右心室内に脳室心房シャントカテーテル片が迷入し経静脈的に回収を行った1例

Intracardiac Migration of a Ventriculoatrial Shunt Catheter Treated by Endovascular Transvenous Retrieval

Ⅰ．はじめに

　水頭症に対する外科的治療として，最近では脳室腹腔（ventriculoperitoneal：VP）シャントや腰椎腹腔シャントが広く行われている．脳室心房（ventriculoatrial：VA）シャントは施行される機会はかなり減ったものの，腹膜炎などの理由により，腹腔側が使用できない場合にはVAシャントが行われる．今回，VAシャントがルートの途中で断裂して心房側カテーテル先端が右心室内に迷入し，経静脈的に回収を行った症例を経験したので報告する．

　The authors report a case of intracardiac migration of a ventriculoatrial (VA) shunt catheter and transvenous retrieval of the migrated shunt catheter. A 67-year-old male,who had previously undergone a VA shunt for hydrocephalus after subarachnoid hemorrhage,presented disorientation,memory disturbance and gait disturbance without any cardiopulmonary symptom. Head CT scan revealed ventriculomegaly that indicated hydrocephalus due to shunt malfunction. Radiogram revealed that the caudal segment of the broken atrial catheter had migrated into the heart (right ventricle). The migrated shunt catheter was retrieved by a transfemoral approach with a pigtail catheter and a snare retriever catheter,although the rostral catheter segment partially remained because of tight adhesion. The VA shunt was then reconstructed. Postoperatively,symptoms due to recurrent hydrocephalus were markedly improved and the VA shunt functioned well. Transvenous catheter retrieval was a less invasive and effective method for VA shunt catheter migration.