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Beers KM, Jacobsen CP, Miller SR, Lehenbauer DG, Maldonado E, Husain SA, Calhoon JH. Reintervention and mortality risk after total anomalous pulmonary venous connection repair. Cardiol Young 2023; 33:2228-2235. [PMID: 36636926 DOI: 10.1017/s1047951122004280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Management of total anomalous pulmonary venous connections has been extensively studied to further improve outcomes. Our institution previously reported factors associated with mortality, recurrent obstruction, and reintervention. The study purpose was to revisit the cohort of patients and evaluate factors associated with reintervention, and mortality in early and late follow-up. METHODS A retrospective review at our institution identified 81 patients undergoing total anomalous pulmonary venous connection repair from January 2002 to January 2018. Demographic and operative variables were evaluated. Anastomotic reintervention (interventional or surgical) and/or mortality were primary endpoints. RESULTS Eighty-one patients met the study criteria. Follow-up ranged from 0 to 6,291 days (17.2 years), a mean of 1263 days (3.5 years). Surgical mortality was 16.1% and reintervention rates were 19.8%. In re-interventions performed, 80% occurred within 1.2 years, while 94% of mortalities were within 4.1 months. Increasing cardiopulmonary bypass times (p = 0.0001) and the presence of obstruction at the time of surgery (p = 0.025) were predictors of mortality, while intracardiac total anomalous pulmonary venous connection type (p = 0.033) was protective. Risk of reintervention was higher with increasing cardiopulmonary bypass times (p = 0.015), single ventricle anatomy (p = 0.02), and a post-repair gradient >2 mmHg on transesophageal echocardiogram (p = 0.009). CONCLUSIONS Evaluation of a larger cohort with longer follow-up demonstrated the relationship of anatomic complexity and symptoms at presentation to increased mortality risk after total anomalous pulmonary venous connection repair. The presence of a single ventricle or a post-operative confluence gradient >2 mmHg were risk factors for reintervention. These findings support those found in our initial study.
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Affiliation(s)
- Kevin M Beers
- Department of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Christian P Jacobsen
- Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Stewart R Miller
- University of Texas San Antonio College of Business, San Antonio, TX, USA
| | - David G Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elaine Maldonado
- Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - S Adil Husain
- Department of Surgery and Pediatrics, University of Utah Health Salt Lake City, UT, USA
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
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2
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Elbayomi M, Pathare P, Nooh E, Harig F, Abdullayev F, Weyand M. Better Late Than Never – A Case of a Congenital Left Partial Anomalous Pulmonary Venous Drainage Diagnosed and Treated in The Sixth Decade of Life. Heart Surg Forum 2023; 26:E170-E173. [PMID: 36972599 DOI: 10.1532/hsf.5273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 03/21/2023]
Abstract
Partial anomalous pulmonary venous drainage (PAPVD) is a relatively uncommon cardiac anomaly. The diagnosis might be challenging as are the presenting symptoms. Its clinical course mimics more familiar diseases, e.g., pulmonary artery embolism. We present a case of PAPVD, which had been misdiagnosed for more than two decades. After establishing the correct diagnosis, the patient got his congenital anomaly surgically corrected and showed excellent cardiac recovery in the six months follow up.
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Affiliation(s)
- Mohamed Elbayomi
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
| | - P Pathare
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
| | - E Nooh
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
| | - F Harig
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
| | - F Abdullayev
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
| | - M Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, Germany.
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3
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Campbell MJ, White BR, Rychik J, Linder J, Faerber JA, Tian Z, Cohen MS. Fetal Doppler Echocardiographic Assessment Predicts Severe Postnatal Obstruction in Total Anomalous Pulmonary Venous Connection. J Am Soc Echocardiogr 2022; 35:1168-1175. [PMID: 35863543 PMCID: PMC9643594 DOI: 10.1016/j.echo.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Obstructed total anomalous pulmonary venous connection (TAPVC) is a form of critical congenital heart disease that usually requires urgent postnatal intervention. Knowing which patients have severe obstruction can aid delivery planning. The authors previously developed a novel quantitative metric of pulmonary venous flow, the pulmonary venous variability index (PVVI). The aim of this study was to test the hypothesis that fetal PVVI and vertical vein Doppler velocities are associated with severe pulmonary vein obstruction postnatally. METHODS A retrospective cohort study of neonates with prenatally diagnosed TAPVC was performed. Patients who underwent fetal echocardiography at the Children's Hospital of Philadelphia with Doppler interrogation of the vertical vein were included for analysis. Twenty-nine patients met criteria (21 with heterotaxy, 18 with supracardiac TAPVC). The latest gestation fetal echocardiogram was used. Severe pulmonary vein obstruction was defined as preoperative death or urgent surgery or catheter-based intervention (first day of life). Measurements of PVVI, defined as (maximum velocity - minimum velocity)/mean velocity, were made offline. Wilcoxon rank sum models were used to assess the associations of severe obstruction and PVVI and maximum, mean, and minimum velocities. RESULTS The mean gestational age at the latest fetal echocardiographic examination was 35 weeks (range, 30-39 weeks). Twelve of the 29 patients (41%) met criteria for severe pulmonary vein obstruction. Lower PVVI was associated with greater risk for severe pulmonary venous obstruction (P = .008). The maximum, mean, and minimum velocities in the vertical vein were all significantly associated with severe pulmonary venous obstruction (P = .03, P = .03, and P = .007, respectively). Qualitative assessment of obstruction was not significantly associated with the outcome. Interobserver reliability for all vertical vein Doppler metrics was high (intraclass correlation coefficient > 0.9). CONCLUSIONS Fetal PVVI and maximum, mean, and minimum velocities are associated with severe postnatal pulmonary vein obstruction in TAPVC. Accurate prediction of obstructed TAPVC could allow safer delivery planning. Further research with larger sample sizes is needed to identify the ideal cutoff values for these Doppler measures.
