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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.
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
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