gms | German Medical Science

Objective: In the management of hydrocephalus has been shown that ventriculoatrial (VA-) shunts have a higher rate of severe complications than ventriculoperitoneal (VP-) shunts. Two cases of intracardiac migration of a distal catheter, in one case with successful retrieval are presented. In addition a review of the literature is provided.

Methods: A 15-year-old female dysraphic patient suffered from headache and nausea. In addition, she presented an episode of tachycardia. A chest radiograph showed that the atrial catheter was disconnected and had migrated into heart and pulmonary artery. An endovascular removal of the migrated intracardiac shunt catheter could be achieved. The VA-shunt was converted into a VP-system again. A 69-year-olf female patient presented with unclear lower back pain, but no hydrocephalic symptoms. A routine MRI showed no recurrence of hydrocephalus, chest radiograph showed that the atrial catheter was disconnected and had migrated into the right atrium. No thrombotic lesions or reduction of the cardiac function especially of the tricuspid valve could be shown and in the myocardium no cicatrices could be found. In the ECG no cardiac arrhythmia could be detected. In this case we decided to leave the atrial catheter in situ and follow the patient. Migration of atrial catheters is a rare but serious complication of VA-systems.

Results: In the follow-up both patients presented no headache, nausea or neurologic deficits.

Conclusions: The first step in such a case is to treat elevated intracranial pressure if present, then the dislocated catheter. In case of low risk of cardiac complications removal of the distal catheter seems not to be necessary.