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Affiliation(s)
- Matthew J Campbell
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, Delaware.
| | - Brian R White
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jack Rychik
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jarrett Linder
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer A Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Zhiyun Tian
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Heinisch PP, Kido T, Burri M, Kornyeva A, Mertin J, Vodiskar J, Strbad M, Cleuziou J, Hager A, Ewert P, Hörer J, Ono M. Impact of total anomalous pulmonary venous connection in staged single ventricle palliation. Ann Thorac Surg 2022; 115:1213-1221. [PMID: 35944702 DOI: 10.1016/j.athoracsur.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Total anomalous pulmonary venous connection (TAPVC) with a functional single ventricle is a risk factor for mortality during staged palliation. This study aimed to assess TAPVC's impact on staged palliation outcomes. METHODS In a total of 602 patients with a functional single ventricle who underwent stage 1 palliation (S1P) at our center between 2001 and 2020, 39 (6.5%) patients were associated with TAPVC. Median age at S1P was 12.0 (interquartile range, 7-21) days with a body weight of 3.1 (interquartile range, 2.8-3.6) kg. Outcomes during staged palliation were compared with the remaining 563 patients without TAPVC. Risk factors for mortality were identified using a Cox proportional hazards regression model. RESULTS Primary diagnosis in functional single-ventricle patients with TAPVC included hypoplastic left heart syndromes (n = 13), unbalanced atrioventricular septal defects (n = 12) tricuspid atresias (n = 2), double inlet left ventricle (n = 1), and others (n = 11). Types of TAPVC were supracardiac (n = 21), cardiac (n = 10), infracardiac (n = 6), and mixed (n = 2). Pulmonary venous obstruction (PVO) was associated in 19 (49%) patients. S1Ps included Norwood (n = 13), aortopulmonary shunt (n = 21), and pulmonary artery banding (n = 5). Thirty-day mortality after S1P was significantly increased in patients with TAPVC vs without TAPVC (43.6% vs 16.3%; P < .001). After bidirectional cavopulmonary shunt and total cavopulmonary connection procedures, mortality was low in both groups, and no statistically significant differences were found. Correction of TAPVC at the time of S1P was not found to be a significant risk factor in univariable Cox regression analysis. In univariate and multivariate analysis, PVO was identified as an independent risk factor for mortality in patients with TAPVC (P < .001). CONCLUSIONS Overall survival is lower in TAPVC single-ventricle patients than in non-TAPVC patients. Most deaths after S1P were associated with TAPVC, but not after S2P. PVO is a mortality risk factor in TAPVC patients.
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Affiliation(s)
- Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Takashi Kido
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Anastasiya Kornyeva
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jannik Mertin
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Janez Vodiskar
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martina Strbad
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julie Cleuziou
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
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5
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Khatib N, Bronshtein M, Beloosesky R, Kidron D, Gover A. Early prenatal diagnosis of scimitar syndrome. Ultrasound Obstet Gynecol 2021; 57:647-648. [PMID: 32196799 DOI: 10.1002/uog.22015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Affiliation(s)
- N Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - M Bronshtein
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - R Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - D Kidron
- Meir Medical Center, Department of Pathology, Kfar Saba, Israel
| | - A Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Mirzai S, Yang B, Mitzman B, Torregrossa G, Balkhy HH. Robotic Repair of Adult Left-Sided Partial Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2020; 111:e77-e79. [PMID: 32693036 DOI: 10.1016/j.athoracsur.2020.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Abstract
Isolated anomalous drainage of the left pulmonary vein to the left innominate vein is a rare variant of partial anomalous pulmonary venous connection. Here, we describe 2 adult patients with this variant who underwent successful robotic totally endoscopic repair with anastomosis of the pulmonary vein to the left atrial appendage.
