Page 9 - Journal of Structural Heart Disease Volume 2, Issue 5

Original Research Article 210
Figure 3. Cardiac catheterization (anterior-posterior views). Panel A. Levophase after right pulmonary angiography demonstrates typical curvilinear pattern (arrows), the so-called “scimitar sign.” Drainage of the upper and middle right pulmonary veins into this de- scending vein (asterisks) connected to the inferior vena cava (IVC) is evident. Panel B. A guide catheter was directed from the IVC into the scimitar vein; hand injection of contrast demonstrates free drainage of the right upper pulmonary vein into this descending vein (arrow) and the left atrium (asterisk). Panel C. Diameter of the connecting vein is 13.9 mm, stenosis before drainage to the IVC 6.6 mm. Panel D. The lower part and stenosis of the anomalous vein are documented by direct angiography. Panel E. Test balloon occlusion of the lower connecting vein. Panel F. After implantation of an Amplatzer Vascular Plug II into the lower part of the scimitar vein, hand injection through the delivery sheath demonstrates no obstruction of the hepatic venous ow into the IVC.
was slightly elevated at 34 mmHg, and the mean pulmonary arterial pressure was 26 mmHg with an indexed pulmonary vascular resistance of 3.0 WE × m2 and a pulmonary to systemic vascular resistance (Rp:Rs) ratio of 0.19. No pulmonary vasodilator studies were performed in the cardiac catheterization lab. The right pulmonary veins were tortuous without any obvious obstruction (Figure 3B). Angiography of the
descending aorta did not reveal evidence of aortopulmonary collateral arteries. Balloon wedge angiography into the right lower pulmonary artery delineated the lower part of the scimitar vein in detail, demonstrating moderate stenosis just below the diaphragm (Figure 3C, D). Balloon occlusion of the vessel did not result in elevation of pulmonary right venous pressure or left ventricular end-diastolic
Journal of Structural Heart Disease, October 2016
Volume 2, Issue 5:208-212