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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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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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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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