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Pulmonary Arterial Hypertension due to Ventriculoatrial Shunts: A Case Report and Literature Review. Neurochirurgie 2022; 68:684-687. [DOI: 10.1016/j.neuchi.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/01/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022]
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Thrombosis associated with ventriculoatrial shunts. Neurosurg Rev 2021; 45:1111-1122. [PMID: 34647222 PMCID: PMC8976808 DOI: 10.1007/s10143-021-01656-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
Ventriculoatrial shunts are the most common second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. Shunting-associated thrombosis is a potentially life-threatening complication after ventriculoatrial shunt insertion. The overall prevalence of this complication is still controversial because of substantial differences in the numbers found in studies using clinical data and in those analyzing postmortem findings. The etiology of thrombosis may be multifactorial, including shunt catheter itself, contents of cerebrospinal fluid, shunt infection, and genetic disorder. The clinical presentation can vary widely, ranging from asymptomatic to a life-threatening condition. Timely recognition of thromboembolic lesions is critical for treatment. However, early diagnosis and management is still challenging because of a relatively long asymptomatic latency and lack of clear guideline recommendations. The purpose of this review is to provide an overview of ventriculoatrial shunt thrombosis, especially to focus on its etiopathogenesis, diagnosis, treatment, and prevention.
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Udayakumaran S, Kumar S. Should not we be using aspirin in patients with a ventriculoatrial shunt? Borrowing a leaf from other specialities: a case for surrogate evidence. Childs Nerv Syst 2021; 37:1137-1142. [PMID: 33033899 DOI: 10.1007/s00381-020-04925-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Ventriculoatrial (VA) shunts are life-saving in circumstances where ventriculoperitoneal shunts (VP) have failed. They are at risk for different complications, and more specific of them are cardiopulmonary complications. Currently, there are no standard recommendations concerning screening for risk factors, prophylaxis, or anticoagulation treatment in patients after VA shunt placement. Our study aims to prospectively study the possible role and efficacy of the use of aspirin to increase the survival of shunts in children with VA shunt and avoid secondary morbidity. In this article, the authors describe the interim results of an ongoing prospective study which supports the use of aspirin for VA shunt. MATERIALS AND METHODS The study design is prospective. The duration of the study is 2011 onwards and is ongoing. Hospital ethics board clearance and consent from the family were taken before inclusion in the study. All patients who had VA shunt were given a once-a-day low-antiplatelet dose of aspirin 5 mg/kg, from the first postoperative day onwards. Primary endpoints of the study are as follows: (1) major distal end malfunction documented on echocardiography or (2) any cardiac complications associated with the VA shunt catheter. RESULTS We have 6 patient since march 2011, who are being followed up. None of the shunts had malfunctioned until the reporting. None of the patients had any cardiac issues reported. The patients are to be followed continually. The present follow-up ranges from 2.5 to 10 years. The patient follow-up is being continued. CONCLUSIONS Aspirin is a drug with well-accepted safety profile, and its use and our preliminary observation and outcome of the use of aspirin in VA shunt are promising.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India. .,Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
| | - Shine Kumar
- Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.,Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
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Minimally invasive procedure for removal of infected ventriculoatrial shunts. Acta Neurochir (Wien) 2021; 163:455-462. [PMID: 33330950 PMCID: PMC7815540 DOI: 10.1007/s00701-020-04675-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Ventriculoatrial shunts were one of the most common treatments of hydrocephalus in pediatric and adult patients up to about 40 years ago. Thereafter, due to the widespread recognition of the severe cardiac and renal complications associated with ventriculoatrial shunts, they are almost exclusively implanted when other techniques fail. However, late infection or atrial thrombi of previously implanted shunts require removal of the atrial catheter several decades after implantation. Techniques derived from management of central venous access catheters can avoid cardiothoracic surgery in such instances. METHODS We retrospectively investigated all the patients requiring removal of a VA shunt for complications treated in the last 5 years in our institution. RESULTS We identified two patients that were implanted 28 and 40 years earlier. Both developed endocarditis with a large atrial thrombus and were successfully treated endovascularly. The successful percutaneous removal was achieved by applying, for the first time in this setting, the endoluminal dilation technique as proposed by Hong. After ventriculoatrial shunt removal and its substitution with an external drainage, both patients where successfully weaned from the need for a shunt and their infection resolved. CONCLUSION Patients carrying a ventriculoatrial shunt are now rarely seen and awareness of long-term ventriculoatrial shunt complications is decreasing. However, these complications must be recognized and treated by shunt removal. Endovascular techniques are appropriate even in the presence of overt endocarditis, atrial thrombi, and tight adherence to the endocardial wall. Moreover, weaning from shunt dependence is possible even decades after shunting.