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama.
| | - Benjamin Yang
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Gianluca Torregrossa
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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8
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Ganapathi P, Nurul Yaqeen ME, Zamzurina AB. It is not asthma! An arcane case of 'Scimitar' syndrome: A case report. Med J Malaysia 2020; 75:184-185. [PMID: 32281607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
'Scimitar' syndrome in adulthood is usually asymptomatic. Significant structural abnormalities symptoms usually manifest early during infancy or young childhood with features of congestive heart failure from significant shunting of the anomalous pulmonary venous drainage. Diagnosis of 'Scimitar' Syndrome in adults is rare and usually an incidental finding on chest radiograph. Here, we report a case of an adult who presented with symptoms in her 40's. This syndrome has never been reported nor discussed in Malaysia. This is the first case report of 'Scimitar' Syndrome in Malaysian literature. The diagnostic dilemma, medical management, and multi-disciplinary management by cardiology, physiotherapy and pulmonary rehabilitation teams are discussed.
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Affiliation(s)
- P Ganapathi
- Hospital Kuala Lumpur, Department of Medicine, Kuala Lumpur, Malaysia.
| | - M E Nurul Yaqeen
- UiTM Medical Centre, Centre for Respiratory Medicine & Sleep Health,Sungai Buloh, Selangor, Malaysia
| | - A B Zamzurina
- Institute of Respiratory Medicine, Kementerian Kesihatan Malaysia, Kuala Lumpur, Malaysia
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9
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Abstract
RATIONALE Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly characterized by the failure of fusion of embryologic pulmonary venous system with left atrium. PATIENT CONCERNS A 45-year-old male patient with PAPVC who was hospitalized because of mild hemoptysis. Images showed the anomalous vein originated from the left upper pulmonary vein and flowed into the left brachiocephalic vein. No other underlying causes for hemoptysis were detected. DIAGNOSIS After multi-disciplinary discussion, the patient was diagnosed as PAPVC of left upper pulmonary vein draining into the left brachiocephalic vein with intact atrial septum. INTERVENTIONS Although surgical correction of PAPVC was feasible, left upper lobectomy was performed as the definitive treatment for both hemoptysis and PAPVC. OUTCOMES The patient had an uneventful postoperative hospital course and was followed up for nearly 2 years without recurrence of hemoptysis. LESSONS PAPVC is associated with atrial septal defect in 80% to 90% of cases while isolated PAPVC with intact atrial septum is an extremely rare entity. We present a rare isolated PAPVC patient with hemoptysis. To our best knowledge, PAPVC associated with hemoptysis has never been reported before.
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Affiliation(s)
| | - Peng Teng
- Department of Cardiothoracic Surgery
| | - Yanyan Yang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, P.R. China
| | - Yiming Ni
- Department of Cardiothoracic Surgery
| | - Liang Ma
- Department of Cardiothoracic Surgery
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10
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Krupickova S, Rigby ML, Jicinska H, Marais G, Rubens M, Carvalho JS. Total anomalous pulmonary venous connection to unroofed coronary sinus diagnosed in a fetus with spinal muscular atrophy Type I. Ultrasound Obstet Gynecol 2017; 50:657-658. [PMID: 28170121 DOI: 10.1002/uog.17432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/06/2017] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Affiliation(s)
- S Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - M L Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - H Jicinska
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
| | - G Marais
- Department of Paediatrics, Croydon Hospital, Croydon, UK
| | - M Rubens
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - J S Carvalho
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
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11
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Abstract
Scimitar syndrome is a variant of partial anomalous pulmonary venous connection (PAPVC), in which all or part of the right lung is drained by right pulmonary veins that anomalously connect to the inferior vena cava (IVC). The affected lung and its associated airways are often hypoplastic. In addition, aortopulmonary collateral vessels may be involved on the affected side, causing sequestration of that side; such involvement is commonly associated with cardiac defects. We report a case of infantile scimitar syndrome that involved a typical association with the right lung, but with extremely unusual associations with congenital hydrocephalus and heart blockage. The presentation of this case and the role of different diagnostic approaches and management are discussed.
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Affiliation(s)
- Abullah Al-Shamrani
- Department of Pediatric, Prince Sultan Medical Military City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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12
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13
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Aboukhoudir F, Aboukhoudir I, Pansieri M, Khennine B, Hirsch JL, Rekik S. [Partial anomalous pulmonary venous return in a 64-year-old woman]. Ann Cardiol Angeiol (Paris) 2015; 64:394-398. [PMID: 26482625 DOI: 10.1016/j.ancard.2015.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Partial anomalous pulmonary venous return (PAPVR) represents 3 % of the congenital cardiopathies. Diagnosis in adults is challenging as clinical symptomatology is non-specific and echocardiographic signs are discrete and misleading potentially confusing with idiopathic pulmonary hypertension. We report the case of a 64-year-old woman in whom we diagnosed PAPVR associated with sinus venosus atrial septal defect. We describe medical history, clinical signs, investigations and postoperative evolution.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - B Khennine
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - J L Hirsch
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier de Belfort, 14, rue de Mulhouse, 90000 Belfort, France.
