Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Abstract

hospital during March 2006. The shunt catheter was easily placed subcutaneously by tunneling with an ordinary shunt passer. The abdominal catheter was introduced into the peritoneum via an incision over the right rectus muscle. Postoperative abdominal radiography confirmed that the catheter was correctly positioned (Fig. 1A).Two years after VP shunting, the patient presented with a bulge at the site of the abdominal incision, and a hernia was diagnosed. The patient provided written, informed consent to undergo repair of the incisional hernia and he was thus examined in more detail preoperatively. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery (Fig. 1B). A CT examination from the neck to the thorax showed the tube passing through the superior vena cava, right atrium and right ventricle, into the main pulmonary artery, and then into the right pulmonary artery ( Fig. 2A and B). After consultation with his original physician regarding removal of the catheter, the patient was transferred to our hospital on November 4, 2008, where he provided written informed consent to the procedure, which was performed on November 7, 2008.Operation: The patient was placed in the supine position and a temporary filter catheter (Toray Medical, Tokyo, Japan) was positioned under general anesthesia from the right femoral vein to the main pulmonary artery using the previous transluminal guide to prevent distal em- A 50-year-old man presented with an abdominal bulge 2 years after receiving a ventriculoperitoneal (VP) shunt for hydrocephalus. Chest radiography revealed that the peritoneal end of the catheter had migrated into the right pulmonary artery. Exploration through a small neck incision revealed that the shunt catheter had entered the internal jugular vein. The catheter was extracted and positioned in the subcutaneous space in preparation for reimplantation. This type of shunt migration is quite unusual, but it could cause lethal pulmonary infarction or arrhythmia. Follow-up radiography should be scheduled to detect such complications. Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Foreign Bodies in the Heart

“…In 13 cases, migration of devices for the treatment of hydrocephalus was found. [13][14][15][16][17][18][19][20][21][22][23] Migrated ventriculo-atrial shunts commonly occur many years after the insertion. In 2 of 4 patients with migrated ventriculo-atrial catheter severe tricuspid stenosis may occur.…”

“…In 1 patient, staphylococcal sepsis occurred, 20 in another abdominal hernia was found at the site of the incision. 22 The presumed mechanism for migration might have been through injury to the internal/external jugular vein during the tunneling and propagation into the heart due to negative inspiratory pressure. [17][18][19][20][21][22] Among the 9 cases, migrated catheters and devices for chemotherapy [24][25][26][27][28][29][30] were mostly found located in the right heart chambers causing complications.…”

“…In 13 cases, migration of devices for the treatment of hydrocephalus was found . Migrated ventriculo‐atrial shunts commonly occur many years after the insertion.…”

“…Among the 8 patients with migrated ventriculo‐peritoneal shunt, migration occurred shortly after insertion in 7 patients, and often was accompanied by neurological symptoms of shunt dysfunction. In 1 patient, staphylococcal sepsis occurred, in another abdominal hernia was found at the site of the incision . The presumed mechanism for migration might have been through injury to the internal/external jugular vein during the tunneling and propagation into the heart due to negative inspiratory pressure …”

“…Occurrence of Different Foreign Bodies in the HeartInferior vena cava filter: struts, limbs, total[1][2][3][4][5][6][7][8][9][10][11][12] 14 Devices for treatment of hydrocephalus[13][14][15][16][17][18][19][20][21][22][23] …”