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Kim YH, Lee SW, Kim DH, Lee CH, Kim CH, Sung SK, Son DW, Song GS. Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt. Korean J Neurotrauma 2020; 16:181-189. [PMID: 33163426 PMCID: PMC7607039 DOI: 10.13004/kjnt.2020.16.e46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Ventriculoatrial shunt (VAS) remains an alternate option for treatment of hydrocephalus in patients with ventriculoperitoneal shunt (VPS) failure. Unfamiliar anatomy for a neurosurgeon has resulted in the VAS falling out of favor as a treatment option. However, there are unsatisfactory reports on the long-term result of VPS, and VAS has been recently re-evaluated. We are to report the simple way to do the VAS using a peel-away sheath in a hybrid operation room. Methods A jugular vein path was drawn by ultrasound, a small incision was made above the clavicle, and a shunt catheter was tunneled into it. The jugular vein was punctured beside the tunneled catheter with a Seldinger needle under ultrasound guidance. A flexible guide wire was introduced into the vein and 6-Fr peel-away sheath was advanced into the vein along the wire. Under fluoroscopic guidance, the catheter was cut to position approximately mid-level in the atrium. After the guide wire was removed, the distal shunt catheter was passed down. After confirming proper position of the distal catheter under the fluoroscope, the catheter-guiding sheath was pulled out as a peeling-away manner. We performed this surgical procedures in 5 cases. Results All the procedures of the VAS using a peel-away sheath were performed in a hybrid operation room Of 5 patients, 3 patients had the distal catheter failures in the peritoneal cavity and 2 patients had shunt A distal catheter was successfully indwelling in all the cases without any difficulties. After the surgery, neither shunt infection nor thromboembolic event happened. Conclusion VAS using fluoroscopy and a peel-away sheath is a good alternative option for hydrocephalus patients with shunt failure related to peritoneal cavity complications.
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Affiliation(s)
- Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Dong Hyun Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
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Pradini-Santos L, Craven CL, Watkins LD, Toma AK. Ventriculoatrial Shunt Catheter Tip Migration Causing Tricuspid Regurgitation: Case Report and Review of the Literature. World Neurosurg 2020; 136:83-89. [DOI: 10.1016/j.wneu.2020.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
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Grunberg J, Rebori A, Verocay MC. Peritoneal Dialysis in Children with Spina Bifida and Ventriculoperitoneal Shunt: One Center'S Experience and Review of the Literature. Perit Dial Int 2020. [DOI: 10.1177/089686080302300514] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The goal of this paper was to review the viability of peritoneal dialysis (PD) in patients with spina bifida and/or ventriculoperitoneal shunt (VPS). Setting Pediatric dialysis unit in a tertiary-care hospital. Data Source The course and outcome in 9 children, 5 from the authors’ experience and 4 from reported experience, are analyzed. Results One patient died of a cause unrelated to PD or VPS, 2 were transferred to hemodialysis because of recurrent peritonitis, 1 discontinued PD transiently, 2 were transplanted, and 3 continue on PD. Six of these 9 children had a functioning VPS, and none presented evidence of ventriculitis or VPS dysfunction, even though 4 had PD-related peritonitis. One child presented with a massive PD-related hydrothorax. Conclusions ( 1 ) Having a VPS is not an absolute contraindication to PD; the available data support the viability of PD in patients with spina bifida and/or a VPS. ( 2 ) If cerebrospinal fluid diversion is needed simultaneously or after starting PD, an extraperitoneal site should be a better choice than VPS. This should avoid the risk of intra- and postoperative infection in the PD catheter secondary to surgical intervention for VPS insertion. ( 3 ) Loss of peritoneal function is a potential late risk related to cerebrospinal fluid and PD. ( 4 ) Spina bifida patients on PD present specific diagnostic challenges due to overlapping symptoms ( e.g., vomiting, abdominal tenderness, fever) secondary to PD- or VPS-related complications ( e.g., peritonitis, visceral injury by devices) or primary disease ( e.g., neurogenic bladder, pyelonephritis), with inherent risks of delaying adequate treatment. Cloudy peritoneal effluent is an early indication of peritonitis, although it is not specific. ( 5 ) Early evaluation by a pediatric surgeon and a neurosurgeon is required for effective management of complications and selection of more efficient individualized therapeutic alternatives. Prompt treatment of complications is crucial. A registry of children with spina bifida on PD and the accumulation of a large population followed up for longer periods will provide an objective assessment of their problems and management.
