Management of maternal ventriculo-atrial shunt malfunction during pregnancy

Abstract

Abstract Hydrocephalic females reaching childbearing age is increasing due to treatment advances. It has been suggested that ventriculo-atrial (VA) shunts be preferred over ventriculo-peritoneal (VP) shunts during pregnancy. We present a case with multiple VA shunt malfunctions during two separate pregnancies. We treated the patient with a valveless VA shunt during both and were able to achieve near-term deliveries. During the second pregnancy the patient had an emergent caesarian section due to severe hydrocephalus and stunted fetal growth. Delivering the child also relieved her hydrocephalus. Of unclear reasons the right atrium failed as a distal absorption site during both pregnancies, and we must conclude that VA shunts do not necessarily alleviate problems regarding pressure at the distal end of the shunt system but never the less should be considered a treatment option on a case-by-case basis. Furthermore we conclude that a valveless shunt should be considered in select cases of maternal shunt malfunction where valves exert to high pressure resistance.