• Laura Pradini-Santos, Claudia L Craven, Laurence D Watkins, and Ahmed K Toma.
• Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
• World Neurosurg. 2020 Apr 1; 136: 83-89.

BackgroundGiven recent positive safety evidence, ventriculoatrial (VA) shunt placement may increase in popularity once more. We describe a rare case of Tricuspid regurgitation due to VA shunt catheter tip traversing the valve.Case DescriptionA woman aged 42 years with a preexisting VA shunt was referred to this center with 3 months of orthostatic headache, nausea, and palpitations that occurred while sleeping on her right side. An echocardiogram demonstrates a VA shunt catheter in the right atrium during cardiac diastole, which traversed the tricuspid annular plane during cardiac systole. The echocardiogram revealed mild to moderate tricuspid regurgitation. She had no clinical evidence of cardiac failure or arrhythmia and had normal electrocardiogram findings. The catheter tip appeared to be adhered to the underside of the leaflets or to the chordae tendineae. Pulling the catheter tip back could therefore cause irreversible damage to the tricuspid valve. For this reason, the catheter was not removed, and the patient was referred for close follow-up with cardiologists. A literature review was performed to determine where this rare complication fits into the spectrum of VA shunt distal catheter complications, and what techniques can be done to avoid similar occurrences.ConclusionsThis report reiterates the importance of ensuring the tip is carefully placed within the atrium, under fluoroscopic guidance. Although rare, the described complication is difficult to manage once it has occurred.Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.

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