Late cardiopulmonary complication of ventriculo-atrial shunt

Abstract

A 30-year-old man presented in 1991, with an 18-month history of progressive dyspnoea and cough. His past history included a lumbosacral meningomyelocele. At 7 months of age progressive hydrocephalus was treated by insertion of a ventriculo-atrial (VA) shunt. The meningomyelocele was repaired at 8 months of age. He also had an ileocutaneous ureterostomy, bilateral ileopsoas transplants, and multiple orthopaedic procedures for subluxation of the hips. By the age of 14 years, the VA shunt had been revised on four occasions because of recoil of the distal catheter into the superior vena cava. Two further shunt revisions were done, one for spontaneous disconnection of the proximal catheter and the other for infection. Catheter associated thrombosis was not found on any of the revisions. He had no history of chronic liver disease, deep venous thrombosis, intravenous drug or appetite suppressant use, systemic hypertension, haemoglobinopathies, or other systemic diseases. On examination he had an elevated jugular venous pressure, parasternal heave, a right ventricular gallop rhythm, and an accentuated pulmonary component of the second heart sound. There was no pulsatile liver or evidence of peripheral oedema. Late complications of ventriculoatrial or ventriculoperitoneal shuntsAfter the introduction of the Spitz-Holter valve in 1952,1 ventriculoatrial shunting became the standard treatment for hydrocephalus. However, over the subsequent years the early enthusiasm was tempered by the recognition of a wide range of serious and even life-threatening complications. Later on, after the introduction of ventriculoperitoneal shunts, comparisons of the long-term results of the two types of shunts for hydrocephalus in children showed that, although both were equally effective, ventriculperitoneal shunts were associated with a lower rate of revision (including prophylactic lengthening of the distal catheter2) and of late and serious complications. Full-Text PDF