Rare sequelae following ventriculoatrial shunt: Case report and review of literature

Abstract

Ventriculoatrial shunt (VA) is one of the oldest solutions for hydrocephalus. However over subsequent years various complication of VA shunt such as obstructions, malposition, shunt infections, cardiac complications such as endocarditis, traumatic perforation, heart failure, tricuspid regurgitation, intraatrial thrombus, and pulmonary hypertension are reported. Hence, VA shunt procedure has fallen into disrepute. Still VA shunt may be a good option in selected patients with hostile peritoneum. Newer placement strategies and monitoring methods have been put forward to reduce complication following VA shunt. In this case report, we share a rare case of endocarditis with tricuspid regurgitation following a migrated retained calcified shunt tube in the right ventricle of heart 30 years after of VA shunt that was successfully managed.

Minimally invasive procedure for removal of infected ventriculoatrial shunts

“…We found several reports describing complications of VAS in adults occurring after the postoperative period (1 month after shunt implantation). Analysis of the reported late complications requiring AVS removal together with the two described in the present work, shows that complications associated with rupture and displacement of the atrial catheter [ 2 , 6 , 15 , 20 , 27 , 36 , 40 ] occur significantly earlier than complications not associated to rupture or displacement of the catheter [ 1 , 4 , 5 , 7 – 9 , 11 , 16 , 29 , 30 , 32 , 34 , 38 , 39 ] (Fig. 5 ).…”

“…3a. d Fluoroscopy antero-posterior projection, obtained after complete removal of the VAS catheter with the safety wire (arrowhead) and guidewire still in place (arrow). e Picture of the distal portion of the VAS catheter obtained immediately after extraction, the catheter is almost completely clean from thrombotic material that was present in vivo enclosed by a large thrombus, or adherent to the atrial wall or to the leaflets of the tricuspid valve are still treated by thoracotomy [13,16,27]. Moreover, emergency thoracotomy is still considered mandatory after cardiac tamponade due to accumulation of CSF in the pericardium secondary to chronic perforation of the atrium by the tip of a VAS catheter which then protrudes into the pericardial space [13,22,27].…”

“…Endovascular approaches were mainly used for retrieval of broken or displaced atrial catheters. However, more complicated cases where the catheter is infected, or enclosed by a large thrombus, or adherent to the atrial wall or to the leaflets of the tricuspid valve are still treated by thoracotomy [ 13 , 16 , 27 ]. Moreover, emergency thoracotomy is still considered mandatory after cardiac tamponade due to accumulation of CSF in the pericardium secondary to chronic perforation of the atrium by the tip of a VAS catheter which then protrudes into the pericardial space [ 13 , 22 , 27 ].…”

Endovascular retrieval of detached ventriculoatrial shunt into pulmonary artery in pediatric patient: Case report

“…Endovascular retrieval of migrated shunts is less invasive, is feasible, and prevents further complications. [ 7 ] The relationship between the catheter and the adjacent cardiac structure is important in decision-making and how safe the retrieval procedure is going to be. This should be assessed by echocardiogram before the retrieval.…”

Intramuscular Migration of Venous Catheter as a Rare Complication of Ventriculoatrial Shunt: Case Report and Literature Review

“…11-13 Therefore, surgery may be required if fragments adhere to the myocardium or cardiac tamponade, perforation, or cardiac thrombus interfere with cardiac valve function. [14][15][16] The causes of death are attributed to indwelling pulmonary artery or intracardiac fragments (recurrent pulmonary embolus). [17][18][19] We report the first case of intramuscular VA shunt migration.…”