Aberrant Blood Supply Research Articles

Nano-Based Theranostics Approach in the Management of Cancer: Review.

Cancer is a prevalent and potentially fatal disease worldwide. The proliferation of abnormal cells and uncontrolled cellular growth characterizes cancer. Cancerous tumors exhibit distinct microenvironments characterized by a deficient lymphatic drainage system and aberrant blood supply. Various medications and diagnostic systems exist for cancer treatment, but they all have inherent limitations and undesirable consequences. Consequently, the achievement of effective cancer detection and treatment remains challenging. Theranostics nanoparticles are becoming increasingly popular in nano drug delivery systems. These nanoparticles can diagnose and treat tumors, making them a promising approach in the field. They are designed to be small in size, allowing them to be effective in delivering drugs to targeted areas. Furthermore, these nanoparticles can fundamentally transform the identification and management of several ailments, including cardiovascular disorders and infectious diseases. Such nanoparticles possess dual capabilities, functioning as therapeutic agents and diagnostic tools. They can transport medicinal substances, such as medications, nucleic acids, or therapeutic proteins, and include substances that can be used for imaging, such as contrast agents or fluorescent dyes, to enable non-invasive diagnostics and monitoring of the effectiveness of the treatment. These techniques can be employed for diagnostic purposes to identify, locate, and determine the extent of disorders using imaging modalities such as magnetic resonance imaging, computed tomography, positron emission tomography, and fluorescence imaging. These nanoparticles can deliver therapeutic compounds to specific locations accurately during therapy. This leads to improved effectiveness of the treatment, decreased adverse effects, and better patient outcomes. They offer a potential nanomedicine approach by providing diagnostic and therapeutic capabilities for disease diagnosis and treatment. Theranostics nanoparticles have distinct characteristics and adaptability, which can transform the healthcare sector by facilitating personalized and precise medical treatments.

A persistent median artery piercing the median nerve: a review and clinical implications

BackgroundThis case report documents a rare variation of a persistent median artery. Normally a transient vessel present during embryologic development of the limbs, the median artery typically regresses by the eighth week of life as the radial and ulnar arteries predominate the distal vascular supply of the hand. In a subset of the adult population, this artery remains as a persistent median artery which most often ends in the carpal tunnel or hand without significant vascular dependence.Case presentationAn 84-year-old female cadaver was found bilaterally to have an artery that penetrated the median nerve in the forearm, continued through the carpal tunnel, then joined the superficial arch, giving rise to the common digital artery to the second webspace. It also gave rise to the radialis indicis, the princeps pollicis, and an anastomotic branch to the radial artery.ConclusionsThis anatomic variant of a persistent median artery piercing the median nerve, traversing the carpal tunnel, and providing aberrant primary blood supply to a large area of the hand are details clinically relevant to those who treat hand disorders and injuries.

Acquired Gastric Dieulafoy-Like Lesion due to Aberrant Blood Supply Diverted From the Left Phrenic Artery to an Enlarged Splenule

Dieulafoy lesion is an aberrant submucosal vessel that can erode into the overlying tissue leading to hemorrhage. It is a rare but important cause of gastrointestinal bleeding. We present a case of a patient who developed an acquired Dieulafoy lesion 39 years after splenectomy. Abdominal computed tomography showed an aberrant vessel from a branch of the left phrenic artery, coursing through the gastric fundus to supply a splenule. Angiography with embolization of the aberrant vessel resulted in no further bleeding.

Hidrotórax fetal secundario a secuestro pulmonar intralobar: terapia fetal mediante escleroterapia percutánea bajo guía ecográfica

Pulmonary sequestration is a mass of non-functioning lung tissue that does not communicate with the tracheobronchial tree and has an aberrant blood supply that comes from the systemic circulation. We present the case of a 34-year-old pregnant woman, with a pregnancy of 25 weeks, with an antenatal diagnosis of pulmonary sequestration with pleural effusion, mediastinal compression, cardiac dextroposition and polyhydramnios. Fetal intervention was performed using percutaneous sclerotherapy, successfully. After 4 weeks, there was evidence of absence of pleural effusion, heart in normal position. The pregnancy ended satisfactorily with a newborn in stable condition. Pulmonary sequestration can present a rapid evolution of mass growth, which produces mediastinal compression, fetal hydrops and polyhydramnios, which produces approximately 100% fetal mortality. It is important to know all available therapeutic options, including percutaneous sclerotherapy under ultrasound guidance, to improve fetal prognosis.

