Pulmonary hypertension after ventriculoatrial shunt implantation

Kluge, Stefan; Baumann, Hannes; Regelsberger, Jan; Kehler, Uwe; Gliemroth, Jan; Koziej, Barbara; Klose, Hans; Meyer, Andreas

doi:10.3171/2010.6.jns091541

Cited by 32 publications

(13 citation statements)

References 19 publications

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“…Ventriculoatrial shunt became accepted treatment for hydrocephalus in the late 1950s [1]. Previous studies reported development of severe pulmonary hypertension after placement of a VAS [2–4]. In patients with a VAS, pulmonary embolism and pulmonary hypertension were recognized clinically in 0.4% and 0.3%, respectively, whereas, at necropsy the frequency of these complications was 59.7% and 6.3% respectively [2].…”

Section: Discussionmentioning

confidence: 99%

Invalidating headaches as a symptom of pulmonary embolism in a Dandy-Walker syndrome with ventriculoatrial shunt

Marchal

Lairez

Marachet

et al. 2011

European Journal of Neurology

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Ventriculoatrial shunt (VAS) is an accepted treatment for hydrocephalus, submitting intra-cranial pressure to right atrial pressure. Several pathological situations can increase right atrial pressure, frequently as a consequence of pulmonary hypertension, and lead to the recurrence of intra-cranial hypertension. We report an unusual aetiology of invalidating headaches in a 26-year-old woman with history of Dandy-Walker syndrome treated initially by multiple ventriculoperitoneal shunts (VPS) switch 2 years ago by a VAS. Congenital heart disease was excluded during the childhood. She was current smoker, obese (body mass index 32.5 kg/m 2 ) and took combined oral contraceptive pill. She also reported a stage II NYHA class dyspnoea aggravated for 2 weeks. On physical examination, the heart rate was 95 beats per minute and the blood pressure 120/70 mmHg. She had an elevated jugular venous pressure and an accentuated pulmonary component of the second heart sound. Cerebral computed tomography (CT) showed a DandyWalker cyst in the posterior fossa (Fig. 1a). ECG reported a sinus rhythm with tachycardia, S1Q3 pattern and negative T waves in the right precordium (Fig. 1b). Arterial blood gas showed hypoxemia (PaO 2 70 mmHg) and hypocapnia (PaCO 2 32 mmHg; pH 7.43). CT pulmonary angiogram confirmed lingular pulmonary emboli with chronic pulmonary embolism signs as pulmonary artery enlargement and pulmonary vascular thickening (Fig. 1c). There was no abnormality of VAS catheter confirmed by transesophageal echocardiography but there was an interauricular septum curve inversion with a right ventricle dilatation (Fig. 1d), and transthoracic echocardiography confirmed a pulmonary hypertension with 65 mmHg systolic pulmonary arterial pressure. There was no intra-cardiac thrombosis. Bilateral leg venogram ultrasound was normal. The final diagnosis was pulmonary emboli with chronic pulmonary heart complicated by exacerbation of intracranial hypertension because of right atrium pressure overload. Search of thrombophilia was negative. Finally, the VAS was replaced by a ventriculoperitoneal shunt, permitting the retrocession of the pain. Retrospective test of the device didnÕt shown dysfunction. Two years later, she is still alive. She takes an oral anticoagulation and reports a NYHA stage 2 dyspnoea. Transthoracic echocardiography follow-up shows pulmonary hypertension stability. DiscussionVentriculoatrial shunt became accepted treatment for hydrocephalus in the late 1950s [1]. Previous studies reported development of severe pulmonary hypertension after placement of a VAS [2][3][4]. In patients with a VAS, pulmonary embolism and pulmonary hypertension were recognized clinically in 0.4% and 0.3%, respectively, whereas, at necropsy the frequency of these complications was 59.7% and 6.3% respectively [2]. Several hypotheses could explain this phenomenon: latent shunt infection could induce a persistent activation of clotting factors, which leads to recurrent pulmonary embolism [5]; other hypothesis suggests a possible role for cerebrosp...

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Section: Discussionmentioning

confidence: 99%

Invalidating headaches as a symptom of pulmonary embolism in a Dandy-Walker syndrome with ventriculoatrial shunt

Marchal

Lairez

Marachet

et al. 2011

European Journal of Neurology

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“…Two commonly used other loci, the right atrium and gallbladder, have their own problems. 1,3,9,17,19,22 Vascular shunts have the problem of malposition as a child grows, septicemia in the setting of infection, and intracardiac migration of the distal catheter in the event of distal catheter fracture. 2,7 Placing a shunt into the gallbladder is technically more complicated.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive technique for insertion of ventriculopleural shunt catheters

Richardson

Handler

2013

PED

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Object Cerebrospinal fluid diversion to the pleural space has employed various methods to insert the distal catheter into the pleural space. The authors report on a minimally invasive method of pleural catheter insertion that they have developed and have used safely in a small series of patients. Methods Pleural shunt catheters were inserted using a split trochar into the pleural space (technique described in further detail in the article). All cases over the previous 10 years in which this technique was employed were reviewed from the existing electronic medical records. Patient age at insertion, sex, reason for hydrocephalus, early and late complications, valve type, and follow-up were recorded. Results Fourteen shunt procedures performed in 10 patients were identified. Two small pneumothoraces were detected on routine postoperative imaging and required no intervention. There were 3 late mechanical complications, including migration of a catheter out of the pleural space, catheter fracture at the insertion point, and the need for a longer catheter due to the patient's growth. Conclusions The authors describe a safe, minimally invasive method for insertion of pleural shunt catheters along with a series of patients who have undergone placement of a pleural shunt catheter using this method without complication directly attributable to the use of this technique.

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“…This serious complication is caused by a skin commensal organism such as Staphylococcus epidermidis or other bacteria, and it requires revision of the shunt system. Very rarely, pulmonary hypertension caused by venous thrombus formation has been reported as a complication of VA shunt (Piatt & Hoffman, 1989, Tonn et al, 2005, Kluge et al, 2010; this could be lethal. As there are fatal cardiopulmonary complications associated with VA shunt, it should be used only in patients whose peritoneal cavity is not suitable for the placement of a distal shunt catheter.…”

Section: Ventriculoatrial Shunt (Va Shunt)mentioning

confidence: 99%