Methodist Journal

FEATURED GUEST EDITOR

ISSUE INTRO

The Burgeoning Field of Cardio-Oncology

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RECOGNITIONS

Barry H. Trachtenberg Leads Issue on Cardio-Oncology

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REVIEW ARTICLES See More

Heart Failure in Relation to Anthracyclines and Other Chemotherapies

Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

The Role of Cardiovascular Imaging and Serum Biomarkers in Identifying Cardiotoxicity Related to Cancer Therapeutics

Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity

Cardiovascular Toxicities of Radiation Therapy

Electrophysiologic Complications in Cancer Patients

Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment?

Future Directions in Cardio-Oncology

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

Do Not Pass Flow: Microvascular Obstruction on Cardiac Magnetic Resonance After Reinfarction Following Primary Percutaneous Coronary Intervention

CLINICAL PERSPECTIVES See More

EXCERPTA

Cardio-Oncology, Then and Now: An Interview with Barry Trachtenberg

POINTS TO REMEMBER

Onconephrology: An Evolving Field

POINTS TO REMEMBER

Herbal Nephropathy

EXCERPTA

Rolling the Dice on Red Yeast Rice

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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