Pericardial tunnel technique in the surgical management of the vertical form of scimitar syndrome.

OBJECTIVES

To optimize the surgical strategy and individualized treatment for scimitar syndrome (SS) by summarizing the clinical outcomes of the pericardial tunnel technique for the vertical form of SS at a single centre.

METHODS

The vertical form was defined as an angle of scimitar vein (SV) insertion to the inferior vena cava (θ) ≤ 45°, whereas the horizontal form was defined as θ > 45°. Nine patients with vertical form were operated on from June 2011 to June 2017. The mean age of patients during surgery was 3.1 ± 3.63 (range 0.3-12) years. Five patients were with infantile form and 4 with childhood/adult form per Dupuis' classification. The pericardial tunnel technique entailed attaching the SV to the right lateral pericardium and directing blood flow to the left atrium through a left atriotomy inside the pericardial tunnel. All patients had associated intracardiac anomalies repaired concomitantly; 3 patients had major collateral arteries occluded or ligated.

RESULTS

There was no in-hospital postoperative death or residual SV obstruction. The postoperative ventilation time was 88.3 ± 63.8 (range 36-264) h. Eight survivors were followed up for 33.4 ± 19.2 (range 2-72) months, with 1 lost to follow-up. Echocardiography demonstrated that 7 survivors had no pulmonary hypertension and 1 had mild pulmonary hypertension; none developed SV obstruction during the follow-ups.

CONCLUSIONS

The pericardial tunnel technique is suitable for the vertical form of SS and is a reasonable option for individualized treatment of SS.