1
|
Ngai C, Freedberg RS, Latson L, Argilla M, Benenstein RJ, Vainrib AF, Donnino R, Saric M. Multimodality imaging of scimitar syndrome in adults: A report of four cases. Echocardiography 2018; 35:1684-1691. [DOI: 10.1111/echo.14124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Calvin Ngai
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Robin S. Freedberg
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Larry Latson
- Department of Radiology; New York University Langone Health; New York City New York
| | - Michael Argilla
- Department of Pediatrics; New York University Langone Health; New York City New York
| | - Ricardo J. Benenstein
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Alan F. Vainrib
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| | - Robert Donnino
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
- Department of Medicine (Cardiology); VA New York Harbor Health Care System (Manhattan Campus); New York City New York
| | - Muhamed Saric
- The Leon H Charney Division of Cardiology; New York University Langone Health; New York City New York
| |
Collapse
|
2
|
Assoignon MP, Christiaens P, Laleman W. Correction of the Scimitar syndrome, a rare cardiac venous anomaly, leading to Budd-Chiari syndrome: a case report. J Med Case Rep 2014; 8:273. [PMID: 25113120 PMCID: PMC4137726 DOI: 10.1186/1752-1947-8-273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Scimitar syndrome is a congenital heart disease characterized by an abnormal drainage of the right lung into the inferior vena cava, the right atrium or a variety of venous connections from the anomalous pulmonary vein to a systemic vein. This left-to-right shunt induces pulmonary hypertension and is an indication for surgical repair in cases of a history of recurrent pneumonia or significant left-to-right shunting. A corrective approach, which consists of rerouting the anomalous pulmonary flow to the left atrium, is usually performed. Complications of scimitar repair are stenosis, thrombosis and occlusion of the scimitar vein and its deviation. CASE PRESENTATION This case report describes a 53-year-old Caucasian woman with known scimitar syndrome, undergoing surgical repair due to invaliding symptoms of dyspnoea, and presenting with postoperative Budd-Chiari syndrome due to anomalous drainage of her right hepatic vein into the left atrium. It is an interesting cause of liver pathology caused by Budd-Chiari that never has been described before. CONCLUSIONS This case report emphasizes the importance of a thorough preoperative evaluation, and the importance of antecedents in newly presenting pathology. It is an interesting cause of a known hepatic syndrome, the Budd-Chiari syndrome. This case report is of interest to many specialties, including Hepatology, Cardiology, Radiology and Cardiovascular Surgery. It exposes a new interesting anatomic variation of the scimitar syndrome with significant postoperative implications.
Collapse
Affiliation(s)
- Marie-Pia Assoignon
- Department of Gastro-enterology/Hepatology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
| | | | | |
Collapse
|
3
|
Ciçek S, Arslan AH, Ugurlucan M, Yildiz Y, Ay S. Scimitar syndrome: the curved Turkish sabre. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:56-61. [PMID: 24725718 DOI: 10.1053/j.pcsu.2014.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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.
Collapse
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
| |
Collapse
|
4
|
Budts W, Rega F, Gewillig M. Percutaneous intracardiac baffle stenting after a scimitar vein correction. Catheter Cardiovasc Interv 2012; 81:E130-3. [DOI: 10.1002/ccd.24411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 03/12/2012] [Indexed: 01/17/2023]
Affiliation(s)
- Werner Budts
- Congenital Cardiology; University Hospitals Leuven; Belgium
| | - Filip Rega
- Congenital Cardiac Surgery; University Hospitals Leuven; Belgium
| | - Marc Gewillig
- Congenital Cardiology; University Hospitals Leuven; Belgium
| |
Collapse
|
5
|
Midyat L, Demir E, Aşkin M, Gülen F, Ulger Z, Tanaç R, Bayraktaroğlu S. Eponym. Scimitar syndrome. Eur J Pediatr 2010; 169:1171-7. [PMID: 20225123 DOI: 10.1007/s00431-010-1152-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 01/20/2010] [Indexed: 12/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Levent Midyat
- Division of Pulmonology-Allergy, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Background—
Scimitar syndrome is a rare congenital heart disease. To evaluate the surgical results, we embarked on the European Congenital Heart Surgeons Association (ECHSA) multicentric study.
Methods and Results—
From January 1997 to December 2007, we collected data on 68 patients who underwent surgery for scimitar syndrome. Primary outcomes included hospital mortality and the efficacy of repair at follow-up. Median age at surgery was 1.4 years (interquartile range, 0.46 to 7.92 years). Forty-four patients (64%) presented with symptoms. Surgical repair included intraatrial baffle in 38 patients (56%; group 1) and reimplantation of the scimitar vein onto the left atrium in 21 patients (31%; group 2). Eight patients underwent right pneumectomy, and 1 had a right lower lobe lobectomy (group 3). Four patients died in hospital (5.9%; 1 patient in group 1, 2.6%; 3 patients in group 3, 33%). Median follow-up time was 4.5 years. There were 2 late deaths (3.1%) resulting from severe pulmonary arterial hypertension. Freedom from scimitar drainage stenosis at 13 years was 83.8% in group 1 and 85.8% in group 2. Four patients in group 1 were reoperated, and 3 patients (2 in group 1 [6%] and 1 in group 2 [4.8%]) required balloon dilation/stenting for scimitar drainage stenosis.