CARCINOID TUMOR IDENTIFIED WITHIN A SEQUESTERED LUNG

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary sequestration is the second most common pulmonary congenital abnormality and is rarely associated with malignancy. We present a case of a young woman with hemoptysis found to have two rare concurrent lung pathologies: a lung carcinoid tumor within a pulmonary sequestration. CASE PRESENTATION: 21 year old female presents following an episode of sudden onset hemoptysis. Patient's medical history was notable for two prior episodes of pneumonia in her teenage years. A CT chest angiogram was obtained and revealed a right upper lobe highly vascular mass-like consolidation. This was followed by bronchial artery angiography which identified a torturous bronchial arterial blood supply to the abnormal area of parenchyma with a large draining vein. Patient underwent a 90 minute right upper lobe robotic resection and the abnormal area was identified with an aberrant arterial blood supply suggestive of a pulmonary sequestration. Pathology consistent with typical carcinoid tumor. Patient was discharged home on post operative day 1 and follow up imaging has not shown recurrence. DISCUSSION: Pulmonary sequestration describes an area of abnormal lung tissue with an anomalous systemic arterial blood supply. It accounts for approximately 6% of all lung congenital abnormalities predominantly affecting males 4:1. Typically patients remain asymptomatic and this finding is incidentally noted on imaging. If superinfected this can be confused with a consolidative pneumonia. Therefore, typical presentation in adults includes history of recurrent infections and hemoptysis. These features are also shared with a primary lung malignancy. Typical carcinoid tumors are indolent neuroendocrine tumors that progress slowly and rarely metastasize. Although primary lung carcinoid tumors are rare, accounting for 1% of lung cancers, it is the most common lung malignancy in children and adolescents. The mainstay of treatment, like pulmonary sequestration, involves resection. Further staging and pathological findings determine additional therapies. This case demonstrates the considerations required in the diagnostic approach of a poorly characterized lesion when a patient presents with a life threatening condition such as hemoptysis. The initial CT imaging showed a vascular lesion, however the degree of aberrant arterial blood supply was only appreciated following bronchial angiography. Endobronchial biopsy carried an increased risk of hemorrhage and may have been inadequate to diagnose the underlying malignancy and sequestration. Therefore, a surgical approach was favored. CONCLUSIONS: This case of an uncommon primary carcinoid lung malignancy identified within a rare congenital abnormality of a pulmonary sequestration highlights the importance of carefully considering these atypical diagnoses and the multidisciplinary approach required for successful diagnosis and treatment. REFERENCE #1: Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev. 2004 Mar;5(1):59-68. doi: 10.1016/j.prrv.2003.09.009. PMID: 15222956. REFERENCE #2: Chakraborty RK, Modi P, Sharma S. Pulmonary Sequestration. [Updated 2021 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532314/ REFERENCE #3: Borczuk AC. Pulmonary Neuroendocrine Tumors. Surg Pathol Clin. 2020 Mar;13(1):35-55. doi: 10.1016/j.path.2019.10.002. Epub 2019 Nov 29. PMID: 32005434. DISCLOSURES: No relevant relationships by Robert Cerfolio, source=Admin input No relevant relationships by David Chen, source=Web Response No relevant relationships by Carina Iskandir, source=Web Response No relevant relationships by Benjamin Kwok, source=Web Response No relevant relationships by Elizabeth Morris, source=Web Response No relevant relationships by Roxana Sulica, source=Web Response

Hepatocellular carcinoma with extrahepatic blood supply from right renal artery

Extrahepatic blood supply is seen in around 17–27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70–83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any risk factors for extrahepatic circulation. He successfully underwent transarterial chemoembolization. There was no evidence of residual disease on repeat imaging.

Pelvic kidney

A pelvic kidney is the most common type of renal ectopia and occurs in 1 in 700 live births.1 Pelvic kidneys are usually smaller than expected for gestational age and have an aberrant blood supply. Most of these kidneys are malrotated on their vertical axis, with the hilum facing anteriorly instead of medially toward the spine.

