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Myocardial Perforation by Ventriculoatrial-Shunt Tubing

Andrievs J. Dzenitis, MD; John Mealey Jr., MD; J. Ronald Waddell, MD
JAMA. 1965;194(11):1251-1253. doi:10.1001/jama.1965.03090240085032.
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CERTAIN well-recognized complications not infrequently follow ventriculoatrial shunts, which are now regarded as the treatment of choice in infantile hydrocephalus.1-3 Common causes necessitating removal or revision of the shunt are sepsis,4,5 body growth, and mechanical separation or malfunction of the component parts.4,6,7 The atrial tubing has been implicated in thromboemboli affecting the pulmonary circulation,5,6,8 in cardiac arrhythmias,4 in focal pericarditis, and in endocardial necrosis.6

This is a report of a unique, well-documented complication of a ventriculoatrial shunt in which the distal silicone-rubber tubing perforated the wall of the right atrium, causing cerebrospinal fluid (CSF) accumulation in the pericardial sac. A similar case was cited by Anderson,1 who successfully treated the patient with a single pericardial tap, but the etiology was never disclosed. Friedman and co-authors4 refer to comparable experiences, but clinical information, treatment, eventual outcome, as well as possible mechanisms, are


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