PMC6526562_01
Frontal upright PA CXR of patient. Arrow pointing to scimitar vein in the right lower lung.
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fig1
When her cough and other symptoms persisted, a chest X-ray was performed and showed a curvilinear abnormality alongside her right heart border consistent with scimitar syndrome (Figure 1).
Coronal CT with IV contrast. Arrow pointing to scimitar vein in the right lower lobe, which drains into the IVC.
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Computed tomography (CT) of the chest (Figure 2) showed a hypoplastic right upper lobe and compensatory large right lower lobe.
Pulmonary angiogram in anterior-posterior projection. The pigtail catheter is in the right pulmonary artery. The arterial phase [left frame] reveals the right pulmonary arteriogram. The right frame shows the venous phase with the scimitar vein from the right upper lobe draining into the IVC.
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fig3
Right pulmonary artery angiogram identified partial anomalous pulmonary venous return via scimitar vein to the IVC (Figure 3).
Schematic diagram of the scimitar vein and the surgically created baffle. The baffle connects the scimitar vein to the left atrium via the right atrium. The blue arrow points to the ligated scimitar vein.
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fig4
A linear incision was made in the anomalous pulmonary vein, and the graft was sutured to this vein meticulously with a continuous 5-0 Prolene suture (Figure 4).
Echocardiogram, apical four chamber view. The left frame shows the baffle traversing the right atrium and opening into the left atrium. The right frame shows color flow through the baffle into the left atrium.
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fig5
The graft passing through the right atrium was noted to be patent with good flow on Doppler (Figure 5).
3D volume rendering of postoperative CT angiogram from a right anterior oblique view. Arrow pointing to the artificial baffle, draining the scimitar vein, aiming posteriorly toward the left atrium.
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One-month postoperative cardiac-gated CTA showed that the synthetic graft remained widely patent with no evidence of thrombus (Figures 6-9).
3D volume rendering of postoperative CTA from a less oblique RAO view. Arrow pointing to the artificial baffle diverting the scimitar vein toward the left atrium behind the right atrium.
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One-month postoperative cardiac-gated CTA showed that the synthetic graft remained widely patent with no evidence of thrombus (Figures 6-9).
3D volume rendering, cutaway view, of postoperative CTA. Arrow pointing to the artificial baffle connecting the scimitar vein with the left atrium via the posterior aspect of the right atrium.
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fig8
One-month postoperative cardiac-gated CTA showed that the synthetic graft remained widely patent with no evidence of thrombus (Figures 6-9).
Oblique multiplanar reformat of postoperative CTA. Arrow pointing to the widely patent artificial baffle connecting the scimitar vein with the left atrium via the posterior aspect of the right atrium. There is no filling defect inside the graft to suggest thrombus.
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fig9
One-month postoperative cardiac-gated CTA showed that the synthetic graft remained widely patent with no evidence of thrombus (Figures 6-9).