Transcardiac migration of ventriculoperitoneal shunt requiring open cardiac surgery: case report and review of the literature

Abstract

Introduction: Cardiac migration of ventriculoperitoneal (VP) shunts has been reported, with most easily removed or shortened via a cervical incision. We present a review of the literature, highlighting our unique case with significant scarring requiring open, on-pump, cardiac surgery for removal of migrated distal tubing.

Case presentation: A 7-year-old boy underwent VP shunt insertion for hydrocephalus secondary to intracranial astrocytoma. He presented at age 17 with evidence of right heart strain, associated with the distal shunt catheter proximally migrated into his heart and pulmonary arteries. Due to his delayed presentation, the catheter was knotted and partially immobilized by scar formation, finally requiring open-heart surgery to remove the catheter.

Conclusions: A multi-disciplinary evaluation with endovascular, neurosurgery, and cardiothoracic surgery may be the safest approach, especially in those patients with knotting on preoperative imaging.

Keywords: Cardiac migration; Ventriculoperitoneal shunt.