Development of pulmonary hypertension in adults after ventriculoatrial shunt implantation.

Abstract

BACKGROUND:

The insertion of ventriculoatrial (VA) shunts for the treatment of hydrocephalus is thought to be associated with the development of pulmonary hypertension in adults.

OBJECTIVES:

It was the aim of this study to describe the frequency and the clinical spectrum of pulmonary hypertension in adults with VA shunts.

METHODS:

Patients with pulmonary hypertension were retrospectively evaluated from January 1999 to December 2006.

RESULTS:

Among the 575 patients with pulmonary hypertension, 6 (mean age 42.5 +/- 8.3 years) were identified as having received a VA shunt. Mean pulmonary artery pressure for these patients was 53.3 +/- 14.9 mm Hg. The interval between shunt placement and the diagnosis of pulmonary hypertension was 9-27 years (median 16.5). While ventilation perfusion scans showed multiple bilateral perfusion defects in all patients, chest CT or pulmonary angiography demonstrated pulmonary thromboembolism in only 2 of the 6 patients. These 2 patients subsequently underwent pulmonary endarterectomy. Another patient required heart-lung transplantation because of severe pulmonary hypertension; lung histology showed prominent eccentric medial hypertrophy and intimal proliferation without evidence of thromboembolism. Contrary to earlier reports, outcomes were generally good, with a 100% survival rate for the first 8 years following diagnosis.

CONCLUSIONS:

Severe pulmonary hypertension can develop in adult patients with VA shunts. Therefore, clinicians should consider pulmonary hypertension as a potential cause for respiratory symptoms in patients who have received VA shunts.

• Authors: Stefan Kluge, Hans Jorg Baumann, Jan Regelsberger, Uwe Kehler, Barbara Koziej, Hans Klose, Ulf Greinert, Georg Kreymann, Andreas Meyer
• Journal: Respiration; international review of thoracic diseases (Respiration) Vol. 78 Issue 1 Pg. 30-5 ( 2009) ISSN: 1423-0356 [Electronic] Switzerland
• PMID: 18799867 (Publication Type: Journal Article)
• Copyright: Copyright 2008 S. Karger AG, Basel.

Topics

• Adolescent
• Adult
• Cerebrospinal Fluid Shunts (adverse effects)
• Child
• Cohort Studies
• Female
• Humans
• Hydrocephalus (therapy)
• Hypertension, Pulmonary (etiology, therapy)
• Middle Aged
• Retrospective Studies
• Treatment Outcome