Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

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RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

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REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

Cholesterol: Can’t Live With It, Can’t Live Without It

CASE REPORTS See More

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

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

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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