Late ventriculo-atrial shunt migration leading to pericardial cerebrospinal fluid effusion and cardiac tamponade.
Details
Serval ID
serval:BIB_BB43584C74DC
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Late ventriculo-atrial shunt migration leading to pericardial cerebrospinal fluid effusion and cardiac tamponade.
Journal
Interactive cardiovascular and thoracic surgery
ISSN
1569-9285 (Electronic)
ISSN-L
1569-9285
Publication state
Published
Issued date
03/2013
Peer-reviewed
Oui
Volume
16
Number
3
Pages
391-393
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
We present the case of a patient with cardiac tamponade secondary to late intrapericardial migration of a disrupted ventriculo-atrial shunt (VAS). A 48-year old woman was referred for cardiac tamponade. She had a history of congenital hydrocephalus with implantation of a VAS (Codman(®)) in 1994. The initial neurological examination was normal. Tomodensitometry showed a discontinuity of the VAS at the cervical level with its distal part floating in the pericardium. Immediate surgery through sternotomy allowed the draining of the pressurized translucid liquid. The distal part of the VAS was extracted and the perforation site on the right ventricle was sutured. The patient showed no neurological trouble 3 months after operation. Surprisingly, cardiac tamponade was not related to bleeding but to the accumulation of translucid liquid whose gross aspect and biochemistry were very suggestive of cerebrospinal fluid (CSF). We hypothesize that a fibrin sheath had developed around the VAS at the time of its disconnection and acted as a fibrous tunnel allowing continued CSF drainage through its distal part. Surgical strategies to prevent late VAS disconnection should be considered at the time of implantation.
Keywords
Cardiac Tamponade/diagnosis, Cardiac Tamponade/etiology, Cardiac Tamponade/surgery, Cerebrospinal Fluid Shunts/adverse effects, Cerebrospinal Fluid Shunts/instrumentation, Device Removal, Drainage, Equipment Design, Equipment Failure, Female, Foreign-Body Migration/diagnosis, Foreign-Body Migration/etiology, Foreign-Body Migration/surgery, Humans, Hydrocephalus/surgery, Middle Aged, Pericardial Effusion/cerebrospinal fluid, Pericardial Effusion/diagnosis, Pericardial Effusion/etiology, Pericardial Effusion/surgery, Reoperation, Sternotomy, Suture Techniques, Tomography, X-Ray Computed, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
28/03/2019 17:50
Last modification date
20/08/2019 15:29