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Affiliation(s)
- José Grunberg
- Pediatric Dialysis Unit, Senniad, Hospital Evangélico, Montevideo, Uruguay
| | - Anabella Rebori
- Pediatric Dialysis Unit, Senniad, Hospital Evangélico, Montevideo, Uruguay
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Al-Schameri AR, Hamed J, Baltsavias G, Winkler P, Machegger L, Richling B, Emich S. Ventriculoatrial Shunts in Adults, Incidence of Infection, and Significant Risk Factors: A Single-Center Experience. World Neurosurg 2016; 94:345-351. [PMID: 27418531 DOI: 10.1016/j.wneu.2016.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, the number of ventriculoatrial (VA) shunt insertions has decreased worldwide, the major cause being the risk of shunt infection. VA shunts remain as an alternative option to ventriculoperitoneal shunts. We describe our 10-year experience with VA shunts by analyzing the incidence of shunt infections and predisposing cofactors. METHODS During a median follow-up of 15.3 months, 259 shunt insertions, performed on 255 patients, were analyzed. The infection rate was calculated and the predisposing cofactors age, gender, cause of the hydrocephalus, previous external ventricle drainage, antibiotic-impregnated catheters, the number of revisions, the educational level of the surgeons, and the duration of the operations were analyzed. Two observation times were stratified. RESULTS We found overall infections in 18 patients (7.1%), 16 deep infections (6.3%) including 1 shunt nephritis (0.4%) and 2 superficial infections (0.8%). Wound dehiscence occurred in 17 patients (6. 6%). Analyzing follow-up time, the infection rate was 3.65% (95% confidence interval, 0.9%-5.9%) at survival time 1, 3.38% (95% confidence interval, 1.1%-6.2%) at survival time 2. In the first 6 months, 95% of patients were free of infection. Only the number of revision procedures was associated with the number of infections (P value < 0.0005). CONCLUSIONS In our patient cohort, the infection rate related to VA shunt insertion is low; the only statistically significant risk factor was the number of revisions. If the VA shunt is applied following a standardized protocol, the infection risk does not represent an argument for reluctance towards the VA draining concept.
