Artikel
Pulmonary hypertension caused by ventriculoatrial shunt : a serious complication of a simple neurosurgical procedure
Pulmonaler Hochdruck: eine unterschätzte Komplikation des ventrikuloatrialen Shunts
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Pulmonary hypertension may be caused by ventriculoatrial shunts. The patho-physiology is not understood completely. The symptoms often develop slowly and remain undetected over years. This evaluation should detect the incidence, severity, and course of shunt-associated pulmonary hypertension.
Methods
Retrospectively 30 patients who had a ventriculoatrial shunt were reexamined for clinical history and for pulmonary hypertension.
Results
Four of 30 patients showed a pulmonary hypertension. All patients were females. The mean age of the patients at diagnosis of pulmonary hypertension was 45,25 years (range: 37-58). The shunt implantation was 9 to 24 years ago (mean: 16,5). In 1 patient comorbidity (pulmonary embolism and tuberculosis) was present before VA-shunt implantation. The mean pulmonary artery pressure was 55.7±5 mmHg, the heart index was 1.9±0.3 l/min/m2, the walking distance in the 6min walking test was 310.8±85.7 m. All patients were initially in NYHA grade 3-4. One patient needed heart-lung transplantation; the other 3 patients are severely handicapped and need an extensive drug combination therapy. The clinical symptoms progressed although the shunts were changed to the peritoneum or gall bladder.
Conclusions
Ventriculoatrial shunts may cause severe pulmonary hypertension. The knowledge of this complication and the severity of this course indicats an even greater restriction in the indication for ventriculoatrial shunts.