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14
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Hazelzet T, Durand I, David N. [Total isolated anomalous pulmonary venous return: Are there any clues for prenatal screening?]. ACTA ACUST UNITED AC 2015; 43:541-8. [PMID: 26139032 DOI: 10.1016/j.gyobfe.2015.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a serious congenital anomaly. TAPVC with obstruction of pulmonary venous return is an emergency requiring urgent intervention. Before 2010, very few isolated TAPVC were diagnosed prenatally. It has been suggested in the past literature that the use of Color flow Doppler is particularly useful for the screening of TAPVC prenatally. In fact, although color-Doppler is often useful to confirm a TAPVC diagnosis, it can be quite misleading in the screening process of the condition. Looking at data of missed TAPVC, we describe how to identify TAPVC during routine cardiac screening. Since 2010, our isolated TAPVC prenatal diagnosis rate is more than 40%.
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Affiliation(s)
- T Hazelzet
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France.
| | - I Durand
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
| | - N David
- Unité de cardiopédiatrie, Rouen University Hospital, 1, rue de Germont, 76031 Rouen, France
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15
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Hernández Pérez FJ, Fiz SS, Mirelis JG. Scimitar syndrome: the role of cardiac magnetic resonance. Rev Esp Cardiol (Engl Ed) 2014; 67:766. [PMID: 25172074 DOI: 10.1016/j.rec.2013.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Affiliation(s)
| | - Santiago Serrano Fiz
- Servicio de Cirugía Cardiovascular, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jesus G Mirelis
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Abstract
Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by an anomalous pulmonary vein (scimitar vein) that drains into the inferior vena cava, a hypogenetic right lung, and dextroposition of the heart. It has been reported in 3% to 6% of patients with partial anomalous pulmonary venous connection. Patients are either diagnosed early with severe symptoms (infantile type) or late with minimal symptoms (childhood/adult type). In this chapter we reviewed the history, pathophysiology, presentation, diagnosis, and treatment methods of Scimitar syndrome in the current era.
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Affiliation(s)
- Sertaç Ciçek
- Anadolu Medical Center Hospital, Center for Heart and Vascular Care, Section of Cardiovascular Surgery and Cardiac Anesthesia, Kocaeli, Turkey.
| | - Ahmet Hulusi Arslan
- Anadolu Medical Center Hospital, Center for Heart and Vascular Care, Section of Cardiovascular Surgery and Cardiac Anesthesia, Kocaeli, Turkey
| | - Murat Ugurlucan
- Anadolu Medical Center Hospital, Center for Heart and Vascular Care, Section of Cardiovascular Surgery and Cardiac Anesthesia, Kocaeli, Turkey
| | - Yahya Yildiz
- Anadolu Medical Center Hospital, Center for Heart and Vascular Care, Section of Cardiovascular Surgery and Cardiac Anesthesia, Kocaeli, Turkey
| | - Sibel Ay
- Anadolu Medical Center Hospital, Center for Heart and Vascular Care, Section of Cardiovascular Surgery and Cardiac Anesthesia, Kocaeli, Turkey
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17
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Dusenbery SM, Geva T, Seale A, Valente AM, Zhou J, Sena L, Geggel RL. Outcome predictors and implications for management of scimitar syndrome. Am Heart J 2013; 165:770-777. [PMID: 23622914 DOI: 10.1016/j.ahj.2013.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/03/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Scimitar syndrome is a rare congenital anomaly. We evaluated risk factors for postoperative pulmonary vein stenosis or death and predictive factors for survival without scimitar vein surgery in patients with scimitar syndrome. METHODS The records of patients with scimitar syndrome evaluated at our medical center between 1964 and 2011 were reviewed. RESULTS Scimitar syndrome was identified in 80 patients, with a median follow-up of 4.5 years. Patients presenting less than 1 year of age had a higher incidence of symptoms, aortopulmonary collaterals, coexisting congenital heart disease (CHD), extracardiac anomalies, and pulmonary hypertension. Of 36 patients having scimitar vein surgery, 18 had postoperative pulmonary vein obstruction that occurred with similar frequency after baffle or reimplantation procedures, early or late in the study period, and tended to be more common in infants (P = .10). Overall, 19 (24%) of 80 died. Multivariate risk factors for death included systolic pulmonary pressure >0.5 systemic level (P = .007) and left pulmonary vein stenosis (P = .009). Pulmonary artery systolic pressure <0.5 systemic level (P = .01) and absence of CHD excluding atrial septal defect (P = .01) were predictive factors in 28 patients who survived and did not have scimitar vein surgery; these patients had no or mild right ventricular dilation and a ratio of pulmonary-to-systemic flow <1.6 either at baseline, after coiling aortopulmonary collaterals or nonscimitar vein intervention. CONCLUSIONS Postoperative pulmonary vein obstruction is common after scimitar vein surgery regardless of redirection technique. Pulmonary hypertension and left pulmonary vein stenosis are risk factors for death, whereas patients without significant pulmonary hypertension or associated CHD did well without scimitar vein surgery. These observations may guide management decisions in patients with scimitar syndrome.