Conclusions—
The surgical treatment of this rare syndrome is safe and effective. The majority of patients were asymptomatic at the follow-up control. There were a relatively high incidence of residual scimitar drainage stenosis that is similar between the 2 reported corrective surgical techniques used.
Collapse
|
7
|
Nuebel J, Januszewska K, Loeff M, Theisen D, Malec E, Dalla-Pozza R. Unique technique of surgery in an unusual variety of Scimitar syndrome: a case report. J Cardiothorac Surg 2010; 5:15. [PMID: 20338047 PMCID: PMC2852378 DOI: 10.1186/1749-8090-5-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/25/2010] [Indexed: 11/10/2022] Open
Abstract
Scimitar syndrome is a rare congenital anomaly characterized by total or partial anomalous pulmonary venous drainage of the right lung to the inferior vena cava. We present a seven year old girl with a systolic murmur who was diagnosed as having a Scimitar syndrome with unusual drainage of the right pulmonary veins. The unique technique of surgery in this patient was appropriate to the unusual, previously not described anatomy.
Collapse
Affiliation(s)
- Julia Nuebel
- Pediatric Cardiology and Intensive Care, Ludwig-Maximilians-University, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
8
|
Vida VL, Speggiorin S, Padalino MA, Crupi G, Marcelletti C, Zannini L, Frigiola A, Varrica A, Di Carlo D, Di Donato R, Murzi B, Bernabei M, Boccuzzo G, Stellin G. The Scimitar Syndrome: An Italian Multicenter Study. Ann Thorac Surg 2009; 88:440-4. [DOI: 10.1016/j.athoracsur.2009.04.099] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/21/2009] [Accepted: 04/24/2009] [Indexed: 01/07/2023]
|
9
|
Karthekeyan RB, Saldanha R, Sahadevan MR, Rao SKG, Vakamudi M, Rajagopal BK. Scimitar Syndrome: Experience with 6 Patients. Asian Cardiovasc Thorac Ann 2009; 17:266-71. [DOI: 10.1177/0218492309104750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Scimitar syndrome is a rare congenital anomaly characterized by anomalous pulmonary venous drainage to the inferior vena cava, causing a left-to-right shunt. Six patients with scimitar syndrome were diagnosed in our hospital between 2002 and 2008. There were 4 girls and 2 boys; 4 < 5 kg in weight, 2 < 8 kg in weight. Scimitar syndrome was suspected in 5 cases because of dextroversion, and diagnosed by color Doppler echocardiography in all 6 when a scimitar vein was detected entering the inferior vena cava. Computed tomography confirmed the diagnosis in all patients. Two patients had horseshoe lung, 2 had a unilobar right lung, 1 had a hypoplastic right lung, and 1 had a hypoplastic right lower lobe. Three patients had severe pulmonary arterial hypertension, 2 had moderate pulmonary arterial hypertension, and one had normal pulmonary arterial pressure. All patients had lower respiratory tract infections, volume loss of the right lung, a normal or hyperinflated left lung, dextroversion of the heart, and scimitar arteries from the descending aorta. Pneumonectomy was performed in 3 patients, lobectomy in 1, ligation of anomalous vessels in 1, and 1 died before surgery.
Collapse
Affiliation(s)
| | - Richard Saldanha
- Sri Ramachandra Medical College and Research Institute Porur, Chennai, India
| | - M Ranjith Sahadevan
- Sri Ramachandra Medical College and Research Institute Porur, Chennai, India
| | - Suresh KG Rao
- Sri Ramachandra Medical College and Research Institute Porur, Chennai, India
| | - Mahesh Vakamudi
- Sri Ramachandra Medical College and Research Institute Porur, Chennai, India
| | | |
Collapse
|
10
|
Rajaii-Khorasani A, Kahrom M, Mottaghi H, Kahrom H. Scimitar syndrome: report of a case and its surgical management. Ann Saudi Med 2009; 29:50-2. [PMID: 19139615 PMCID: PMC2813621 DOI: 10.4103/0256-4947.51820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ahmad Rajaii-Khorasani
- Division of Cardiothoracic Surgery, Ghaem & Razavi Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | | |
Collapse
|
11
|
Karthekeyan RB, Yachendra, Kumar SM, Rao S, Vakamudi M, Komarakshi B, Saldhana R. Pneumonectomy in scimitar syndrome —is it correct? Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0037-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|