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Migration of ventriculoperitoneal shunt into the heart--case report
Hiroyuki Imamura1, Mikio Nomura
1Department of Neurosurgery, Keiwakai Ebetsu Hospital, Ebetsu, Hokkaido.
Insights
A misplaced ventriculoperitoneal shunt catheter migrated into the heart via the internal jugular vein. This rare complication required surgical correction to reposition the shunt.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Medical Imaging
Background:
- Hydrocephalus management often involves cerebrospinal fluid (CSF) shunting procedures.
- Ventriculoperitoneal (VP) shunting is a common surgical intervention for hydrocephalus.
- Subarachnoid hemorrhage can lead to hydrocephalus requiring CSF diversion.
Observation:
- A 76-year-old male developed catheter migration 18 days post-VP shunt surgery.
- Fluoroscopy and 3D CT revealed the peritoneal catheter within the heart and internal jugular vein.
- The catheter's subcutaneous wire guide likely perforated the internal jugular vein.
Findings:
- The VP shunt catheter migrated from the abdomen into the right atrium.
- Catheter migration occurred through an internal jugular vein perforation.
- Negative intrathoracic and venous pressure facilitated catheter advancement into the heart.
Implications:
- This case highlights a rare but serious complication of VP shunting.
- Prompt diagnosis and surgical intervention are crucial for managing catheter migration.
- Understanding migration pathways can inform future shunt design and placement techniques.
Abstract:
A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.