Transesophageal Echocardiography-Guided Ventriculoatrial Shunt Insertion

2019 ◽  
Vol 19 (1) ◽  
pp. 25-31
Author(s):  
Albert McAnsah Isaacs ◽  
Danae Krahn ◽  
Andrew M Walker ◽  
Heather Hurdle ◽  
Mark G Hamilton
Keyword(s):  
Transesophageal Echocardiography ◽  
Perioperative Complications ◽  
Superior Vena ◽  
Vena Cava ◽  
Shunt Revision ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Time Required

Abstract BACKGROUND Determining an optimal location within the right atrium (RA) for placement of the distal ventriculoatrial (VA) shunt catheter offer several operative challenges that place patients at risk for perioperative complications and downstream VA shunt failure. Utilizing transesophageal echocardiography (TEE) guidance to place distal VA shunt catheters may help to circumvent these risks. OBJECTIVE To review our current practice of VA shunt insertion using TEE guidance. METHODS A retrospective review of all consecutive patients who underwent VA shunt procedures between December 19, 2016 and January 22, 2019, during which time intraoperative TEE was used for shunt placement was performed. Data on the time required for shunt placement and total procedure time, baseline echocardiography findings, and short- and long-term complications of shunt placement were assessed. RESULTS A total of 33 patients underwent VA shunt procedures, with a median follow-up time of 250 (88-412) d. The only immediate complication related to shunt placement or TEE use was transient ectopy in 1 patient. The mean time for atrial catheter insertion was 12.6 ± 4.8 min. Right-heart catheters were inserted between the RA-superior vena cava junction and 22 mm within the RA in all but 3 procedures. A total of 7/33 patients (21%) underwent shunt revision. Indications for revisions included distal clots, proximal obstruction, positive blood culture, and shunt valve revision. No other complications of VA shunt insertion were reported. CONCLUSION VA shunt insertion using TEE allows for precise distal catheter placement. Early patient experience confirms this technique has a low complication rate.

Ventriculofemoroatrial shunt: a viable alternative for the treatment of hydrocephalus

1997 ◽  
Vol 86 (6) ◽  
pp. 1063-1066 ◽  
Author(s):  
Matthew F. Philips ◽  
Steven B. Schwartz ◽  
Alexander D. Soutter ◽  
Leslie N. Sutton
Keyword(s):  
Superior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Distal Catheter ◽  
Content Type ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Intercurrent Disease ◽  
Feasible Alternative

✓ Children with shunted hydrocephalus often have a myriad of other medical conditions. When these concomitant problems involve the pleura, peritoneum, and/or the venous system, placement of the distal catheter may prove to be problematic. This report presents preliminary results in three hydrocephalic children following ventriculofemoroatrial shunt placement. The peritoneal and pleural cavities in each of these children were compromised and there was no vascular access into the superior vena cava due to intercurrent disease. An alternative technique for ventriculoperitoneal shunt placement was performed via the femoral vein. Fluoroscopic guidance was used to confirm the intraatrial position of the distal end of the shunt catheter. Follow-up review to date shows no complications. This newly described technique provides a feasible alternative to distal shunt catheter placement in patients in whom more traditional sites are unavailable.

Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography

2006 ◽  
Vol 105 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Theofilos G. Machinis ◽  
Kostas N. Fountas ◽  
John Hudson ◽  
Joe Sam Robinson ◽  
E. Christopher Troup
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Distal Catheter ◽  
The Mean ◽  
The Right

Objective Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. Methods Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65–120 minutes) and the mean operative blood loss was 23 ml (range 10–50 ml). No procedure-related complication was noted. Conclusions Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.

