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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2009; 36(2): 184–185.
PMCID: PMC2676609

Pulmonary Artery Embolization of Ventriculoatrial Shunt Fragment

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin Street, Suite 2480, Houston, TX 77030

An adult man had been treated at the age of 5 years for hydrocephalus that was secondary to childhood meningitis. A ventriculoatrial (VA) shunt, placed at that time, malfunctioned and was functionally replaced with a ventriculoperitoneal shunt when the patient was 11 years old. He was unaware of any problem with either catheter thereafter. At age 53 years, the man presented at our emergency department with severe chest discomfort. Electrocardiography and cardiac biomarkers were normal. Chest radiography showed a catheter within the left main pulmonary artery (Fig. 1). The presence of a free-floating catheter fragment within both main pulmonary arteries was confirmed by multidetector (64-slice) computed tomography (Figs. 2A and and2B).2B). After the catheter fragment was removed percutaneously by means of snare retrieval (Fig. 2C), the patient experienced no further symptoms. Computed tomographic coronary angiography revealed no obstructive coronary artery disease, and the patient's coronary calcium score was 22. We conjecture, in accordance with the sequence of events and the patient's response to treatment, that the embolized catheter had been present in the pulmonary artery for only a short time before the patient's current presentation.

figure 27FF1
Fig. 1 Chest radiograph in posteroanterior projection shows the tip of the embolized ventriculoatrial shunt catheter within the left main pulmonary artery (black arrows, magnified in the inset). A ventriculoperitoneal shunt is also seen (white arrows). ...
figure 27FF2
Fig. 2 A) Transverse 2-dimensional and B) 3-dimensional volume-rendered-reconstruction computed tomography of the heart shows the embolized ventriculoatrial catheter fragment within the left and right main pulmonary arteries (arrows). C) Photograph shows ...

Comment

In the past, VA catheter shunts were used in the treatment of hydrocephalus. These catheters substantially reduced mortality rates; however, they were associated with malfunction, infection, or thromboembolism. Accordingly, VA shunts were replaced with ventriculoperitoneal shunts. The migration of a VA catheter to the pulmonary artery has rarely been reported.1–3

Footnotes

Address for reprints: Jamshid Shirani, MD, Department of Cardiology, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA 17822-2160. E-mail: ude.regnisieg@1inarihsj

References

1. James CA, McFarland DR, Wormuth CJ, Teo CM. Snare retrieval of migrated ventriculoatrial shunt. Pediatr Radiol 1997; 27(4):330–2. [PubMed]
2. Korja M, Karvonen MK, Haapanen A, Marttila RJ. Shunt catheter migration into pulmonary arteries. Neurol India 2008;56(1):103. [PubMed]
3. Irie W, Furukawa M, Murakami C, Kobayashi M, Maeda K, Nakamaru N, et al. A case of V-A shunt catheters migration into the pulmonary artery. Leg Med (Tokyo) 2009;11(1):25–9. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute