Inserción de derivación ventrículo-atrial guiada por fluoroscopia

Ernesto Enrique Horta-Tamayo, Luis Cesar Acosta-González, Carlos García-Alonso, Enrique Antonio González-Hernández

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Fundamento: La derivación ventrículo-atrial se realiza de manera habitual para el tratamiento de la hidrocefalia cuando la derivación ventrículo-peritoneal ha fallado o los pacientes presentan alguna enfermedad intrabdominal que contraindica el peritoneo como destino ideal. Durante la cirugía, la colocación del extremo distal del catéter en la unión cavo-atrial es esencial en la prevención de posibles complicaciones.

Objetivo: Describir las características clínicas de un paciente que recibió derivación ventrículo-atrial guiada por fluoroscopia.

Presentación de caso: Femenina, de 26 años, manualidad derecha con antecedentes de hidrocefalia comunicante posmeningítica en la infancia, por la cual se le realizó derivación ventrículo-peritoneal. Sufrió múltiples reintervenciones por obstrucción del catéter. Comenzó con signos de hipertensión intracraneal por lo que se exterioriza el catéter, con desaparición de los síntomas. Se recoloca en la transcavidad de los epiplones y presenta reaparición de los síntomas neurológicos, síndrome peritoneal y seudoquistes en la ecografía abdominal. Se decidió realizar derivación ventrículo-atrial con el método fluoroscópico para garantizar posición ideal. Se ha mantenido con tratamiento antiagregante y seguimiento ecocardiográfico y radiológico, sin complicaciones.

Conclusiones: La derivación ventrículo-atrial es una opción cuando la derivación ventrículo-peritoneal está contraindicada. La utilización de la fluoroscopia transoperatoria permite la colocación óptima del extremo distal del catéter. La ecocardiografía seriada posibilita la detección temprana de posibles complicaciones y el tratamiento antiagregante contribuye a disminuir las de origen intravascular.

Palabras clave

Derivación ventrículo-atrial; hidrocefalia; derivación ventriculoperitoneal; complicaciones; fluoroscopia.

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