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[Thromboembolism as a complication of Pudenz-Heyer drainage with cardiac shunt]
O Galal1, G Schleicher, N Klüting
1Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität Essen.
Insights
A child with a ventriculoatrial shunt developed a right atrial thrombus causing potential embolism. Early detection via 2D-echocardiography is crucial for managing this rare complication.
Area of Science:
- Pediatric Neurosurgery
- Cardiology
- Medical Imaging
Background:
- Ventriculoatrial shunts are used to treat hydrocephalus.
- Shunt infection can lead to serious complications.
- Thrombus formation and embolism are potential risks associated with ventriculoatrial shunts.
Observation:
- A 2.7-year-old boy with a ventriculoatrial Pudenz Heyer shunt presented with symptoms of shunt infection.
- 2D-echocardiography revealed a pedunculated right atrial thrombus prolapsing through the tricuspid valve.
- Lung scintigraphy indicated multiple defects consistent with embolism.
Findings:
- Surgical exploration and cardiopulmonary bypass were performed for thrombus excision.
- No organisms were isolated from the excised thrombus, ruling out a primary infectious etiology.
- The case highlights thrombus and embolism as possible complications of ventriculoatrial Pudenz Heyer shunts.
Implications:
- This case underscores the importance of considering thrombus and embolism in patients with ventriculoatrial shunts presenting with concerning symptoms.
- Regular 2D-echocardiography is recommended for early detection of atrial thrombi.
- Prompt diagnosis and surgical intervention are vital to prevent potentially life-threatening embolic events.
Abstract:
We report the case of a 2.7 year old boy with ventriculoatrial Pudenz Heyer shunt for hydrocephalus internus presenting with symptoms suggestive of shunt infection. 2D-echocardiography showed a pedunculated right atrial thrombus that prolapsed through the tricuspid valve in diastole. Scintigraphy of the lungs showed multiple defects suggestive of embolism. The thrombus was excised after exploratory surgery with cardiopulmonary bypass. No organisms could be isolated from the thrombus. In ventriculo-atrial Pudenz Heyer shunt thrombi and embolism are possible complications. The regular use of 2D-echocardiography in order to detect these thrombi at a very early stage is discussed.