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Affiliation(s)
| | - Jasmina Hamed
- Neurological Department, Medical University of Vienna, Vienna, Austria
| | | | - Peter Winkler
- Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Machegger
- Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria
| | | | - Stephan Emich
- Neurosurgical Department, Paracelsus Medical University, Salzburg, Austria
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Craven C, Asif H, Farrukh A, Somavilla F, Toma AK, Watkins L. Case series of ventriculopleural shunts in adults: a single-center experience. J Neurosurg 2016; 126:2010-2016. [PMID: 27392271 DOI: 10.3171/2016.4.jns16641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid shunts. Various alternative sites have been used, particularly in the presence of certain contraindications. The pleural cavity has been used; however, a paucity of evidence details ventriculopleural (VPL) shunt survival, complication, and revision rates in adults. The aim of this study was to present a single center's experience with VPL shunts, identifying complication, revision, and survival rates. METHODS A single-center, retrospective case series analysis was conducted for VPL shunt insertions and revisions over a period of 5 years. Demographic as well as clinical data were collected. Ventriculopleural shunt survival was assessed using Kaplan-Meier curves and the log rank (Cox-Mantel) test. RESULTS Twenty-two VPL shunts were inserted in 19 patients. Median survival of the VPL shunts was 14 months. Pathological indication for the VPL shunt did not significantly affect survival. A total of 10 complications was observed: 2 infections, 2 cases of overdrainage, 2 obstructions, 1 distal catheter retraction, 2 symptomatic pleural effusions, and 1 asymptomatic pleural effusion. CONCLUSIONS Ventriculopleural shunting is a safe and viable second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. While VPL shunts have a high revision rate, their complication rate is comparable to that of VP shunts. Ventriculopleural shunt survival can be improved by careful patient selection and the implementation of a combination of valves with antisiphon devices.
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Affiliation(s)
- Claudia Craven
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Hasan Asif
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Amna Farrukh
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Flavia Somavilla
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Laurence Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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McGovern RA, Kelly KM, Chan AK, Morrissey NJ, McKhann GM. Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus? J Neurosurg 2014; 120:1458-64. [DOI: 10.3171/2014.1.jns131808] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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 shunt–treated 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.
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Affiliation(s)
| | | | | | - Nicholas J. Morrissey
- 2Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, New York
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Abstract
OBJECTIVE The objective of this article is to describe an approach to imaging CSF shunts. Topics reviewed include the components and imaging appearances of the most common types of shunts and the utility of different imaging modalities for the evaluation of shunt failure. Complications discussed include mechanical failure, infection, ventricular loculation, overdrainage, and unique complications related to each shunt type. CONCLUSION This article reviews the imaging features of common CSF shunts and related complications with which radiologists should be familiar.
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Marchal P, Lairez O, Marachet MA, Massabuau P, Galinier M, Roncalli J. Invalidating headaches as a symptom of pulmonary embolism in a Dandy-Walker syndrome with ventriculoatrial shunt. Eur J Neurol 2011; 18:e102-3. [DOI: 10.1111/j.1468-1331.2011.03429.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kluge S, Baumann HJ, Regelsberger J, Kehler U, Gliemroth J, Koziej B, Klose H, Meyer A. Pulmonary hypertension after ventriculoatrial shunt implantation. J Neurosurg 2010; 113:1279-83. [DOI: 10.3171/2010.6.jns091541] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Ventriculoatrial (VA) shunts inserted for the treatment of hydrocephalus are known to be a risk factor for pulmonary hypertension. The aim of this study was to evaluate the incidence of pulmonary hypertension among adult patients with VA shunts.
Methods
All patients who had received a VA shunt at one of two institutions between 1985 and 2000 were invited for a cardiopulmonary evaluation. The investigation included a thorough history taking, clinical examination, echocardiography, and pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO). Pulmonary hypertension was defined as systolic pulmonary artery pressure > 35 mm Hg at rest.
Results
The study group consisted of 86 patients, of whom 38 (44%) could be examined. The patients' mean age was 47.1 ± 18.4 years; the median interval between shunt insertion and cardiopulmonary evaluation was 15 years (range 5–20 years). Of the 38 patients, 20 (53%) had Doppler velocity profiles of tricuspid regurgitation that were adequate for the estimation of pulmonary artery systolic pressure. Doppler-defined pulmonary hypertension was observed in 3 patients (8%), 2 of whom underwent right heart catheterization. Chronic thromboembolic pulmonary hypertension was confirmed in both patients, and medical therapy, including anticoagulation, was started. The VA shunt was removed in both cases and replaced with a different type of device. Pulmonary function tests revealed a restrictive pattern in 15% and typical obstructive findings in 9% of patients. In 30% of patients the DLCO was less than 80% of predicted, and blood gas analysis showed hypoxemia in 6% of patients. No significant differences in pulmonary function tests were noted between the patients with and without echocardiographic evidence of pulmonary hypertension. However, patients with pulmonary hypertension had significantly lower DLCO values.
