Udayakumaran Suhas, Kumar Shine
Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India.
Asian J Neurosurg. 2024 Nov 21;20(1):88-94. doi: 10.1055/s-0044-1795165. eCollection 2025 Mar.
Ventriculoatrial (VA) shunts have the potential to preserve life in the event of failure of ventriculoperitoneal (VP) shunts. Contrary to VP shunts, they are susceptible to consequences, particularly cardiac problems. There are no established guidelines for screening patients following VA shunt placement regarding prevention, anticoagulant treatment, or risk factor screening. We aim to investigate aspirin's potential function and effectiveness in enhancing shunt survival and preventing secondary morbidity from distal thrombosis in children with VA shunts. The study's design is prospective and observational. It began in 2011 and is ongoing. Before inclusion in the study, we obtained clearance from the hospital ethics board and consent from the family. All patients with VA shunts were given a once-a-day antiplatelet dose of 5 mg/kg of aspirin from the first postoperative day. The study's primary end points include: (1) Major distal end malfunction documented on echocardiography or (2) any cardiac complications directly associated with the VA shunt. Since March 2011, 13 patients have been followed up. So far, no cardiac complications have been ascribed to VA shunts in any of the patients. The current follow-up period is 28 to 170 months. Patient follow-up is continuing. Our observations regarding the efficacy and safety of aspirin in VA shunts are encouraging. However, sufficient time would be needed to establish its effectiveness in chronic sequelae such as pulmonary hypertension.
在脑室腹腔（VP）分流术失败的情况下，脑室心房（VA）分流术有挽救生命的潜力。与VP分流术不同，VA分流术容易引发各种后果，尤其是心脏问题。目前尚无关于VA分流术后患者预防、抗凝治疗或风险因素筛查的既定指南。
我们旨在研究阿司匹林在提高VA分流患儿分流管使用寿命及预防远端血栓形成所致继发性疾病方面的潜在作用和效果。
本研究采用前瞻性观察设计。研究始于2011年，目前仍在进行中。在纳入研究前，我们获得了医院伦理委员会的批准及患儿家属的同意。所有VA分流术患者自术后第一天起每日服用5mg/kg的阿司匹林进行抗血小板治疗。本研究的主要终点包括：（1）超声心动图显示的主要远端分流管故障，或（2）任何与VA分流术直接相关的心脏并发症。
自2011年3月起，对13例患者进行了随访。迄今为止，所有患者均未出现与VA分流术相关的心脏并发症。目前的随访期为28至170个月。患者随访仍在继续。
我们关于阿司匹林在VA分流术中有效性和安全性的观察结果令人鼓舞。然而，要确定其在诸如肺动脉高压等慢性后遗症中的有效性，还需要足够的时间。
