Intracardial Catheter Migration of a Ventriculoperitoneal Shunt: Pathophysiology and Interdisciplinary Management.
Adult
Device Removal
/ methods
Echocardiography, Transesophageal
Heart Atria
/ diagnostic imaging
Heart Ventricles
/ diagnostic imaging
Humans
Male
Neurosurgical Procedures
Patient Care Team
Postoperative Complications
/ diagnostic imaging
Prosthesis Failure
Pulmonary Artery
/ diagnostic imaging
Radiography, Thoracic
Radiology, Interventional
Surgery, Computer-Assisted
Vena Cava, Superior
/ diagnostic imaging
Ventriculoperitoneal Shunt
Interdisciplinary management
Interventional snaring
Interventional therapy
Intracardial migration
Pathophysiology
VP shunt
Ventriculoperitoneal shunt
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
08
10
2019
revised:
13
12
2019
accepted:
15
12
2019
pubmed:
27
12
2019
medline:
25
3
2020
entrez:
27
12
2019
Statut:
ppublish
Résumé
Intracardial migration of a ventriculoperitoneal (VP) shunt (ICMVP) is a rare complication that has been described in only single case reports. Here we report the successful interdisciplinary management of an ICMVP and provide a review of the relevant literature. A 38-year-old-patient with shunt-dependent hydrocephalus caused due to a Blake's pouch cyst presented in our hydrocephalus outpatient clinic with thoracic pain and nocturnal cough at 7 months after VP shunt implantation (with initially a proper location on computed tomography scan of the head and X-ray of the abdomen). A new X-ray of the abdomen and the thorax revealed a dislocated shunt with migration of the distal catheter into the superior cava vein, right atrium, and right heart ventricle, with some loops in both pulmonary arteries. The catheter was successfully removed by an interdisciplinary team in general anesthesia under ultrasound, X-ray guidance, and cardiovascular parameter control by withdrawing the shunt into the superior cava vein and removing the remnant portion of the distal catheter (with a knot) by interventional snaring. Cardiac and vascular surgeons were on standby. The management of an ICMVP is complex and carries a high risk for severe potential complications. Two different pathophysiological mechanisms have been discussed in the literature, including gradual erosion into an adjacent vein and transvenous catheter placement of the initial shunt secondary to subcostal placement of shunt tunneling instruments. The suction effect of the venous system results in gradual pulling of the catheter into the venous system.
Sections du résumé
BACKGROUND
BACKGROUND
Intracardial migration of a ventriculoperitoneal (VP) shunt (ICMVP) is a rare complication that has been described in only single case reports. Here we report the successful interdisciplinary management of an ICMVP and provide a review of the relevant literature.
CASE DESCRIPTION
METHODS
A 38-year-old-patient with shunt-dependent hydrocephalus caused due to a Blake's pouch cyst presented in our hydrocephalus outpatient clinic with thoracic pain and nocturnal cough at 7 months after VP shunt implantation (with initially a proper location on computed tomography scan of the head and X-ray of the abdomen). A new X-ray of the abdomen and the thorax revealed a dislocated shunt with migration of the distal catheter into the superior cava vein, right atrium, and right heart ventricle, with some loops in both pulmonary arteries. The catheter was successfully removed by an interdisciplinary team in general anesthesia under ultrasound, X-ray guidance, and cardiovascular parameter control by withdrawing the shunt into the superior cava vein and removing the remnant portion of the distal catheter (with a knot) by interventional snaring. Cardiac and vascular surgeons were on standby.
CONCLUSIONS
CONCLUSIONS
The management of an ICMVP is complex and carries a high risk for severe potential complications. Two different pathophysiological mechanisms have been discussed in the literature, including gradual erosion into an adjacent vein and transvenous catheter placement of the initial shunt secondary to subcostal placement of shunt tunneling instruments. The suction effect of the venous system results in gradual pulling of the catheter into the venous system.
Identifiants
pubmed: 31877393
pii: S1878-8750(19)33118-3
doi: 10.1016/j.wneu.2019.12.089
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
222-227Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.