Catheter-induced thrombus in the superior vena cava diagnosed by transesophageal echocardiography

1998 ◽  
Vol 42 (10) ◽  
pp. 1227-1230 ◽  
Author(s):  
T. Weber ◽  
G. Huemer ◽  
H. Tschernich ◽  
A. Kranz ◽  
M. Imhof ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava

Catheter induced superior vena cava syndrome aggravated by shunt placement

2006 ◽  
Vol 7 (2) ◽  
pp. 94-95 ◽  
Author(s):  
W.H.M. Verbeek ◽  
R.K. Riezebos ◽  
C.E.H. Siegert ◽  
M.C. Weijmer
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Shunt Placement ◽  
Vena Cava Syndrome

Utility of transesophageal echocardiography in the assessment of mediastinal masses and superior vena cava obstruction

1991 ◽  
Vol 122 (5) ◽  
pp. 1469-1472 ◽  
Author(s):  
Phillip R. Dawkins ◽  
Marcus F. Stoddard ◽  
Norman E. Liddell ◽  
Rita Longaker ◽  
David Keedy ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Superior Vena Cava Obstruction ◽  
Mediastinal Masses

Ventriculosagittal Sinus Shunt Placement: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 778-780 ◽  
Author(s):  
Uzma Samadani ◽  
Julian A. Mattielo ◽  
Leslie N. Sutton
Keyword(s):  
Clinical Presentation ◽  
Air Embolism ◽  
Pneumatosis Intestinalis ◽  
Seldinger Technique ◽  
Ventricular Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Sagittal Sinus ◽  
Theoretical Advantage

Abstract OBJECTIVE AND IMPORTANCE Determining an appropriate site for distal catheter placement for ventricular shunting for some hydrocephalic patients can be difficult. We describe a simplification of the technique for sagittal sinus shunt placement using a guidewire. CLINICAL PRESENTATION A 20-month-old infant with hydrocephalus secondary to Alexander's disease developed erosion of her parieto-occipital ventriculoperitoneal shunt reservoir through an occipital decubitus scalp ulceration. Her hydrocephalus was temporarily treated with a ventriculostomy; however, she developed pneumatosis intestinalis while in the hospital. TECHNIQUE The patient underwent placement of a ventriculosagittal sinus shunt. The ventricular catheter and shunt valve were placed through a burr hole at Kocher's point, and the distal end of the catheter was placed in the superior sagittal sinus by using the Seldinger technique. CONCLUSION Ventriculosagittal sinus shunting may be used as an alternative to traditional methods for patients for whom distal shunt placement is problematic. Our technique has the theoretical advantage of reducing the risks of blood loss or air embolism by not requiring a scalpel incision into the sinus.

Pericardial tamponade by Holter ventriculoatrial shunts

1971 ◽  
Vol 35 (6) ◽  
pp. 695-699 ◽  
Author(s):  
Stavros Tsingoglou ◽  
Herbert B. Eckstein
Keyword(s):  
Pericardial Tamponade ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Revision Procedure ◽  
Content Type ◽  
Cardiac Perforation ◽  
Cardiac Wall ◽  
Cardiac Silhouette ◽  
Fine Print

✓ Ten cases of cardiac tamponade caused by pericardial perforation by a Holter catheter in the treatment of hydrocephalus by ventriculoatrial drainage are reported. These 10 cases occurred in an 8-year practice of two surgeons in a period during which approximately 1800 Holter shunts were inserted and an approximately equal number of operations for lengthening of the distal catheter were performed. The etiological factors, the clinical picture, and the diagnosis are discussed. Cardiac perforation is caused either by forceful introduction of the distal catheter during a shunt revision procedure or by too long a distal catheter that ulcerates through the cardiac wall. Enlargement of cardiac silhouette after shunt insertion is virtually diagnostic of a pericardial effusion. If undiagnosed, this condition was invariably fatal, but if diagnosed in time, immediate treatment was always curative. The distal catheter should be shortened, but suture of the cardiac perforation itself is not necessary.

scholarly journals Transesophageal Echocardiography and Intraoperative Diagnosis of Persistent Left Superior Vena Cava

2009 ◽  
Vol 59 (6) ◽  
pp. 751-755
Author(s):  
Alexander Alves da Silva ◽  
Enis Donizetti Silva ◽  
Arthur Vitor Rosenti Segurado ◽  
Pedro Paulo Kimachi ◽  
Claudia Marquez Simões
Keyword(s):  
Transesophageal Echocardiography ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Intraoperative Diagnosis
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