Transcardiac migration of ventriculoperitoneal shunt requiring open cardiac surgery: case report and review of the literature

INTRODUCTION

Cardiac migration of ventriculoperitoneal (VP) shunts has been reported, with most easily removed or shortened via a cervical incision. We present a review of the literature, highlighting our unique case with significant scarring requiring open, on-pump, cardiac surgery for removal of migrated distal tubing.

CASE PRESENTATION

A 7-year-old boy underwent VP shunt insertion for hydrocephalus secondary to intracranial astrocytoma. He presented at age 17 with evidence of right heart strain, associated with the distal shunt catheter proximally migrated into his heart and pulmonary arteries. Due to his delayed presentation, the catheter was knotted and partially immobilized by scar formation, finally requiring open-heart surgery to remove the catheter.

CONCLUSIONS

A multi-disciplinary evaluation with endovascular, neurosurgery, and cardiothoracic surgery may be the safest approach, especially in those patients with knotting on preoperative imaging.

Pericardial effusion and cardiac tamponade after ventriculoperitoneal shunt placement: a case report

Insertion of a ventriculoperitoneal shunt is a common neurosurgical procedure in both adult and paediatric patients. It is one of the most important treatments in cases of hydrocephalus; however, there is a wide range of complications: the most common complication being a shunt infection, and examples of rare complications are shunt migrations and cardiac tamponade. Several reports of distal ventriculoperitoneal shunt migration in different sites, including chest, right ventricle, pulmonary artery, bowel and scrotum were published. But pericardial effusion with cardiac tamponade and its relationship to distal ventriculoperitoneal shunt migration into the pericardial sac has never been reported.

Intracardiac migration of a distal shunt catheter: an unusual complication of ventricular shunts. Report of 2 cases

Unusual complications of peritoneal shunts are a well-known occurrence. The authors present 2 cases of intracardiac migration of a distal shunt catheter, summarizing the diagnosis and management of each case. This complication seems to be a rare occurrence; the transgression of the jugular vein leading to intracardiac migration of a shunt catheter has been reported only 6 times previously. The authors highlight the importance of careful and proper placement of the distal peritoneal catheter during the tunneling process, in particular avoiding too deep a penetration of the shunt passer into the neck tissues and too medial a shunt passage near the sternal notch to avoid vascular structures.