Transvenous Repositioning of a Distal Ventriculoatrial Shunt Catheter Terminating in the Coronary Sinus in a Pediatric Patient With a Duplicated Superior Vena Cava.

Ventriculoatrial shunts (VAS) are an alternative to ventriculoperitoneal shunts (VPS) for cerebrospinal fluid (CSF) diversion in patients with peritoneal contraindications. Although rare, complications such as catheter migration or malposition can occur and may be exacerbated by underlying congenital venous anomalies. Endovascular techniques have emerged as a minimally invasive option for VAS revision, yet reports remain limited and primarily focus on acquired malpositions. To our knowledge, no prior case describes endovascular VAS repositioning in the context of a duplicated superior vena cava (SVC) with catheter termination in the coronary sinus. In this case, a 15-year-old female patient with a history of congenital hydrocephalus and prior VPS placement underwent conversion to a VAS due to abdominal pseudocyst formation. Chest radiography obtained postoperatively demonstrated an abnormal left-sided venous course of the distal catheter. Subsequent chest CT confirmed traversal of the catheter through a duplicated left SVC with termination in the coronary sinus, risking the development of thromboembolism. To avoid the risks associated with open surgical revision, such as vascular injury, infection, and compromised venous access, an endovascular approach was selected. Using transfemoral venous access and fluoroscopic guidance, the catheter was successfully repositioned from the coronary sinus into the right atrium, with correct positioning confirmed on postoperative chest X-ray. Fluoroscopy time was 11.3 minutes, maximum radiation dose was 24.9 mGy (968.21 µGy/m2), and total procedural time was 28 minutes. The catheter was repositioned within eight minutes of procedure onset. No contrast was used during the procedure, and image guidance was purely with fluoroscopy. The patient had no postoperative complications. During yearly follow-up, the patient remained free of symptoms of shunt malfunction, and surveillance chest radiography confirmed the distal catheter tip within the right atrium. This case highlights the importance of targeted preoperative imaging, as preoperative transthoracic echocardiography (TTE) may fail to identify anomalous thoracic venous anatomy. In such cases, screening chest CT or CT venography may be prudent when anatomical variants are suspected. In addition, endovascular repositioning of malpositioned distal VAS catheters within the venous system may represent a lower-risk alternative to open distal shunt revision in carefully selected patients.