Huge thrombosis as a consequence of VA-shunts.
OBJECTIVE
Thrombosis is a rare but serious consequence of VA-shunts. We present two cases of near fatal thrombosis and its successful (but in case 2, atypical) management.


RESULTS
Case 1: A 38-year-old woman with VA-shunt suffered from rapidly progressing heart failure and later from progressing underdrainage signs nine years after shunting due to a thrombus on the atrial shunt catheter that occluded >80% of the right atrium. Cardio-surgical removal of thrombus and VA-shunt catheter and VP-shunting normalized neurological and cardiological state. Case 2: A 40-year-old woman received a VA-shunt 5 years before she suddenly suffered dyspnea and venous congestion. Secondarily, underdrainage occurred. The underlying huge thrombosis of the superior caval vein could not be excised because the necessary thoracotomy would have interrupted vital venous bypasses along the thoracic wall. Anticoagulants (heparin, cumarin) and ETV relieved all neurological and cardiological symptoms.


CONCLUSIONS
Sudden or unexpected symptoms of cardiac failure in the presence of a VA-shunt must be recognized as serious. Interestingly, despite distal shunt occlusion, underdrainage symptoms might be initially mild.
Kiefer
Michael
M
Department of Neurosurgery, Saarland University Medical School, Homburg-Saar, Germany. Michael.Kiefer@uks.eu
Eymann
Regina
R
D000293:Adolescent; D000328:Adult; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*