Unanticipated stenosis of the systemic arterial supply in scimitar syndrome

A 28-year-old woman, with known Scimitar syndrome, was evaluated for moderate exercise intolerance. Examination was notable for grade 2/6 systolic murmur over the pulmonary area. The electrocardiogram was unremarkable. Chest X-ray demonstrated dextroposition of the heart with a shadow suggestive of the scimitar vein. Transthoracic echocardiogram was technically challenging with no evidence of pulmonary hypertension or intracardiac shunts. Cardiovascular magnetic resonance showed moderately dilated right …