LETTERS TO EDITOR
Year : 2018 | Volume
: 34 | Issue : 1 | Page : 127--128
An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively
Gaurav Singh Tomer1, Keerthi P Nandakumar2, Vikas Chauhan1, Surya Kumar Dube1,
1 Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
Correspondence Address:
Surya Kumar Dube
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi
India
How to cite this article:
Tomer GS, Nandakumar KP, Chauhan V, Dube SK. An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively.J Anaesthesiol Clin Pharmacol 2018;34:127-128
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How to cite this URL:
Tomer GS, Nandakumar KP, Chauhan V, Dube SK. An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2021 Jan 16 ];34:127-128
Available from: https://www.joacp.org/text.asp?2018/34/1/127/227569 |
Full Text
Ventriculoatrial (VA) shunt channels cerebrospinal fluid (CSF) from the ventricle of the brain into the right atrium (RA) of the heart. It is a less commonly performed CSF diversion procedure and is often indicated in conditions where repetitive shunt revisions may be required due to ventriculoperitoneal shunt obstruction, infection, or migration.[1] There are a variety of techniques suggested to confirm position of catheter tip into RA such as transesophageal echocardiography (TEE), chest X-ray, and pressure waveform. The least reliable among these is chest X-ray.
Exposure to ionizing radiation during surgical intervention in a growing child for prolong duration may be hazardous as children are more radiosensitive than adults (i.e., increased cancer risk per unit dose of ionizing radiation).[2] TEE is another method to confirm the catheter position.[3] The shortcomings of TEE are high cost, insertion, and interpretation in a child.
We applied pressure waveform concept (useful for correct positioning of central venous pressure catheter) for correct VA shunt catheter placement.[4],[5] We connected the distal end of VA shunt to a pressure transducer via a fluid filled pressure monitoring line and obtained continuous pressure tracing according to the depth of VA shunt lying inside the chambers of heart. Initially, we obtained a right ventricular type of pressure tracing immediately following insertion of VA shunt catheter, and then it was withdrawn gradually to get a right arterial pressure tracing. With this report, here we highlight the importance of pressure waveform monitoring as a safe alternative to fluoroscopy/TEE to guide the correct placement of VA shunt intraoperatively.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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| 2 | Camarata PJ, Haines SJ. Ventriculoatrial shunting. In: Rengachary SS, Wilkins RH, editors. Neurosurgical Operative Atlas. Chicago: The American Association of Neurological Surgeons; 1993. p. 231-9. |
| 3 | Machinis TG, Fountas KN, Hudson J, Robinson JS, Troup EC. Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography. Technical note. J Neurosurg 2006;105:153-6. |
| 4 | Cantu RC, Mark VH, Austen WG. Accurate placement of the distal end of a ventriculo-atrial shunt catheter using vascular pressure changes. Technical note. J Neurosurg 1967;27:584-6. |
| 5 | Myles LM, Neil-Dwyer G. Ventriculo-atrial shunt insertion: Pressure monitoring as an aid to accurate placement. Br J Neurosurg 2000;14:462-3. |
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