• Sasan Darius Adib, Mario Lescan, Mirjam Renovanz, Martin U Schuhmann, Leonidas Trakolis, Malte Bongers, Marcos Tatagiba, Alexander Döbele, and Gerd Grözinger.
• Department of Neurosurgery, University of Tübingen, Tübingen, Germany. Electronic address: sasan_adib2002@yahoo.de.
• World Neurosurg. 2020 Mar 1; 135: 222-227.

BackgroundIntracardial migration of a ventriculoperitoneal (VP) shunt (ICMVP) is a rare complication that has been described in only single case reports. Here we report the successful interdisciplinary management of an ICMVP and provide a review of the relevant literature.Case DescriptionA 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 at 7 months after VP shunt implantation (with initially a proper location on computed tomography 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.ConclusionsThe management of an ICMVP is complex and carries a high risk for severe potential complications. Two different pathophysiological mechanisms have been discussed in the literature, including gradual erosion into an adjacent vein and transvenous catheter placement of the initial shunt secondary to subcostal placement of shunt tunneling instruments. The suction effect of the venous system results in gradual pulling of the catheter into the venous system.Copyright © 2019 Elsevier Inc. All rights reserved.

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