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Affiliation(s)
- Susan M Dusenbery
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA
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18
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Affiliation(s)
- Seigo Miyoshi
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Japan.
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19
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Casolo G, Del Meglio J, Tessa C, Comella A, Vignali C. [Scimitar syndrome in adults: a rare anomaly completely characterized by cardiac magnetic resonance]. G Ital Cardiol (Rome) 2012; 13:304-305. [PMID: 22495648 DOI: 10.1714/1056.11563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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20
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21
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Ferreira MS, Carvalho N, Teixeira A, Nogueira G, Marques M, Abecassis M, Neves J, Anjos R. [Total anomalous pulmonary venous connection: a 17-years experience of a single pediatric cardiology center]. Rev Port Cir Cardiotorac Vasc 2012; 19:11-16. [PMID: 23641468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We reviewed our patients who underwent surgical repair for total anomalous pulmonary venous connection at our hospital. MATERIAL AND METHODS All patients with total anomalous pulmonary venous connection who underwent correction from February 1995 to October 2012 were included in this retrospective analysis. Clinical data was collected on presentation,morphology, associated cardiac lesions, echocardiography and cardiac cathetherization results, surgical repair and postoperative course. RESULTS There were 25 patients in the cohort, median age 19 days. The type of total anomalous venous connection was supracardiac in fifteen, cardiac in five, infracardiac in four, mixed-type in one patient. Six patients had single-ventricle anatomy with atrial isomerism in five. All patients with biventricular anatomy had cardiac defects associated: interauricular communication(17), patent arterial duct (9), tricuspid insufficiency (3), pulmonary stenosis (2), interventricular communication (1), mitral valve atresia (1), aortic arch hypoplasia (1). Nine patients (36%) presented with pulmonary venous obstruction. Respiratory distress was the most frequent symptom on presentation (80%), five patients were invasively ventilated. One patient was treated with extracorporeal membrane oxygenation prior to surgical correction. Twenty four cases were diagnosed with transthoracic echocardiography alone. Nine patients were evaluated with angiography that confirmed the echocardiographic diagnosis in eight patients; it allowed diagnosis of total anomalous pulmonary venous connection in one patient. Twenty four patients were submitted to surgery in the first six months of live (68% in neonatal period), one patient was operated at 27 years. Total anomalous pulmonary venous connection was corrected at first surgery in 22 patients. Two patients died after surgical correction,one with infracardiac total anomalous pulmonary venous connection with obstruction and another with supracardiac type with complex cardiac anomaly. There were no deaths in the last eleven years (14 patients). Postrepair pulmonary venous obstruction was diagnosed in one patient who was reoperated successfully. CONCLUSION Echocardiography provides adequate diagnostic data on total anomalous pulmonary venous connection so that surgery can be performed without angiography in most cases. Early surgical correction of total anomalous pulmonary venous connection has acceptable mortality and good long-term postrepair outcome.
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Affiliation(s)
- Mara Silva Ferreira
- Serviços de Cardiologia Pediátrica e de Cirurgia Cardiotorácica do Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Portugal
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22
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Abstract
Scimitar syndrome is a rare congenital heart disease. It is divided into subgroups of infantile, adult, and multiple cardiac and extracardiac malformation. Most patients are diagnosed during infancy and occasionally in adolescence, but very few patients are older than 20 years of age, and only some cases have severe symptoms that require surgical correction. We report a case of a man 54 years of age who was diagnosed with asymptomatic scimitar syndrome with insignificant left-to-right shunt (Qp/Qs = 1.51) with a medical history of type 2 diabetes mellitus and hyperlipidemia. Related literature on scimitar syndrome, particularly on older adults, is also reviewed.
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Affiliation(s)
- Shiang-Fen Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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23
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Dobrowolski P, Zaborowska E, Michałowska I, Kowalski M, Hoffman P. [Scimitar syndrome in an adult - partial anomalous pulmonary venosus connection]. Kardiol Pol 2011; 69:1282-1284. [PMID: 22219109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Scimitar syndrome is a type of partial anomalous pulmonary venous connections, in which part or even the entire right lung is typically drained by right pulmonary veins that anomalously drain into the inferior vena cava. The affected lung is often hypoplastic. The severity of clinical signs and symptoms depend on the degree of a left-to-right shunt and the presence of pulmonary defects. We present a 60 year-old women who has been asymptomatic for a long time.