Conclusions
The authors detected pulmonary hypertension by using Doppler echocardiography in a significant proportion of patients with VA shunts. It is therefore recommended that practitioners perform regular echocardiography and pulmonary function tests, including single-breath DLCO in these patients to screen for pulmonary hypertension to prevent hazardous late cardiopulmonary complications.
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Affiliation(s)
| | | | | | - Uwe Kehler
- 2Neurosurgery, University Medical Center Hamburg-Eppendorf; and
| | - Jan Gliemroth
- 3Department of Neurosurgery, Medical University Lübeck, Germany
| | | | - Hans Klose
- 1Departments of Respiratory Medicine and
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Grover SK, Puri R, Wong TLD, Dundon BK, Tayeb H, Steele PM. Ventriculo-atrial shunt induced severe pulmonary arterial hypertension: a time for routine screening? Intern Med J 2010; 40:386-7. [PMID: 20575997 DOI: 10.1111/j.1445-5994.2010.02178.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prastaro M, Rapacciuolo A, di Pietro E, Esposito C, Esposito F, Russolillo V, Iodice R, Orefice G, Vosa C, Chiariello M. Recurrent pulmonary and cerebral thromboembolism in an adult patients following incomplete removal of ventriculoatrial shunt for congenital hydrocephalus. BMJ Case Rep 2009; 2009:bcr03.2009.1645. [PMID: 21853011 DOI: 10.1136/bcr.03.2009.1645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 34-year-old man was admitted to our hospital's department of neurology because he had experienced a cryptogenic stroke followed by a transient ischaemic attack. The patient suffered from congenital hydrocephalus which was treated by ventriculoatrial shunt at 8 months of age. Twelve months later, because of recurrent infections, the catheter was partially removed and the distal segment was left in place. At admission, the transoesophageal echocardiogram showed severe pulmonary hypertension (80 mm Hg confirmed by invasive measurement). The distal tip of the catheter had migrated into the left atrium through a patent foramen ovale inducing a massive right-to-left shunt. We surgically removed the catheter and closed the interatrial defect. At 1 and 6 months follow-up the patient was asymptomatic with a reduced pulmonary hypertension (50 mm Hg). Since there was no other clinical finding responsible for the recurrent thromboembolic events, both at the pulmonary and cerebral level, the catheter was removed to prevent further complications.
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Affiliation(s)
- Maria Prastaro
- Federico II University of Naples, Cardiology, Via S. Pansini, 5, Naples, 80131, Italy
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Wilkinson N, Sood S, Ham SD, Gilmer-Hill H, Fleming P, Rajpurkar M. Thrombosis associated with ventriculoatrial shunts. J Neurosurg Pediatr 2008; 2:286-91. [PMID: 18831666 DOI: 10.3171/ped.2008.2.10.286] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this single-center study, the authors examined the clinical characteristics, risk factors, treatment strategies, and outcomes in patients with thrombosis associated with ventriculoatrial (VA) shunts. METHODS Inpatient and outpatient charts of patients who underwent treatment and follow-up in the Hematology-Oncology Division at the authors' institution and in whom thrombosis developed secondary to a VA shunt placement were reviewed. A complete thrombophilia work-up was performed in each patient, and these records were also reviewed. Treatment including medical and surgical management was noted and outcome data were recorded. RESULTS Resolution of thrombosis was seen after anticoagulation therapy in all patients; this may be an alternative to surgical therapy. CONCLUSIONS Patients with VA shunts represent a unique group at risk for thrombosis. The duration of anticoagulation therapy must be individualized. However, larger studies are needed to evaluate the efficacy of screening for asymptomatic thrombosis and to investigate the role of prophylactic anticoagulation.
