A Scimitar Syndrome Variant Associated with Critical Aortic Coarctation in a Newborn

Patient: Female, newborn Final Diagnosis: Scimitar syndrome variant associated with critical aortic coarctaition Symptoms: Absence of pedal pulse • apnea • cardiogenic shock • extremely poor clinical condition • hepatomegaly • livedo reticularis • pallor • tachycardia Medication: — Clinical Procedure: — Specialty: Cardiology • Pulmonology OBJECTIVE: Rare disease BACKGROUND: Scimitar syndrome (SCS) is a rare congenital cardiopulmonary malformation, characterized by anomalous pulmonary venous drainage from the right lung associated with aortopulmonary collateral arteries and pulmonary hypoplasia. The variant described in the case presented here, with total anomalous right pulmonary venous drainage into the superior and inferior vena cava, can be expected in 2% of patients with scimitar syndrome. To the best of our knowledge, the association between the variant of SCS and coarctation of aorta described in our patient has never been reported before in the literature. CASE REPORT: A female newborn with a gestational age of 35 weeks presented with a rare combination of scimitar syndrome and aortic coarctation. The patient had a variant of SCS that included anomalous drainage of the right upper and lower pulmonary vein into the superior and inferior vena cava, respectively; relative right lung hypoplasia; and right lower lobe sequestration supplied by aortopulmonary collateral arteries that originated from the truncus coeliacus. The diagnosis was confirmed with computed tomography angiography after resection of the aortic coarctation with extended end-to-end anastomosis. Subsequently, interventional closure of the collateral artery supplying the right lower lobe was performed with an AMPLATZER™ Vascular Plug 4. The patient’s clinical course was complicated by suspicious acute endocarditis and chylous pleural effusion. After a prolonged hospitalization, she was discharged in clinically stable condition. CONCLUSIONS: The diagnosis of SCS should be considered when pulmonary hypertension persists after coarctation repair in a child with dextroposition of the heart and right lung hypoplasia. Successful treatment of this rare combination of conditions calls for teamwork by highly experienced specialists.