Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique

Case report

Restricted access

The authors report a complex case in a 35-year-old woman who underwent shunt placement at birth for myelomeningocele. She had previously undergone more than 30 shunt revisions, with placement of the distal catheter in the peritoneum multiple times, and also in the pleura, the gall bladder, and the upper venous system. All shunts had failed and the possible placement sites were now anatomically hostile. A median sternotomy was performed as the next option. The catheter was placed directly into the appendage of the right atrium and secured with a pursestring suture. One month postoperatively, the patient presented with a large pericardial effusion after the distal catheter migrated out of the atrium and into the pericardial space. A repeat sternotomy was performed to drain the pericardial CSF collection. The catheter was reinserted into the atrial appendage, and a tunnel was created in the atrial wall to fix the device more securely. At 1 year postoperatively, the patient had no further symptoms of shunt obstruction or cardiac tamponade, and imaging studies suggested that the shunt system was functional. The authors report the first successful ventricle to direct heart shunt in an adult.

Abbreviation used in this paper: VP = ventriculoperitoneal.
Article Information

Contributor Notes

Address correspondence to: Andrew N. Nemecek, M.D., Department of Neurological Surgery, CH8N Oregon Health & Science University, 3303 Southwest Bond Avenue, Portland, Oregon 97239. email: nemeceka@ohsu.edu.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Martin JEKeating RFCogen PHMidgley FM: Long-term follow-up of direct heart shunts in the management of hydrocephalus. Pediatr Neurosurg 38:94972003

    • Search Google Scholar
    • Export Citation
  • 2

    Milhorat THMcClenathan JE: Direct cardiac shunt for hydrocephalus of infancy and childhood. Technical note. J Neurosurg 42:6056081975

    • Search Google Scholar
    • Export Citation
  • 3

    Scarff JE: Treatment of hydrocephalus: an historical and critical review of methods and results. J Neurol Neurosurg Psychiatry 26:1261963

    • Search Google Scholar
    • Export Citation
  • 4

    Tubbs RSBarnhart DAcakpo-Satchivi L: Transfemoral vein placement of a ventriculoatrial shunt. Technical note. J Neurosurg 106:68692007

    • Search Google Scholar
    • Export Citation
  • 5

    Vernet OCampiche Rde Tribolet N: Long-term results after ventriculoatrial shunting in children. Childs Nerv Syst 9:2532551993

  • 6

    Weinman DPaul AT: Ventriculoauriculostomy for infantile hydrocephalus using a direct cardiac approach. Technical note. J Neurosurg 27:4714741967

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 172 168 34
Full Text Views 89 74 0
PDF Downloads 104 64 1
EPUB Downloads 0 0 0
PubMed
Google Scholar