Myocardial perforation by ventriculoatrial-shunt tubing

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Abstract
CERTAIN well-recognized complications not infrequently follow ventriculoatrial shunts, which are now regarded as the treatment of choice in infantile hydrocephalus.1-3Common causes necessitating removal or revision of the shunt are sepsis,4,5body growth, and mechanical separation or malfunction of the component parts.4,6,7The atrial tubing has been implicated in thromboemboli affecting the pulmonary circulation,5,6,8in cardiac arrhythmias,4in 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,1who successfully treated the patient with a single pericardial tap, but the etiology was never disclosed. Friedman and co-authors4refer to comparable experiences, but clinical information, treatment, eventual outcome, as well as possible mechanisms, are

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