Loss-of-function variants in PPP1R12A: From isolated sex reversal to holoprosencephaly spectrum and urogenital malformations

In two independent ongoing next-generation sequencing projects for individuals with holoprosencephaly and individuals with disorders of sex development, and through international research collaboration, we identified twelve individuals with de novo loss-of-function (LoF) variants in protein phosphatase 1, regulatory subunit 12a (PPP1R12A), an important developmental gene involved in cell migration, adhesion, and morphogenesis. This gene has not been previously reported in association with human disease, and it has intolerance to LoF as illustrated by a very low observed-to-expected ratio of LoF variants in gnomAD. Of the twelve individuals, midline brain malformations were found in five, urogenital anomalies in nine, and a combination of both phenotypes in two. Other congenital anomalies identified included omphalocele, jejunal, and ileal atresia with aberrant mesenteric blood supply, and syndactyly. Six individuals had stop gain variants, five had a deletion or duplication resulting in a frameshift, and one had a canonical splice acceptor site loss. Murine and human in situ hybridization and immunostaining revealed PPP1R12A expression in the prosencephalic neural folds and protein localization in the lower urinary tract at critical periods for forebrain division and urogenital development. Based on these clinical and molecular findings, we propose the association of PPP1R12A pathogenic variants with a congenital malformations syndrome affecting the embryogenesis of the brain and genitourinary systems and including disorders of sex development.

Intralobar Pulmonary Sequestration with Rete Mirabile as Part of Its Systemic Artery

Intralobar sequestration (ILS) is a complex lung lesion where part of a lower lobe lacks communication with the tracheobronchial tree and receives an aberrant arterial blood supply from the systemic circulation. That systemic artery is usually large, originating from the thoracic aorta or the abdominal aorta and its upper branches. We describe a case of ILS where a large systemic artery coming up from below the diaphragm is formed by the convergence of many very small serpiginous arteries coming up from the area of the celiac trunk and common hepatic artery: a kind of “rete mirabile”. This peculiar morphology was not described before.

Loss-of-Function Variants in PPP1R12A: From Isolated Sex Reversal to Holoprosencephaly Spectrum and Urogenital Malformations

In two independent ongoing next-generation sequencing projects for individuals with holoprosencephaly and individuals with disorders of sex development, and through international research collaboration, we identified twelve individuals with de novo loss-of-function (LoF) variants in protein phosphatase 1, regulatory subunit 12a (PPP1R12A), an important developmental gene involved in cell migration, adhesion, and morphogenesis. This gene has not been previously reported in association with human disease, and it has intolerance to LoF as illustrated by a very low observed-to-expected ratio of LoF variants in gnomAD. Of the twelve individuals, midline brain malformations were found in five, urogenital anomalies in nine, and a combination of both phenotypes in two. Other congenital anomalies identified included omphalocele, jejunal, and ileal atresia with aberrant mesenteric blood supply, and syndactyly. Six individuals had stop gain variants, five had a deletion or duplication resulting in a frameshift, and one had a canonical splice acceptor site loss. Murine and human in situ hybridization and immunostaining revealed PPP1R12A expression in the prosencephalic neural folds and protein localization in the lower urinary tract at critical periods for forebrain division and urogenital development. Based on these clinical and molecular findings, we propose the association of PPP1R12A pathogenic variants with a congenital malformations syndrome affecting the embryogenesis of the brain and genitourinary systems and including disorders of sex development.

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Conventional Transarterial Chemoembolization (TACE) of a Hepatocellular Carcinoma with Aberrant Extrahepatic Blood Supply using Balloon Microcatheter for Flow Redirection

Sustained multiple organ ischaemia after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma.

Transarterial chemoembolization (TACE) with drug-eluting beads (DC beads) may enhance drug delivery to tumours and reduce systemic toxicity. TACE with DC beads leads to significantly fewer serious side-effects compared with conventional TACE. A 66-year-old man with hepatocellular carcinoma (HCC) complained of continuous abdominal pain 1 month after TACE with DC beads. At the time of TACE, angiography revealed severe stenosis of both hepatic arteries. The diagnostic work up on admission suggested severe bile duct injury with regional bile duct dilatation, segmental liver and spleen infarction, necrotizing pancreatitis, as well as gastric and duodenal ulcers. The pathology specimens of the duodenum contained DC beads that had passed through small vessels in the connective tissue. The patient's condition appeared to improve after 2 weeks of antibiotic treatment and supportive care, but new multifocal liver and spleen infarction subsequently developed. After 2 months, he was well enough to be discharged. His HCC partially responded to the TACE with DC beads but eventually progressed and he died after 11 months. The present case report highlights unexpected ongoing multiple organ ischaemia in a 66-year-old man treated for HCC using TACE with DC beads. The use of TACE with DC beads should be carefully considered in patients with vascular strictures or aberrant blood supply.

