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Ventriculoatrial shunt catheter displacement in a child with partial anomalous pulmonary venous return: case report
Mohamed Samy A Elhammady1, David M Benglis, Sanjiv Bhatia
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Miami and Miami Children's Hospital, Miami, FL 33136, USA.
Insights
Ventriculoatrial (VA) shunt malfunction occurred due to catheter displacement in an infant with hydrocephalus and anomalous pulmonary venous return. This rare complication led to respiratory distress and neurological decline, highlighting the need for vigilance.
Area of Science:
- Pediatric Neurosurgery
- Medical Device Complications
- Congenital Abnormalities
Background:
- Ventriculoatrial (VA) shunts are a common treatment for infant hydrocephalus.
- Partial anomalous pulmonary venous return is a rare congenital heart defect.
- VA shunts carry risks, including infection and obstruction.
Observation:
- An 18-month-old girl with hydrocephalus and partial anomalous pulmonary venous return experienced acute respiratory compromise.
- Initial imaging showed a lung infiltrate, with the distal shunt catheter tip appearing normal.
- Subsequent chest radiography revealed distal catheter displacement into the left innominate vein.
Findings:
- The patient's respiratory distress worsened, necessitating mechanical ventilation.
- Neurological signs of shunt malfunction, including dilated pupils, became apparent.
- The case illustrates a rare complication of VA shunt distal catheter displacement.
Implications:
- This case highlights a critical, albeit infrequent, complication of VA shunts.
- Early recognition and prompt management are crucial for favorable outcomes.
- Understanding potential shunt migration pathways is important for neurosurgeons.
Abstract:
Ventriculoatrial (VA) shunts remain the most used alternative to ventriculoperitoneal shunts in infants with hydrocephalus. The authors report a case of an acute VA shunt malfunction as a result of distal catheter displacement in an 18-month-old girl with partial anomalous pulmonary venous return. The child presented with respiratory compromise, and a chest radiograph revealed a lung infiltrate and normal position of the distal shunt catheter tip. Computed tomography demonstrated stable ventricle size in comparison with previous studies. As the patient's respiratory distress progressed, she required intubation, mechanical ventilation with high airway pressures and inspired oxygen concentrations, muscle relaxants, and sedation. A routine morning chest radiograph several days after admission revealed displacement of the distal catheter into the left innominate vein. Later that day the child's pupils were noted to be large and unreactive and a distal shunt malfunction was diagnosed. Complications of VA shunts and the presumed mechanism by which the catheter became displaced are discussed.
