MEDICAL COMPLICATIONS OF VENTRICULOATRIAL SHUNTS

Background: Ventriculo-atrial shunts (VASs) and ventriculo-peritoneal shunts (VPSs) are the symptomatic treatment of choice for hydrocephalu s. Bacterial contamination of the atrial part of VASs (usually with St aphylococcus epidermidis) can result in further organ complications, i n most instances immune complex mediated glomerulonephritis (''shunt-n ephritis'') or direct microbial heart valve destruction. Patients and Methods: In a retrospective study, we analyzed clinical and laboratory data of 11 patients with VAS associated complications as well as the course of the disease. Results: The following complications were obser ved: glomerulonephritis (n = 9), glomerulonephritis and aortic valve d estruction (n = 1), pulmonary embolism, pulmonary hypertension and tri cuspid valve insufficiency (n = 1). Out of the 11 patients, 8 suffered from unexplained fever. All 11 patients had elevated circulating immu ne complexes. In 3 of 4 patients initially requiring dialysis, renal f unction improved which allowed to stop hemodialysis. Renal function al so improved in 3 of 5 patients who presented with elevated serum creat inine. Unfortunately, the patient with multiple pulmonary embolisms an d tricuspid valve insufficiency died of progressive pulmonary hyperten sion. Conclusion: The prognosis for impaired renal function is good on ly if the VAS infection is diagnosed early and an immediate surgical a nd antibiotic treatment leads to an eradication of the underlying chro nic infection. .