An easy and feasible way of confirming correct placement of ventriculoatrial shunt intraoperatively.

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.[45] 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a right ventricular type of pressure tracing immediately following insertion of VA shunt catheter, and then it was withdrawn gradually to get a right arterial pressure tracing.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.

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