Fluoroscopy guided ventriculo-atrial shunt insertion

Abstract

Background: The ventriculo-atrial shunt is performed routinely for the treatment of hydrocephalus when the ventriculo-peritoneal shunt has failed or patients present some intra-abdominal disease that contraindicates the peritoneum as an ideal destination. During surgery, placing the distal end of the catheter at the cavo-atrial junction is essential for preventing possible complications. Objective: To describe the clinical characteristics in a patient who received fluoroscopy-guided ventriculo-atrial shunt. Case presentation: Female, 26 years old, right handedness with antecedents of post-meningitic communicating hydrocephalus in childhood, for which she was submitted to ventriculo-peritoneal shunt. She underwent multiple reinterventions due to catheter obstruction. She started with intracranial hypertension signs, so the catheter was exteriorized, with symptoms disappearing. It is replaced in the transcavity of the omentum and presents reappearance of neurological symptoms, peritoneal syndrome and pseudocysts on abdominal ultrasound. The decision was made to perform a ventriculo-atrial shunt with the fluoroscopic method in order to guarantee ideal position. She has been maintained with antiplatelet treatment and echocardiographic and radiological monitoring, without complications. Conclusions: Ventriculo-atrial shunt is an option when ventriculo-peritoneal shunt is contraindicated. The use of transoperative fluoroscopy allows optimal placing of catheter distal end. Serial echocardiography allows early detection of potential complications and antiplatelet therapy contributes to reducing those of intravascular origin.

Keywords

• derivación ventrículo-atrial
• hidrocefalia
• derivación ventriculoperitoneal
• complicaciones
• fluoroscopia.