Case Report Percutaneous Intracardiac Baffle Stenting After a Scimitar Vein Correction Werner Budts, 1 * MD, PhD, Filip Rega, 2 MD, PhD, and Marc Gewillig, 1 MD, PhD A typical scimitar vein was surgically corrected in a female patient of 35 years old. The postoperative course was uneventful and in the first months after the functional capacity normalized. Six months after the correction, the patient developed progres- sive dyspnea. Kinking and distal stenosis of the intracardiac baffle which connected the scimitar vein to the left atrium were diagnosed. Balloon dilatation and stenting could normalize the blood flow through the baffle. The patient remains symptom-less up to six months after the procedure. V C 2012 Wiley Periodicals, Inc. Key words: congenital heart disease; anomalous pulmonary venous return; stent; transcatheter intervention INTRODUCTION The number of adult congenital heart disease patients is continuously growing. As the consequence of repair in childhood, some residual lesions persist and sequels may become more important at older age. Also, due to advanced imaging techniques and better awareness of underlying structural anomalies, some congenital defects are merely diagnosed later in life. In several of these cases, surgery is indicated for prognostic reasons. How- ever, redo surgery or repair at older age is more complex and holds a higher risk for complications. Therefore, when surgery did not succeed, a less invasive transcathe- ter procedure might still belong to the possibilities. This is one of the reasons for the growing interest in hybrid procedures. We present a case report, where a patient had surgery for a congenital heart defect, the short-term result was not optimal, but a transcatheter procedure could offer a therapeutic solution. CASE REPORT A 35-year-old female patient was referred to our hospital for the correction of a scimitar vein, an anom- alous pulmonary venous return of the entire right lung into the inferior vena cava. She was treated conserva- tively for years, but became recently symptomatic. Transthoracic echocardiography showed enlarged right heart cavities and right heart catheterization revealed a pulmonic to systemic cardiac output ratio of 1.7/1 without pulmonary hypertension. There were no medi- cal antecedents except bronchial asthma, which was treated with inhalation corticosteroids and bronchodila- tors. The surgeon created an intracardiac baffle with an autologous pericardial patch between the scimitar vein and the left atrium, as indicated in Fig. 1. The corrective procedure went easily, the postopera- tive course was uneventful, and the patient became completely asymptomatic. However, after 6 months, she started to complain from shortness of breath, even more than before the surgical correction. The physical examination, the electrocardiogram, and the chest X-ray were all normal. Transthoracic echocardiography showed normalized dimensions of the right heart, how- ever, a distal baffle stenosis was observed on transoe- sophageal echocardiography (Fig. 2). A CT scan of the chest showed also a kink in the intracardiac baffle at the level of the diaphragm (Fig. 3). 1 Congenital Cardiology, University Hospitals Leuven, Belgium 2 Congenital Cardiac Surgery, University Hospitals Leuven, Belgium Conflicts of interest: Nothing to report. *Correspondence to: Werner Budts, MD, PhD, Congenital and Struc- tural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. E-mail: werner.budts@uzleuven.be Received 4 February 2012; Revision accepted 12 March 2012 DOI 10.1002/ccd.24411 Published online in Wiley Online Library (wiley onlinelibrary.com) V C 2012 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 00:000–000 (2012)