Methodist Journal

IN THIS ISSUE

Nutritional Supplements and the Heart

Vol 15, Issue 3 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Dietary Supplements: Facts and Fallacies

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RECOGNITIONS

Drs. Raizner and Cooke Take the Lead in Special Issue on Supplements

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REVIEW ARTICLES See More

Recent Clinical Trials Shed New Light on the Cardiovascular Benefits of Omega-3 Fatty Acids

Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment

Coenzyme Q10

Red Yeast Rice for Hypercholesterolemia

Inorganic Nitrate Supplementation for Cardiovascular Health

Vitamin D and Calcium Supplements: Helpful, Harmful, or Neutral for Cardiovascular Risk?

Cardiovascular Risk of Proton Pump Inhibitors

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

CASE REPORTS See More

A Rare Case of Pancreatitis-Induced Thrombosis of the Aorta and Superior Mesenteric Artery

Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in the Setting of Critical Bicuspid Aortic Valve Stenosis

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Snoopy’s Heart: A Case of Complete Congenital Absence of the Pericardium

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 10, Issue 4 (2014)

Article Full Text

CASE REPORTS

Magnetic Resonance Imaging of a Scimitar Vein and Aortic Dissection

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Article Citation:

Kongkiat Chaikriangkrai, Juan C. Lopez-Mattei, Jose Flores-Arredondo, Huie Lin, Michael Reardon, Su Min Chang, and Dipan Shah. Magnetic Resonance Imaging of a Scimitar Vein and Aortic Dissection. Methodist DeBakey Cardiovascular Journal. October 2014, Vol. 10, No. 4, pp. 257.

doi: https://doi.org/10.14797/mdcj-10-4-257

Keywords
Type B aortic dissecting aneurysm , Scimitar syndrome

Case Report

A 49-year-old man with hypertension presented with epigastric abdominal pain. Using magnetic resonance angiography (MRA), he was found to have a type B aortic dissecting aneurysm (marked * in Figure 1,) with extension from the aortic isthmus to juxtarenal aorta and contained rupture at the thoracic level. Incidentally, MRA also revealed a scimitar vein (marked + in Figure 1), an anomalous right inferior pulmonary vein draining into the inferior vena cava, without associated congenital anomalies. Further investigation demonstrated preserved ventricular function, normal-sized cardiac chambers, and Qp:Qs of 1.2 without evidence of pulmonary hypertension. He underwent a successful repair of the dissection without surgical intervention for the incidental scimitar vein.

Scimitar syndrome, a congenital developmental failure of connecting right pulmonary veins to the left atrium, can be found in an isolated form or in association with other anomalies including right lung hypoplasia, dextroposition of the heart, and atrial septal defect. Diagnosis is made by demonstration of the scimitar vein through cardiac catheterization, computed tomography, or magnetic resonance angiography. Isolated scimitar vein is associated with a benign clinical course and requires no surgical intervention.1 Surgical repair is indicated in symptomatic cases or in those with pulmonary hypertension, increased pulmonary blood flow (Qp:Qs > 1.5), enlargement of the right cardiac chambers, stenosis of the scimitar vein, or associated anomalies that indicate surgery by themselves.2 The aim of the surgery is for physiological correction and not just simply ligating the scimitar vein to decrease the risk of pulmonary congestion or infarction. Current commonly performed surgical approaches include reimplantation of the scimitar vein into the left atrium and creation of intra-atrial baffle to direct blood flow to the left atrium. Both techniques have been shown to have comparable long-term results.3

Figure 1. Magnetic resonance angiography imaging of a Type B aortic dissecting aneurysm (*) and a Scimitar vein (+). Ant: anterior view; Post: posterior view; Rt: right lateral view; Lt: left lateral view.
References
1. Vida VL , Padrini M , Boccuzzo G , Agnoletti G , Bondanza S , Butera G , et al.; en nombre de la Sociedad Italiana de Cardiología Pediátrica. Natural history and clinical outcome of “uncorrected” scimitar syndrome patients: a multicenter study of the Italian society of pediatric cardiology. Rev Esp Cardiol. 2013 Jul;66(7):55660. [Crossref]
2. Najm HK , Williams WG , Coles JG , Rebeyka IM , Freedom RM. Scimitar syndrome: twenty years’ experience and results of repair. J Thorac Cardiovasc Surg. 1996 Nov;112(5):11618; discussion 1168–9. [Crossref]
3. Vida VL , Padalino MA , Boccuzzo G , Tarja E , Berggren H , Carrel T et al. Scimitar syndrome: a European Congenital Heart Surgeons Association (ECHSA) multicentric study. Circulation. 2010 Sep 21;122(12):115966. [Crossref]

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