A Case of Intra - Abdominal Extralobar Pulmonary Sequestration: Prenatal Detection, Postnatal Diagnostic Approach and Outcome

This paper describes the perinatal and postnatal outcome of a case considered to have a fetal intra-abdominal extralobar pulmonary sequestration (ELS). Routine midtrimester fetal ultrasonographic scan detected an abdominal echogenic mass between aorta and stomach. It was considered primarily as an intra-abdominal ELS. At postnatal 2 months, computed tomography (CT) scan with intravenous contrast described it as an ELS at the level of diaphragmatic hiatus by showing the aberrant blood supply to the sequestration with venous drainage into the portal confluence. The patient is now 4 years old and asymptomatic; she is being followed-up by a pediatric surgeon. Intra-abdominal ELSs usually remain asymptomatic throughout life; they may be safely observed without surgery unless they become symptomatic or show any change in the characteristics of the radiologic appearance.

Complementary actions of dopamine D2 receptor agonist and anti-vegf therapy on tumoral vessel normalization in a transgenic mouse model.

Angiogenesis contributes in multiple ways to disease progression in tumors and reduces treatment efficiency. Molecular therapies targeting Vegf signaling combined with chemotherapy or other drugs exhibit promising results to improve efficacy of treatment. Dopamine has been recently proposed to be a novel safe anti-angiogenic drug that stabilizes abnormal blood vessels and increases therapeutic efficacy. Here, we aimed to identify a treatment to normalize tumoral vessels and restore normal blood perfusion in tumor tissue with a Vegf receptor inhibitor and/or a ligand of dopamine G protein-coupled receptor D2 (D2R). Dopamine, via its action on D2R, is an endogenous effector of the pituitary gland, and we took advantage of this system to address this question. We have used a previously described Hmga2/T mouse model developing haemorrhagic prolactin-secreting adenomas. In mutant mice, blood vessels are profoundly altered in tumors, and an aberrant arterial vascularization develops leading to the loss of dopamine supply. D2R agonist treatment blocks tumor growth, induces regression of the aberrant blood supply and normalizes blood vessels. A chronic treatment is able to restore the altered balance between pro- and anti-angiogenic factors. Remarkably, an acute treatment induces an upregulation of the stabilizing factor Angiopoietin 1. An anti-Vegf therapy is also effective to restrain tumor growth and improves vascular remodeling. Importantly, only the combination treatment suppresses intratumoral hemorrhage and restores blood vessel perfusion, suggesting that it might represent an attractive therapy targeting tumor vasculature. Similar strategies targeting other ligands of GPCRs involved in angiogenesis may identify novel therapeutic opportunities for cancer.

Aberrant Renal Vessel Causing Hydronephrosis in Crossed-Fused Ipsilateral Ectopic Kidney: A Rare Case Report

A crossed-fused ectopic kidney is a rare congenital anomaly, and uncommonly we see an aberrant vessel as a cause of hydronephrosis in a kidney. We report a case of 4-year-old boy with crossed-fused right renal ectopia with hydronephrosis in the both kidneys. The aberrant renal vessel was found pressing the left pelvi-ureteric junction causing hydronephrosis. Dismembered pyeloplasty of the left kidney was performed anterior to the aberrant vessel. The patient is doing well in the follow-up visits and his renal function is stabilized. Aberrant blood supply may be a cause of hydronephrosis in the crossed-fused ectopic ipsilateral kidney. Keeping this entity in differential diagnosis will help in successful management of the crossed-fused ectopic kidney.

Combined Preoperative Angiography With Transient Uterine Artery Embolization Makes Laparoscopic Surgery for Massive Myomatous Uteri a Reasonable Option: Case Reports

Herein are reported perioperative outcomes in 2 women who underwent laparoscopic myomectomy and hysterectomy to treat massive leiomyomas. Although we counseled the patients about the high risk of conversion to laparotomy, we would not have attempted the laparoscopic approach without a preoperative angiogram and transient uterine artery embolization. Preoperative angiography and selective embolization enable identification of an aberrant parasitic blood supply and minimization of intraoperative bleeding. In the appropriate hands, these tools make a minimally invasive surgical approach possible even for the largest myomatous specimens.