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24
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Wong DTH, Grosse-Wortmann L, Yoo SJ. Transpleural pulmonary-to-systemic venous collaterals in a case with obstructed scimitar vein. Pediatr Cardiol 2010; 31:1086-8. [PMID: 20508925 DOI: 10.1007/s00246-010-9741-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
Scimitar syndrome is a rare cause of left-to-right shunting. Surgery is indicated for a pulmonary-to-systemic blood flow ratio greater than 1.5:1 and not infrequently is complicated by postoperative obstruction. This report presents a case of scimitar syndrome and reviews how magnetic resonance imaging (MRI) can be used for initial and follow-up assessment of the syndrome with emphasis on suspected pulmonary venous obstruction. Given the potential high incidence of postoperative occlusion, MRI provides hemodynamic and anatomic information for both initial and follow-up assessment of scimitar syndrome. MRI clearly demonstrated transpleural pulmonary-to-systemic venous collaterals draining the obstructed scimitar vein.
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Affiliation(s)
- Derek T H Wong
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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25
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Puccioni E, Paperini L, Festa P. [If things do not make sense or they make it too much. Scimitar syndrome]. G Ital Cardiol (Rome) 2009; 10:118-123. [PMID: 19348150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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26
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Khalilzadeh S, Hassanzad M, Khodayari AA. Scimitar syndrome. Arch Iran Med 2009; 12:79-81. [PMID: 19111036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Scimitar syndrome or congenital pulmonary venolobar syndrome is a rare anomaly most commonly consisting of partial pulmonary venous drainage into the hepatic portion of the inferior vena cava, right lung hypoplasia, dextroposition of the heart, and anomalous systemic arterial supply from aorta or one of its branches to the right lung. We report a four-year-old girl with recurrent pneumonia and failure to thrive, who was diagnosed as having scimitar syndrome.
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Affiliation(s)
- Soheila Khalilzadeh
- Chronic Respiratory Disease Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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27
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Akay HO, Kervancioglu M, Nazaroglu H, Katar S, Ozmen CA, Kilinc I, Senturk S. Horseshoe lung associated with rare bilateral variant of scimitar syndrome: demonstration by 64-slice MDCT angiography. Pediatr Radiol 2008; 38:563-6. [PMID: 18189131 DOI: 10.1007/s00247-007-0722-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Revised: 11/07/2007] [Accepted: 11/27/2007] [Indexed: 11/30/2022]
Abstract
Scimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.
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28
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Khatri S, Khatri P, Kumar RS. Scimitar syndrome in an asymptomatic adult: adult depiction by 64-slice CT angiography. Indian Heart J 2008; 60:271. [PMID: 19240321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Sanjay Khatri
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Mogappair, Chennai 600037, India
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29
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de Castro García FJ, Santos Sánchez JA, Gutiérrez Díez JA. Casos en Imagen: 2.—Síndrome de la cimitarra. Radiología 2007; 49:322, 370-1. [PMID: 17910865 DOI: 10.1016/s0033-8338(07)73798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Makaryus AN, Henry SA, Rutkin B, Boxt L. Thrown a curve. Am J Med 2007; 120:420-1. [PMID: 17466652 DOI: 10.1016/j.amjmed.2007.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 02/15/2007] [Accepted: 02/15/2007] [Indexed: 10/23/2022]
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31
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Dahya V, Mayosi BM. Assessing scimitar syndrome - use of MRI and MRA. S Afr Med J 2007; 97:248-9. [PMID: 17446946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Affiliation(s)
- Vijay Dahya
- Division of Radiology, Groote Schuur Hospital, University of Cape Town, South Africa
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32
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Lam TT, Reemtsen BL, Starnes VA, Wells WJ. A novel approach to the surgical correction of scimitar syndrome. J Thorac Cardiovasc Surg 2007; 133:573-4. [PMID: 17258607 DOI: 10.1016/j.jtcvs.2006.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 10/06/2006] [Accepted: 10/16/2006] [Indexed: 11/23/2022]
Affiliation(s)
- Tuan T Lam
- Department of Cardiothoracic Surgery, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, Calif 90054, USA
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33
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Wu CY, Zhao J, Jiang TY, Huang XY. Noncompaction cardiomyopathy associated with hypogenetic lung. Chin Med J (Engl) 2007; 120:174-6. [PMID: 17335669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Affiliation(s)
- Chang-yan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing 100029, China
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34
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Walsh S. A Swashbuckling film not starring Johnny Depp. J Pediatr Health Care 2007; 21:49-50, 67-8. [PMID: 17198899 DOI: 10.1016/j.pedhc.2006.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 09/12/2006] [Indexed: 11/29/2022]
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35
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Doğan OF, Onuk BE, Demircin M. Incidental diagnosis of Scimitar syndrome using 3-D chest computed tomography in a child. Anadolu Kardiyol Derg 2006; 6:405-6. [PMID: 17162305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Omer Faruk Doğan
- Department of Cardiovascular Surgery, School of Medicine, Hacettepe University, Ankara, Turkey.
