Pulmonary hypertension after ventriculoatrial shunt implantation.

OBJECT Ventriculoatrial (VA) shunts inserted for the treatment of hydrocephalus are known to be a risk factor for pulmonary hypertension. The aim of this study was to evaluate the incidence of pulmonary hypertension among adult patients with VA shunts. METHODS All patients who had received a VA shunt at one of two institutions between 1985 and 2000 were invited for a cardiopulmonary evaluation. The investigation included a thorough history taking, clinical examination, echocardiography, and pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO). Pulmonary hypertension was defined as systolic pulmonary artery pressure>35 mm Hg at rest. RESULTS The study group consisted of 86 patients, of whom 38 (44%) could be examined. The patients' mean age was 47.1±18.4 years; the median interval between shunt insertion and cardiopulmonary evaluation was 15 years (range 5-20 years). Of the 38 patients, 20 (53%) had Doppler velocity profiles of tricuspid regurgitation that were adequate for the estimation of pulmonary artery systolic pressure. Doppler-defined pulmonary hypertension was observed in 3 patients (8%), 2 of whom underwent right heart catheterization. Chronic thromboembolic pulmonary hypertension was confirmed in both patients, and medical therapy, including anticoagulation, was started. The VA shunt was removed in both cases and replaced with a different type of device. Pulmonary function tests revealed a restrictive pattern in 15% and typical obstructive findings in 9% of patients. In 30% of patients the DLCO was less than 80% of predicted, and blood gas analysis showed hypoxemia in 6% of patients. No significant differences in pulmonary function tests were noted between the patients with and without echocardiographic evidence of pulmonary hypertension. However, patients with pulmonary hypertension had significantly lower DLCO values. CONCLUSIONS The authors detected pulmonary hypertension by using Doppler echocardiography in a significant proportion of patients with VA shunts. It is therefore recommended that practitioners perform regular echocardiography and pulmonary function tests, including single-breath DLCO in these patients to screen for pulmonary hypertension to prevent hazardous late cardiopulmonary complications.

[1]  J. Belperio,et al.  Diagnosis and hemodynamic assessment of pulmonary arterial hypertension. , 2009, Seminars in respiratory and critical care medicine.

[2]  H. Baumann,et al.  Development of Pulmonary Hypertension in Adults after Ventriculoatrial Shunt Implantation , 2008, Respiration.

[3]  J. Hankinson,et al.  Standardisation of the single-breath determination of carbon monoxide uptake in the lung , 2005, European Respiratory Journal.

[4]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[5]  M. Schemper,et al.  Medical conditions increasing the risk of chronic thromboembolic pulmonary hypertension , 2005, Thrombosis and Haemostasis.

[6]  Horst Olschewski,et al.  Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. , 2004, European heart journal.

[7]  D. Mccrory,et al.  Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. , 2004, Chest.

[8]  Gérald Simonneau,et al.  Chronic thromboembolic pulmonary hypertension , 2004, European Respiratory Journal.

[9]  M. Yigla,et al.  Pulmonary hypertension in patients with end-stage renal disease. , 2003, Chest.

[10]  P. Sanders,et al.  Late cardiopulmonary complication of ventriculo-atrial shunt , 2001, The Lancet.

[11]  T. W. van der Mark,et al.  Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension. , 2000, The European respiratory journal.

[12]  J. Pascual,et al.  Development of pulmonary hypertension after placement of a ventriculoatrial shunt. , 1993, Mayo Clinic proceedings.

[13]  W. Penny,et al.  Cor Pulmonale as a Complication of Ventriculo‐atrial Shunts Reviewed , 1993, Developmental medicine and child neurology.

[14]  E H Bergofsky,et al.  Survival in Patients with Primary Pulmonary Hypertension: Results from a National Prospective Registry , 1991 .

[15]  A. Franco,et al.  Thromboembolic complications of ventriculoatrial shunts. , 1984, Surgical neurology.

[16]  F. M. Anderson.  Ventriculocardiac shunts. Identification and control of practical problems in 143 cases. , 1973, The Journal of pediatrics.

[17]  B. Stein,et al.  Lung scan evaluation of the shunted hydrocephalic. , 1970, Transactions of the American Neurological Association.

[18]  H. Warden,et al.  Thrombo-embolic complications of ventriculo-atrial shunts. Angiocardiographic and pathologic correlations. , 1966, Journal of neurosurgery.

[19]  S. Friedman,et al.  PULMONARY VASCULAR CHANGES COMPLICATING VENTRICULOVASCULAR SHUNTING FOR HYDROCEPHALUS. , 1964, The Journal of pediatrics.

[20]  F. M. Anderson,et al.  COR PULMONALE SECONDARY TO VENTRICULOAURICULOSTOMY. , 1964, American journal of diseases of children.