It is concluded that two-dimensional and Doppler echocardiography permit demonstration of the anomalous drainage, analyze the anomalous flow velocity pattern, and detect other associated cardiac abnormalities.

Scimitar etcetera--the dysmorphic right lung

'Dysmorphic lung' is introduced as a term to describe any complex congenital malformation which involves both abnormal vascular morphology and disordered growth of a whole lung. The major group within this definition is the scimitar syndrome, which we choose to mean a hypoplastic lung with anomalous venous drainage and various degrees of collateral arterial supply. Nine typical cases of scimitar are presented, with three closely related cases. Six other cases of dysmorphic lungs are also present. The relationships between the groups are discussed, and an effort is made to clarify the nomenclature used in this condition.