Right heart complications of ventriculoatrial shunt

Natarajan, Arun; Mazhar, Sajjad

doi:10.1093/eurheartj/ehr164

Cited by 25 publications

(15 citation statements)

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“…[7] However, complications should not be neglected that range from something simple like an occlusion to other more significant problems like bacteremias and cardiac disorders due to cardiac placement and systemic drainage. [2714]…”

Section: Discussionmentioning

confidence: 99%

“…Obstructions, malpositions, and shunt infections are the most frequent problems in VA shunts. [41314] Numerous complications have been reported in the literature and most of them could have been treated or prevented. For example, Elhammady, et al .…”

Section: Discussionmentioning

confidence: 99%

“…To sum up, they diagnosed catheter-related right heart complications, such as significant calcific tricuspid stenosis and a dilated right atrium that was revealed in transthoracic echocardiography. [14] Ben-Ami, et al . reported a catheter related Gram-positive bacteremia and nephritis in a 47-year-old woman who had a VA shunt for 10 years due to hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

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Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

Yavuz

Demirtaş²,

Çalışkan³

et al. 2013

Surg Neurol Int

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Background:Ventricular shunts are used to drain cerebrospinal fluid into extra-cranial spaces. Ventriculoatrial (VA) shunts are provided to transfer cerebrospinal fluid from the cerebral ventricle into the right atrium of the heart. A single center experience of indications, procedure, and clinical outcomes in VA shunt was presented in current study.Methods:VA shunts were applied in 10 patients who had repeated previous shunt dysfunction or infection. The reasons, clinical findings, replacement methods, and postoperative clinical follow-ups and outcomes were recorded retrospectively.Results:There were seven female (70%) and three (30%) male patients; their ages ranged from 5 to 13 years (mean ± SD; 8.5 ± 2.6 years). Shunt re-placement reasons were as follows: Shunt occlusion in five patients, intraperitoneal infection in four patients and a distal catheter was kinked and knotted in one patient. Postoperative early complications were seen in one patient as early catheter thrombosis and catheter revision were applied. Late complications were seen in two patients as follows: Catheter infection and infective endocarditis occurred in one patient and pulmonary thrombus occurred in one other patient. There was not any catheter-related mortality observed at the one year follow-up period.Conclusion:VA shunts may be an option for cerebrospinal fluid drainage at necessary conditions. However, sterilization and general training on asepsy and antisepsy are the most important determinants affecting the clinical outcome due to the cardio systemic relationship.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

Yavuz

Demirtaş²,

Çalışkan³

et al. 2013

Surg Neurol Int

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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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“…36 Yet VA shunting may be underutilized due to the technical preferences and biases of neurosurgeons, as well as concerns arising from case reports of cardiopulmonary complications. 8,18,23,27,28,33,37 However, most of these complications have been reported in adult patients in whom VA shunts had been placed when they were children for pediatric indications. There are few studies directly comparing the complications of VA and VP shunts, particularly in the NPH population.…”

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confidence: 99%

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

McGovern¹,

Kelly²,

Chan³

et al. 2014

JNS

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Object. Ventriculoatrial (VA) shunting is rarely used for patients with normal-pressure hydrocephalus (NPH), likely due to surgeon technical preference and case reports indicating cardiopulmonary complications. However, these complications have typically been limited to adults in whom VA shunts had been placed when they were children. Few studies have directly compared VA shunting to ventriculoperitoneal (VP) shunting in cases of NPH.Methods. The authors retrospectively analyzed all NPH patients treated by a single surgeon at their center from January 2002 through December 2011. Thirty patients were treated with VA shunts (14 male) and 157 with VP shunts (86 male). The patients' mean age (± SD) at surgery was 73.7 ± 9.4 years for VA shunting and 76.0 ± 8.2 years for VP shunting; the median durations of follow-up were 42.0 months (IQR 19.2-63.6 months) and 34.2 months (IQR 15.8-67.5), respectively. Statistical analysis was performed using chi-square tests and Wilcoxon rank-sum tests.Results. Perioperative and postoperative complications for VA and VP shunting cohorts, respectively, included distal revision (2.7% vs 6.6%, p = 0.45), proximal revision (2.7% vs 2.5%, p = 0.97), and postoperative seizure (2.7% vs 1.5%, p = 0.62). Shunt drainage-related subdural hematomas/hygromas developed in 8.1%/27.0% of VA shunttreated patients versus 6.6%/26.4% of VP shunt-treated patients (p = 0.76/0.98) and were nearly always successfully managed with programmable-valve adjustment. Symptomatic intracerebral hemorrhage (1.5%) and shunt infection (2.0%) were only observed in those who underwent VP shunting. Of note, no cardiovascular complications were observed in any patient, and there were no cases of distal occlusion of the VA shunt.Conclusions. The authors found no significant differences in complication rates between VA and VP shunting, and VA shunting was not associated with any cardiopulmonary complications. Thus, in the authors' experience, VA shunting is at least as safe as VP shunting for treating NPH. (http://thejns.org/doi/abs/10.3171/2014.1.JNS131808) Key woRDS • normal-pressure hydrocephalus • ventriculoatrial shunt • ventriculoperitoneal shuntAbbreviations used in this paper: NPH = normal-pressure hydrocephalus; VA = ventriculoatrial; VP = ventriculoperitoneal.

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Right heart complications of ventriculoatrial shunt

Cited by 25 publications

References 0 publications

Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

Minimally invasive technique for insertion of ventriculopleural shunt catheters

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

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