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36
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Pérez-David E, Mahía-Casado P, García-Fernández MA. [Scimitar syndrome: application of magnetic resonance angiography]. Rev Esp Cardiol 2006; 59:1330. [PMID: 17194430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Esther Pérez-David
- Laboratorio de Ecocardiografía, Servicio de Cardiología, Hospital Gregorio Marañón, Madrid, Spain
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37
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Abstract
We report a patient with abnormal systemic blood supply to the right lung and right-sided anomalous pulmonary venous drainage to the inferior vena cava (scimitar syndrome or pulmonary venolobar syndrome). In addition, she had an atrial septal defect, underdeveloped right pulmonary artery, an aberrant right bronchus, and tracheobronchomalacia. She improved markedly after palliative interventional closure of her atrial septal defect.
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Affiliation(s)
- Hans H Odland
- Department of Pediatric Cardiology, National Hospital, 0027 Oslo, Norway.
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38
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Abstract
We report a rare variant of the Scimitar syndrome, in which the right lower pulmonary vein takes a meandering course before finally connecting in normal fashion to the left atrium. The pulmonary parenchymal segment drained by the tortuous vein is supplied by a systemic collateral artery, which was coiled via a catheter. We also closed the intracardiac defects by surgery. The elder brother of the patient had classical Scimitar syndrome.
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Affiliation(s)
- Ghassan H Al-Naami
- Cardiac Science Department, Pediatric Cardiology Division, King AbdulAziz Medical City, Riyadh, Saudi Arabia.
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39
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Kashyape SS, Tilak AM. Scimitar syndrome. Indian Pediatr 2006; 43:364-5. [PMID: 16651679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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40
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Babaoğlu K, Eroğlu AG, Adaletli I, Camcioğlu Y. Scimitar syndrome: imaging by telecardiography, heart catheterization and angiography. Anadolu Kardiyol Derg 2006; 6:101-2. [PMID: 16524819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Kadir Babaoğlu
- Department of Pediatric Cardiology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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41
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Espinola-Zavaleta N, Játiva-Chávez S, Muñoz-Castellanos L, Zamora-González C. [Clinical and echocardiographic characteristics of scimitar syndrome]. Rev Esp Cardiol 2006; 59:284-8. [PMID: 16712755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Seven patients with scimitar syndrome underwent retrospective clinical and echocardiographic examination. The findings were: respiratory infection with dyspnea on moderate exercise in 90%, scimitar sign in four (57%), dextrocardia in five (71%), and interatrial septal defect in five (71%), one of whom had patent ductus arteriosus. Overall, two patients had patent ductus arteriosus: one also had aortic coarctation and the other, a bicuspid aortic valve. Dilation of the right cavities was found in five (71%) and blunt edge in five (71%). In two patients, anomalous drainage was into the right atrium; in another two, into the inferior vena cava; and in three, towards the junction of the right atrium and the inferior vena cava. In three patients, drainage was obstructed. Six patients with cardiac abnormalities proceeded to surgery. Scimitar syndrome is a rare entity. In the large majority of patients (86%), diagnosis and follow-up can be performed echocardiographically.
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MESH Headings
- Aortic Coarctation/diagnosis
- Aortic Coarctation/diagnostic imaging
- Aortic Coarctation/surgery
- Cardiac Catheterization
- Dextrocardia/diagnosis
- Dextrocardia/diagnostic imaging
- Ductus Arteriosus, Patent/diagnosis
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/surgery
- Echocardiography, Doppler, Color
- Heart Atria/abnormalities
- Heart Atria/diagnostic imaging
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/surgery
- Humans
- Radiography, Thoracic
- Reoperation
- Retrospective Studies
- Scimitar Syndrome/complications
- Scimitar Syndrome/diagnosis
- Scimitar Syndrome/diagnostic imaging
- Sensitivity and Specificity
- Vena Cava, Inferior/abnormalities
- Vena Cava, Inferior/diagnostic imaging
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42
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Abstract
Scimitar syndrome is a rare congenital anomaly consisting in part of right pulmonary venous return to the inferior vena cava. There is a clear bimodal presentation of this syndrome with either an infantile manifestation or a pediatric/adult form. The infantile variant is marked by a higher incidence and severity of associated defects, heart failure, pulmonary hypertension, and significant mortality. The patient with the pediatric/adult form is less severely affected and may be asymptomatic on diagnosis. In this article, we review the historical aspects, presentation, and pathophysiology of Scimitar syndrome and discuss available treatment strategies. We emphasize the safe and effective approach developed at Indiana University that obviates both the need for an intra-atrial baffle or use of cardiopulmonary bypass. The results with our alternative approach to Scimitar syndrome are summarized and they compare favorably with other published reports.