Giant area of transient hepatic attenuation difference, mimicking incidentaloma at liver ultrasound

Concurrent with recent advances in diagnostic imaging techniques, the incidental finding of liver tumors, or incidentalomas, is increasing in asymptomatic and healthy individuals [1]. A 56-year-old healthy man underwent an abdomen ultrasound for a clinical check-up. A diffuse bright liver echo-pattern (indicating a low-moderate grade steatosis) and an unusual image (diameter approximately 10 cm) in the VI–VII hepatic segment, characterized by a massive giant hypoechoic lesion with poorly defined margins and a near rounded hyperechoic area (diameter about 4 cm) in the context were found (Fig. 1). The ultrasonographer suspected an angioma as first diagnostic hypothesis; however the large hypoechoic area around it, was not unique interpretation. In order to clarify the nature of the lesion, a contrast-enhancement examination was indicated to exclude an incidentaloma. Contrast-enhanced ultrasound revealed an irregularly circular lesion, characterized by early arterial nodular enhancement with delayed centripetal fill-in during the arterial phase. At 36 seconds, the lesion had almost completely filled in. At 45 seconds, the lesion was completely enhanced and sustained enhancement was observed in the late phase scan. The picture was suggestive for hepatic angioma (Fig. 2). Contrast-enhanced MultiSlice computed tomography (CT scan) (Fig. 3) was performed to confirm the diagnosis that proved to be an angioma in the VI hepatic segment (diameter about 4.6 cm), revealing in contour a segmental area of transiently increased enhancement during the arterial phase, with isodense aspect to hepatic parenchyma on venous phase thus suggesting transient hepatic attenuation differences (THAD). THAD is a hepatic perfusion anomaly, caused by an aberrant dual blood supply associated with numerous liver disorders, and it is visible on a contrast-enhanced biphasic spiral CT scan as parenchymal areas of high attenuation in the arterial phase, becoming an isodense image with the normal parenchyma in the portal venous phase [2]. Occasionally, attenuation differences may persist up to the portal venous phases due to a concurrent obstruction of a hepatic vein branch. THADs can be confused with tumor lesions, and are a compensatory relationship between two liver sources of blood supply so that the arterial flow increases as the portal flow decreases. In other words, this particular condition, also called steal syndrome, is seen when there are extensive anastomoses between two vascular beds, and the arterial supply to one is stenosed or occluded, resulting in diversion of blood to the other vascular bed. This is a result of communication between the main vessels, sinusoids, and peribiliary venules, which open in response to the autonomic nervous system, and humoral factors activated by the liver’s demand for oxygen and metabolites. These lesions do not cause a mass effect on the vascular structures, and normal hepatic vascular structures can be seen passing through them. The lesions can be encountered in an entire lobe (lobar), segment (segmental), subsegment (subsegmental) or in a sub-capsular area of the liver. THADs may be noted to accompany hypervascular tumors, generally malignant but also benign (hepatocellular carcinoma, hypervascular metastases, cholangiocarcinoma, hemangioma, focal nodular hyperplasia, pyogenic abscess and focal eosinophilic necrosis) due to a steal syndrome [3]. However, they may also occur in patients without hepatic focal G. Parrinello D. Torres (&) G. Licata Biomedical Department of Internal and Specialty Medicine, Di.Bi.Mi.S., Internistic and Cardiovascular Diagnostic Ultrasound Laboratory, A.O.U Policlinico Paolo Giaccone, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy e-mail: daniele_torres@libero.it

A Patient with an Aberrant Pulmonary Blood Supply and Recurrent Infection

A case of intralobar pulmonary sequestration presenting with recurrent episodes of infection is reported. Pulmonary sequestration is a rare congenital malformation characterized by accessory lung tissue with no direct connection to the tracheobronchial tree and is supplied by an aberrant systemic artery. The aberrant artery is key to both diagnosis and treatment. The correct diagnosis may be suspected on clinical grounds and should be confirmed by identifying the lesion and aberrant artery on imaging studies. Surgical resection is curative, taking particular care not to injure the aberrant artery, which may result in devastating intraoperative hemorrhage.

