Unusual Migration of the Distal Catheter of a Ventriculoperitoneal Shunt into the Heart: Case Report

Frazier, James L.; Wang, Paul P.; Patel, Salil H.; Benson, Jane E.; Cameron, Duke E.; Hoon, Alexander H.; Avellino, Anthony M.

doi:10.1227/00006123-200209000-00042

Cited by 26 publications

(27 citation statements)

References 13 publications

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“…[5][6][7][8][9][10] The intervals between the VP shunt operation and a diagnosis of migration ranged from 18 days to 4 years. The shunt catheter had penetrated the right internal jugular vein in two patients, the right external jugular vein in two, and the remaining two were not described.…”

Section: Discussionmentioning

confidence: 99%

Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Ryugo

Imagawa

Nagashima

et al. 2009

Annals of Vascular Diseases

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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

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Section: Discussionmentioning

confidence: 99%

Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Ryugo

Imagawa

Nagashima

et al. 2009

Annals of Vascular Diseases

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“…Several cases of VP shunt catheter migration into the heart or pulmonary artery were reported and summarized in the literature 3,4,8,10,11,13,14) . This type of migration may be lethal, possibly causing pulmonary emboli, arrhythmia, sepsis, or cardiac insufficiency 7,15) .…”

Section: Discussionmentioning

confidence: 99%

“…The time until distal shunt intracardiac migration diagnosed was ranged from 18 days to 4 years in reported cases 3,4,8,10,11,13,14) . We found incidentally that the distal catheter migration was ended on postoperative 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Upward Migration of Distal Ventriculoperitoneal Shunt Catheter into the Heart : Case Report

Chong

Kim

Cho

et al. 2008

J Korean Neurosurg Soc

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“…Migration of the VP shunt catheter into the heart and pulmonary artery is rare, with only 11 cases previously reported. [1][2][3][4][5][6][7][8][9]11) Here, we report a case of migration of the peritoneal shunt catheter into the internal jugular vein (IJV) and the heart through the external jugular vein (EJV), and discuss the potential mechanisms of migration.…”

Section: Introductionmentioning

confidence: 99%

Migration of a Distal Ventriculoperitoneal Shunt Catheter Into the Internal Jugular Vein and Heart Through the External Jugular Vein -Case Report-

Kano

Kurosaki

Iwasa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 6-year-old boy had undergone ventriculoperitoneal (VP) shunt for acute hydrocephalus because of a brain tumor at the age of 11 months, and presented with vomiting and somnolence after the shunt malfunctioned 6 days after VP shunt reconstruction, during which the right external jugular vein was injured during the tunneling process and the peritoneal catheter was not fixed to the peritoneum with a purse string suture. Radiography revealed an abnormal route of the peritoneal catheter, suggesting that the distal VP shunt catheter had migrated into venous vasculature through the right external jugular vein. Computed tomography revealed that the peritoneal catheter had migrated into the internal jugular vein and the right atrium. At surgery, the peritoneal catheter was exposed through a small incision on the subclavicular region, was easily extracted from the internal jugular vein and the heart as there was no coiling or adhesion of the distal catheter to the vascular tissues, and was repositioned into the peritoneum with weak fixing between the subcutaneous tissues of the right subclavicular region and the right abdominal rectus muscle fascia as a temporary emergency measure. Peritoneal shunt migration into the internal jugular vein and the heart through the external jugular vein can be lethal because of pulmonary infarction or arrhythmia, and must be detected as soon as possible. Periodic follow-up radiography should be scheduled after VP shunt placement, even in the absence of symptoms.

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Unusual Migration of the Distal Catheter of a Ventriculoperitoneal Shunt into the Heart: Case Report

Cited by 26 publications

References 13 publications

Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Migration of Distal Ventriculoperitoneal Shunt Catheter into the Pulmonary Artery

Upward Migration of Distal Ventriculoperitoneal Shunt Catheter into the Heart : Case Report

Migration of a Distal Ventriculoperitoneal Shunt Catheter Into the Internal Jugular Vein and Heart Through the External Jugular Vein -Case Report-

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