Diagnostic aid of transesophageal echocardiography in an adult case of scimitar syndrome: confirmation of the findings at surgery and review of the literature.

The diagnosis of scimitar syndrome is straightforward when the scimitar vein is visible on the chest radiograph; however, a diagnosis is not definitive when this vein is obscured by dextroversion, and therefore other investigative modalities are needed. These methods include pulmonary angiography, computed tomographic scan, and magnetic resonance imaging, which have know limitations, and transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), which are particularly useful because they are noninvasive, versatile, and accurate. TEE is superior to TTE in the diagnosis of this syndrome and other forms of partial anomalous pulmonary venous return. TEE should compliment TTE whenever the latter is of poor quality or the information is incomplete. Moreover, TEE is vital in both the perioperative evaluation of the repair and the confirmation of the patency of the pulmonary venous to left atrial anastomosis. The advantages of TEE are demonstrated by this case report, and its accuracy is confirmed at surgery.