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Affiliation(s)
- Ulf Gudjonsson
- Section of Cardiothoracic Surgery, James W. Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, IN 46202-5123, USA
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43
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44
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Khan MA, Torres AJ, Printz BF, Prakash A. Usefulness of magnetic resonance angiography for diagnosis of scimitar syndrome in early infancy. Am J Cardiol 2005; 96:1313-6. [PMID: 16253605 DOI: 10.1016/j.amjcard.2005.06.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 06/22/2005] [Accepted: 06/22/2005] [Indexed: 10/25/2022]
Abstract
This study evaluated the feasibility and accuracy of the magnetic resonance angiography (MRA) evaluation of scimitar syndrome in early infancy in 4 subjects. MRA imaging was successful, with excellent imaging quality to evaluate the main and lobar pulmonary artery branches, lobar pulmonary veins, scimitar vein, and systemic-pulmonary collateral arteries in all subjects. There was good agreement between findings with MRA, x-ray angiography (n = 3), surgical inspection (n = 3), and autopsy (n = 1).
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Affiliation(s)
- Muhammad A Khan
- Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
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45
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Abstract
An 18-month-old boy, referred because of an infection of the airways, was found to have a right-sided heart, a hypoplastic right lung, absence of the right pulmonary artery, and persistence of the hepatic venous plexus. The benign association of this unusual variant of the scimitar syndrome and persistence of the hepatic venous plexus needs to be recognised in order to avoid extensive investigations and surgery involving the inferior caval vein.
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Affiliation(s)
- Gabriella Agnoletti
- Service de Cardiologie Pédiatrique, Necker Enfants Malades, 75743 Paris, France.
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46
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Affiliation(s)
- A Khan
- Department of Respiratory and General Medicine, Derriford Hospital, Plymouth PL6 8DH, UK.
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47
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Tueche SG, Demanet H, Goldstein JP, Dessy H, Viart P, Deuvaert FE. Association of a Cor Triatriatum Sinister and a right partial anomalous pulmonary venous return. A case report. Acta Chir Belg 2005; 105:217-8. [PMID: 15906920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A 56-day old baby girl referred for recurrent respiratory tract infections and stridor, showed a rare association of a Cor Triatriatum Sinister (CTS) and a right Partial Anomalous Pulmonary Venous Return (PAPVR), in the form of a stenosed Scimitar vein, draining the right pulmonary veins to the subdiaphragmatic inferior vena cava (IVC), on echography and angiography. The baby underwent successful surgical repair of the CTS, by resection of the obstructive false membrane and reconnection of the Scimitar vein to the left atrium. At the age of 5 years, the child is doing well without any evidence of obstruction on the right or the left pulmonary venous drainage.
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Affiliation(s)
- S G Tueche
- Department of Cardiac Surgery, Brugmann University Hospital, Brussels, Belgium.
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48
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Abstract
Scimitar syndrome, a rare anomaly of partial pulmonary venous drainage into the hepatic portion of the inferior vena cava, detected in a ten-day-old neonate who presented clinically with respiratory distress and diagnosed on ultrasound of the thorax is being reported here.
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Affiliation(s)
- Muktachand L Rokade
- Department of Radiology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Dr. A.L. Nair Road, Mumbai, India
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49
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Abstract
Scimitar syndrome is a relatively uncommon constellation of cardio-pulmonary anomalies, its typical feature being partial anomalous pulmonary venous connection. It can present in the neonatal period as well as later in life. We present the case of a girl diagnosed in the newborn period, along with a brief review of literature.
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Affiliation(s)
- Arvind Sehgal
- Grace Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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Tutar E, Fitöz S, Atalay S, Uysalel A, Aral A, Ekici F, Eyileten ZB, Kendirli T. Magnetic resonance angiographic and three-dimensional computerized tomographic identification of scimitar syndrome in an 8-month-old infant. Turk J Pediatr 2005; 47:92-4. [PMID: 15884639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Scimitar syndrome is a rare congenital abnormality. Clear anatomic definition is an important issue before operation. We report definition of both abnormal pulmonary venous drainage and anomalous systemic arterial supply by gadolinium-enhanced magnetic resonance angiography and three-dimensional computerized tomography in an eight month-old infant with scimitar syndrome. The presented case study confirms that these noninvasive diagnostic tools can successfully be used to provide valuable information about vascular anatomy in infants with scimitar syndrome.
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Affiliation(s)
- Ercan Tutar
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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