Thrombus is a frequent cause of shunt malfunction both of the proximal
end following intraventricular hemorrhage and of the distal catheter
of a vascular shunt. Continued blockages may result in numerous shunt
revisions until the blood has been cleared. We have treated 3 children
with shunt malfunctions secondary to thrombus with urokinase, a throm
bolytic agent. Two children had intraventricular hemorrhage following
a shunt revision and were treated with intrashunt urokinase, and 1 wit
h occlusion of an atrial catheter was treated with both intrashunt and
systemic urokinase. All were symptomatic at the time of treatment (he
adaches, vomiting, full fontanel, somnolence) and all had ventriculome
galy demonstrated on computed tomography. Various dosage regimens were
used with total intrashunt doses of 20,000, 50,000, and 70,000 IU. Al
l improved clinically, computed tomography scans demonstrated improvem
ent, and all were discharged from the hospital. There were no complica
tions of the urokinase administration. The 2 children with proximal oc
clusion have not required further shunt revisions at 12 and 27 months
following treatment. The infant with atrial end occlusion subsequently
underwent two proximal revisions with eventual removal of the atrial
catheter because of infection. We conclude the intrashunt urokinase ca
n be of value in the treatment of shunts by blood and blood products.