Pulmonary Sequestration: An Aberrant Systemic Blood Supply Demonstrated By Computed Tomographic Angiography With 3-Dimensional Reconstruction

A 2-day-old, full-term neonate diagnosed with a cystic lesion of the left lung during antenatal ultrasound with subsequent magnetic resonance imaging for characterization was referred for surgical consultation. The prenatal magnetic resonance image scan was remarkable for abnormal increased T2 signal of the left upper lobe (arrow, Fig 1) as compared with the remainder of the lungs. The differential diagnosis included bronchopulmonary sequestration versus cystic adenomatoid malformation. The neonate underwent a 16-slice multi-detector computed tomographic angiogram with volume rendered imaging (Fig 2) that revealed a hypervascular mass (3.7 × 2.6 × 2.1 cm) in the anterior aspect of the left lung base with the appearance of normal lung parenchyma. Both the arterial supply, arising from the left subclavian artery immediately proximal to the origin of a dilated left internal mammary artery, and venous drainage exiting the left innominate vein were prominent vessels running parallel to each other (arrow, Fig 2). Findings in the left lung base were compatible with an extralobar sequestration. The patient underwent a muscle-sparing left thoracotomy. Intraoperative findings included the aforementioned sequestered lung segment, adjacent to the inferior lingular segment, which was attached by a solitary vascular pedicle to the chest wall. Division of this attachment allowed for subsequent excision.Fig 2View Large Image Figure ViewerDownload (PPT) Pulmonary sequestration is an uncommon mass comprising 6% of all congenital pulmonary malformations. This consists of nonfunctioning, noncommunicating, primitive lung tissue with its blood supply originating from an anomalous systemic artery [1Laberge J.M. Puligandla P. Flageole H. Asymptomatic congenital lung malformations.Semin Pediatr Surg. 2005; 14: 16-33Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar]. Extralobar sequestration specifically forms less than 10% of all sequestrations, with the majority located in the left chest between the hemidiaphragm and the left lower lobe. Due to the propensity for respiratory, hemorrhagic, and malignant complications, management consists of complete surgical excision [2Shanmugan G. MacArthur K. Pollack J.C. Congenital lung malformations—antenatal and postnatal evaluation and management.Eur J Cardiothorac Surg. 2005; 27: 45-52Crossref PubMed Scopus (95) Google Scholar]. In this particular case, we operated early due to an extenuating psychosocial circumstance (ie, the child and family were at extremely high risk for being lost to follow-up) [1Laberge J.M. Puligandla P. Flageole H. Asymptomatic congenital lung malformations.Semin Pediatr Surg. 2005; 14: 16-33Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar], and the patient was physiologically mature enough to undergo the procedure. Although the precise timing of surgical intervention remains somewhat controversial, the consensus recommendations in the literature are that patients should undergo surgery sometime during infancy; this approach seems to balance the issues of infectious risk, whereas simultaneously optimizing developmental maturation of the child [1Laberge J.M. Puligandla P. Flageole H. Asymptomatic congenital lung malformations.Semin Pediatr Surg. 2005; 14: 16-33Abstract Full Text Full Text PDF PubMed Scopus (233) Google Scholar, 2Shanmugan G. MacArthur K. Pollack J.C. Congenital lung malformations—antenatal and postnatal evaluation and management.Eur J Cardiothorac Surg. 2005; 27: 45-52Crossref PubMed Scopus (95) Google Scholar].

Interventional Rerouting of Scimitar Vein to Left Atrium Using an Amplatzer Vascular Plug

Scimitar syndrome is a rare congenital anomaly accounting for about 0.5% of all congenital heart diseases. In its most common form, it is characterized by anomalous drainage of one or all right side pulmonary veins into inferior vena cava or rarely into hepatic, portal, or azygous veins. Other associated anomalies can be hypoplasia or agenesis of right lung, hypoplasia of right pulmonary artery, bronchial anomalies, aberrant blood supply and (or) sequestration of right lung, and variety of intracardiac defects which commonly includes atrial or ventricular septal defects and tetrology of Fallot. The usual treatment of these patients is surgical rerouting of Scimitar vein into left atrium (LA) by baffle formation, lobectomy, embolization or ligation of aberrant blood supply and various combinations of these. Nonsurgical and interventional treatments are rarely possible. We report a rare case where complete rerouting of anomalous venous drainage to LA could be achieved by interventional treatment by a simple deployment of a vascular plug in combination with embolization of aberrant vascular supply to the same area, thus avoiding surgical intervention.