title: Transcardiac migration of ventriculoperitoneal shunt requiring open cardiac surgery: case report and review of the literature.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Section of Neurosurgery, Department of Surgery, The University of Chicago Medicine, 5841 S Maryland Ave, MC 3026, Chicago, IL, 60637, USA. Ashley.ralston@uchospitals.edu.
authors.forename: Ashley
authors.identifier: http://orcid.org/0000-0003-4008-1290
authors.initials: A
authors.lastname: Ralston
authors.affiliation: Section of Neurosurgery, Department of Surgery, The University of Chicago Medicine, 5841 S Maryland Ave, MC 3026, Chicago, IL, 60637, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago Medicine, 5841 S Maryland Ave, MC 4050, Chicago, IL, 60637, USA.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ziemer
authors.affiliation: Section of Neurosurgery, Department of Surgery, The University of Chicago Medicine, 5841 S Maryland Ave, MC 3026, Chicago, IL, 60637, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Frim
mesh_terms: D001254:Astrocytoma / Q000150:complications; D001932:Brain Neoplasms / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006321:Heart; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Cardiac migration; Ventriculoperitoneal shunt