LAUSR

BACKGROUND Intracardial migration of a ventriculoperitoneal (VP) shunt is a rare complication and it has been described in only single case reports. Herein, we report the successful interdisciplinary management of an intracardial migration of a VP shunt and provide a review of the literature. CASE DESCRIPTION A 38-year-old-patient with shunt-dependent hydrocephalus caused due to a Blake´s pouch cyst presented in our hydrocephalus outpatient clinic with thoracic pain and nocturnal cough seven months after VP shunt implantation (with initially proper location in CT scan of the head and X-ray of the abdomen). A new X-ray of the abdomen and the thorax revealed a dislocated shunt with migration of the distal catheter into the superior cava vein, right atrium, and right heart ventricle with some loops in both pulmonary arteries. The catheter was successfully removed by an interdisciplinary team in general anesthesia under ultrasound, X-ray guidance and cardiovascular parameter control by withdrawing the shunt into the superior cava vein and removing the remnant portion of the distal catheter (with a knot) by interventional snaring. Cardiac and vascular surgeons were on standby. CONCLUSIONS The management of an intracardially migrated ventriculoperitoneal shunt is complex and poses a high risk for severe potential complications. Two different pathophysiological mechanisms have been discussed in the literature, such as gradual erosion into an adjacent vein and transvenous catheter placement of the initial shunt secondary to subcostal placement of shunt tunneling instruments. Suction effect of venous system results in gradual pulling of the catheter into the venous system.