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Migration of a ventriculoperitoneal shunt into the pulmonary artery
R C Morell1, W O Bell, G E Hertz
1Department of Anesthesia, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1009.
Abstract:
Ventriculoperitoneal (VP) shunts have been reported to migrate into a number of unusual locations within the abdomen, chest, and pelvis. We report a case in which a documented, correctly placed VP shunt subsequently migrated to an intravascular location. This intravascular migration led to malposition of the shunt tubing within the pulmonary artery. Attempts to remove the catheter via a postauricular incision were complicated by arrhythmias induced by traction on the shunt tubing. Eventual removal of the shunt was accomplished in stages, through the use of an intravascular, radiographically guided snare, introduced through the femoral vein.
Insights
A ventriculoperitoneal (VP) shunt migrated intravascularly into the pulmonary artery. This rare complication required complex, staged removal using intravascular techniques.
Area of Science:
- Neurosurgery
- Cardiology
- Radiology
Background:
- Ventriculoperitoneal (VP) shunts are commonly used to treat hydrocephalus.
- Shunt migration to unusual abdominal, thoracic, or pelvic locations is a known complication.
- Intravascular migration of VP shunts is exceedingly rare.
Observation:
- A documented, correctly placed VP shunt migrated to an intravascular location.
- The shunt tubing malpositioned within the pulmonary artery.
- Attempts at removal via a postauricular incision caused arrhythmias due to traction.
Findings:
- The VP shunt migrated intravascularly into the pulmonary artery.
- Surgical removal attempts were complicated by arrhythmias.
- Successful staged removal was achieved using a radiographically guided intravascular snare via the femoral vein.
Implications:
- This case highlights a rare but serious complication of VP shunts.
- It underscores the importance of considering intravascular migration in shunt malfunction.
- Advanced intravascular techniques may be necessary for complex shunt removals.