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Affiliation(s)
- Norka Wilkinson
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
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Bhasin RR, Chen MK, Pincus DW. Salvaging the "lost peritoneum" after ventriculoatrial shunt failures. Childs Nerv Syst 2007; 23:483-6. [PMID: 17333209 DOI: 10.1007/s00381-006-0292-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 05/16/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Placement of a ventriculoperitoneal (VP) shunt is the long-standing treatment of choice for hydrocephalus. However, in many patients with repeated distal failures, ventriculoatrial (VA) shunts are placed. Should the VA shunt fail, finding appropriate distal sites is often difficult. MATERIALS AND METHODS We identified six patients, over a 3-year period, in whom conversion of VA to VP shunt was successfully performed with the aid of diagnostic laparoscopy or laparotomy. There were no ensuing shunt failures during the follow-up period (mean 1.5 years). CONCLUSION Because of the benefits of VP over VA shunting, every effort should be made to preserve the peritoneum as the target for the distal catheter. Laparotomy/laparoscopy is useful in locating suitable peritoneal targets when converting to VP shunt after VA shunt failure, or as a final effort before VA shunt conversion.
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Affiliation(s)
- R Rick Bhasin
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Tonn P, Gilsbach JM, Kreitschmann-Andermahr I, Franke A, Blindt R. A rare but life-threatening complication of ventriculo-atrial shunt. Acta Neurochir (Wien) 2005; 147:1303-4. [PMID: 16172832 DOI: 10.1007/s00701-005-0619-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Accepted: 07/14/2005] [Indexed: 10/25/2022]
Abstract
Insertion of ventriculoperitoneal and ventriculoatrial shunts is routinely performed. Infarction pneumonia and atrial thrombus formation are described as very rare complications of ventriculoatrial shunts. We present the case of a female patient with ventriculoatrial shunt insertion as long term treatment for aequeductal stenosis who presented with recurrent episodes of dyspnoea, chest pain, and unilateral pleural effusion. Diagnostic evaluation revealed a positive D-dimer test, bilateral basal infiltrates and pleural effusion. Transesophageal echocardiography established the diagnosis of a thrombus in the right atrium. Laboratory testing for thrombophilia revealed a homozygous factor V Leiden mutation. In the following, a shunt revision was performed.
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Affiliation(s)
- P Tonn
- Department of Emergency Psychiatry, Clinic North, Hamburg, Germany.
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Yurtseven T, Erşahin Y, Kitiş O, Mutluer S. Thrombosis and thrombophilebitis of the internal jugular vein as a very rare complication of the ventriculoatrial shunt. Clin Neurol Neurosurg 2005; 107:144-6. [PMID: 15708232 DOI: 10.1016/j.clineuro.2004.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2003] [Revised: 05/10/2004] [Accepted: 05/28/2004] [Indexed: 10/26/2022]
Abstract
A 21-year-old man presented with a sausage shaped mass lesion, located in the right anterolateral region of the neck. He had been operated on for hydrocephalus and thoraco-lumbar myelomeningocele at the age of 10 days and 2 months, respectively. Although he was asymptomatic at the age of 10 years, ventriculoatrial (VA) shunt was considered non-functional. Doppler ultrasound showed thrombosis of the right internal jugular vein. Cervical magnetic resonance imaging displayed thrombosis and thrombophilebitis of the right internal jugular vein with loss of flow pattern. VA shunt was removed under general anesthesia and shunt material sent for culture. Staphylococcus aureus grew from the culture of shunt material. A cephalosporin (cefuroxime axetil) was administered and the neck mass disappeared in 4 weeks. He has been symptom free for the last 5 years. VA shunts for hydrocephalus have some well-defined specific complications. In this paper, a case with VA shunt related thrombosis and thrombophilebitis of internal jugular vein was presented and management of VA shunt related cardiovascular complications were discussed.
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Affiliation(s)
- Taşkin Yurtseven
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Faculty of Medicine, Ege University, Bornova, Izmir 35100, Turkey.
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