Incidental Migration of Distal Catheter to Heart after Ventriculo-Peritoneal Shunt :
A Case Report

, Ho-Young Ahn; , Hyung-Jin Lee; , Ji-Ho Yang; , Il-Woo Lee

Case Report

Journal of Korean Society of Geriatric Neurosurgery 2014;10(2):192-195.
Published online December 30, 2014.

Incidental Migration of Distal Catheter to Heart after Ventriculo-Peritoneal Shunt : A Case Report

Ho-Young Ahn , Hyung-Jin Lee , Ji-Ho Yang , Il-Woo Lee

Department of Neurosurgery, Daejeon St. Mary’s Hospital, Catholic University of Korea, Daejeon, Korea

뇌실복강단락술 후 복부 원위 도관의 심장 내로의 전위 : 증례 보고

안호영·이형진·양지호·이일우

가톨릭대학교 의과대학 대전성모병원 신경외과학교실

Abstract

The ventriculo-peritoneal (V-P) shunt is the most common and effective procedure to treat hydrocephalus. Complications of V-P shunts may happen anyplace along their passage, but migration of the distal catheter of V-P shunt into the heart is very rare. A seventy five year old woman underwent V-P shunt for communicating hydrocephalus after subarachnoid hemorrhage. Postoperative chest and abdominal radiography confirmed the accurate distal catheter position into the upper midline of the abdomen. Three weeks later, the patient presented with pitting edema and increased level of serum BUN and creatine. 2D-echocardiogram and chest radiography for evaluation of heart failure revealed an abnormal route of distal catheter of V-P shunt, suggesting that distal catheter had migrated into right ventricle outflow tract. The right parieto-occipital scalp incision was reopened to disconnect the distal catheter. Then, the distal migrated catheter was removed under fluoroscopic guidance. The distal catheter migration into heart can be lethal because of septicemia, arrhythmia, embolism and pulmonary infarction. Periodic regular follow-up radiography is considered after shunt procedure and early treat after detection is crucial. The authors discuss about possible mechanisms of catheter migration and managements.

Key Words: HydrocephalusㆍVentriculoperitoneal ShuntㆍMigrationㆍHeart