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Fatal cardiopulmonary complications in children treated with ventriculoatrial shunts
T Lundar1, I A Langmoen, K H Hovind
1Department of Neurosurgery, National Hospital, University of Oslo, Norway.
Insights
Ventriculoatrial (VA) shunts were used in 1298 children between 1965-1986. Fatal complications related to the atrial catheter occurred in 3% of VA shunt patients, with pulmonary hypertension being a significant concern.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Medical Device Complications
Background:
- Ventriculoatrial (VA) shunts were a common treatment for pediatric hydrocephalus between 1965 and 1986.
- Pudenz VA shunts were primary, with mini-Holter VA shunts used for distal failures since 1980.
- Long-term follow-up (10-23 years) is available for many children with VA shunts.
Purpose of the Study:
- To evaluate the long-term outcomes and complications of ventriculoatrial (VA) shunting in a pediatric population.
- To assess the incidence of fatal complications directly related to the atrial catheter in VA shunts.
- To investigate the occurrence and management of late-onset pulmonary hypertension in children with VA shunts.
Main Methods:
- Retrospective analysis of 2065 shunt procedures in 716 children from 1965 to 1986.
- Focus on 1298 ventriculoatrial (VA) shunt procedures and their associated outcomes.
- Review of patient records for shunt-related complications, mortality, and specific adverse events like pulmonary hypertension.
Main Results:
- A cumulative death rate of 24% was observed in all patients; 9% were tumor-related deaths.
- Among 450 children with VA shunts, 15 (3%) experienced fatal complications linked to the atrial catheter.
- Late-onset pulmonary hypertension occurred in three cases, with one case responding well to anticoagulant therapy.
Conclusions:
- Ventriculoatrial (VA) shunting carries a significant risk of fatal atrial catheter complications, including pulmonary hypertension.
- Long-term monitoring is crucial for detecting late-onset complications such as irreversible pulmonary hypertension.
- While rare, pulmonary hypertension associated with VA shunts can be a serious, late-developing complication requiring careful management.
Abstract:
During the years from 1965 to 1986, 716 children underwent a total of 2065 shunt procedures in our department. Of these, 1298 were ventriculoatrial (VA). Until 1979, Pudenz VA shunts were almost exclusively used as the primary procedure as well as in revisions. Since 1980, mini-Holter VA shunts have been implanted as a second choice, usually in cases with repeated distal failure in ventriculoperitoneal (VP) shunts. Observation time for children with VA shunts is therefore from 10 to 23 years for the great majority. The cumulative death rate for all patients is 24% (175/716), 9% (64/716) being tumor patients who eventually died as a result of their neoplasm. Most of the other deaths were caused by shunt infection or occurred in a group of children where shunts had been implanted for palliative reasons and where follow-up was only sporadic. Among the 450 children with VA shunts, 15 fatal complications occurred that were directly related to the atrial catheter, resulting in an accumulated incidence of 3% of such serious side effects from VA shunting. Three of these 15 fatal cases presented with nonspecific signs of cardiopulmonary failure following 10-21 years' shunting, and they died from irreversible pulmonary hypertension within a few months. A fourth case of late cor pulmonale has done unexpectedly well and has improved considerably while receiving anticoagulant therapy for over a period of 3 years.