Ventriculofemoroatrial shunt: a viable alternative for the treatment of hydrocephalus

✓ 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.

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Transesophageal Echocardiography-Guided Ventriculoatrial Shunt Insertion

Operative Neurosurgery ◽

10.1093/ons/opz353 ◽

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.

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Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000540 ◽

2018 ◽

Vol 13 (4) ◽

pp. 300-304 ◽

Cited By ~ 2

Author(s):

Vivek A. Wadhawa ◽

Kartik G. Patel ◽

Chirag P. Doshi ◽

Jigar K. Shah ◽

Jaydip A. Ramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Minimally Invasive ◽

Superior Vena Cava ◽

Femoral Artery ◽

Superior Vena ◽

Femoral Vein ◽

Vena Cava ◽

Pediatric Cardiac Surgery

Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.

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Shunt catheter impacted in the vena cava

Journal of Neurosurgery ◽

10.3171/jns.1980.52.1.0109 ◽

1980 ◽

Vol 52 (1) ◽

pp. 109-110 ◽

Cited By ~ 2

Author(s):

Patrick M. Foy ◽

Malcolm D. Shaw ◽

John L. Mercer

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Content Type ◽

Shunt Catheter ◽

Atrial Catheter ◽

Dependent Patient ◽

Fine Print

✓ A shunt-dependent patient had an atrial catheter firmly adherent in the superior vena cava. Thoracotomy was required for its removal.

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Partial Anomalous Pulmonary Venous Connection: Forty-Six Years of Follow-Up

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120960482 ◽

2021 ◽

Vol 12 (1) ◽

pp. 70-75

Author(s):

Anne Kathrine M. Nielsen ◽

Vibeke E. Hjortdal

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava ◽

Node Disease ◽

Sinus Node Disease ◽

Patch Technique ◽

Anomalous Pulmonary Venous Connection

Background: Surgical repair of partial anomalous pulmonary venous connection (PAPVC) may disturb the electrical conduction in the atria. This study documents long-term outcomes, including the late occurrence of atrial tachyarrhythmia and bradyarrhythmia. Methods: This retrospective study covers all PAPVC operations at Aarhus University Hospital between 1970 and 2010. Outcome measures were arrhythmias, sinus node disease, pacemaker implantation, pathway stenosis (pulmonary vein(s), intra-atrial pathway, and/or superior vena cava), and mortality. Data were collected from databases, surgical protocols, and hospital records until May 2018. Results: A total of 83 patients were included with a postoperative follow-up period up to 46 years. Average age at follow-up was 43 ± 21 years. During follow-up, new-onset atrial fibrillation or atrial flutter appeared in four patients (5%). Sinus node disease was present in nine patients (11%). A permanent pacemaker was implanted in seven patients (8%) at an average of 12.7 years after surgery. Pulmonary venous and/or superior vena cava obstruction was seen in five patients (6%). Stenosis was most prevalent in the two-patch technique, and arrhythmia was most prevalent in the single-patch technique. Sixty-seven (81%) of 83 patients had neither bradyarrhythmias nor tachyarrhythmias or pacemaker need. Conclusions: This study contributes important long-term data concerning the course of patients who have undergone repair of PAPVC. It confirms that PAPVC can be operated with low postoperative morbidity. However, late-onset stenosis, bradyarrhythmias and tachyarrhythmias, and need for pacemaker call for continued follow-up.

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Hydrocephalus resulting from superior vena cava thrombosis in an infant

Journal of Neurosurgery ◽

10.3171/jns.1975.42.5.0597 ◽

1975 ◽

Vol 42 (5) ◽

pp. 597-601 ◽

Cited By ~ 41

Author(s):

Floyd L. Haar ◽

Carole A. Miller

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Venous Pressure ◽

Vena Cava ◽

Normal Pressure ◽

Dural Sinus ◽

Communicating Hydrocephalus ◽

Content Type ◽

Venous Structure ◽

Vena Cava Thrombosis

✓ The authors report an unusual case of superior vena cava thrombosis in an infant who subsequently developed communicating hydrocephalus; they also review previously reported cases of dural sinus hypertension, and separate them into two groups. Patients in the first group develop hydrocephalus and those in the second develop a pseudotumor-like syndrome. The former patients tend to have generalized increase in intracranial venous pressure while the latter have a normal pressure in some major intracranial venous structure(s). The absence of venous cushioning of the choroid plexus pulse wave is proposed as the cause of ventricular enlargement in the former group. In addition, patients in the large-ventricle group were younger than patients in the small-ventricle group.

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Single sweep pulmonary vein isolation using the endoscopic ablation system. Dream or reality?

EP Europace ◽

10.1093/europace/euab116.066 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

B Schmidt ◽

S Tohoku ◽

S Bordignon ◽

S Chen ◽

S Zanchi ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Superior Vena ◽

Safety Data ◽

Vena Cava ◽

Private Company ◽

Endoscopic Ablation ◽

First Pass ◽

Diagnostic Catheter

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): CardioFocus Background The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF). In randomized studies, however, point-by-point laser ablation resulted in longer procedure times. The novel X3 EAS is now equipped with a motor driven laser generator that sweeps the diode laser beam around the individual PV ostium at a pre-defined speed (2.25°/sec) thus allowing for contiguous circumferential ablation (RAPID mode). Purpose To determine the feasibility of single sweep ablation using the new X3 EAS. Methods Consecutive AF patients were enrolled. After single transseptal puncture selective PV angiographies were performed. A 3D enabled circular mapping catheter was used to record PV potentials and to create a 3D map of the left atrium. Then, the transseptal sheath was exchanged for the 12F EAS delivery sheath. The EAS was inflated to obtain optimal circumferential contact to the PV ostium. Before ablation, the laser generator was retracted to ensure optimal contact behind the catheter shaft (blind spot). Ideally, RAPID mode ablation was employed at 13-15W. In case of esophageal heating >39°C or suboptimal tissue exposure point-by-point ablation (5.5-12W for 20-30 secs) was used instead. During ablation at the septal PVs phrenic nerve pacing was performed via a diagnostic catheter in the superior vena cava. Single sweep ablation was defined as one single RAPID energy application per PV to complete the singular, circular lesion set. PV conduction was re-assessed after all PVs had been treated. In case of residual PV conduction, gap mapping followed by EAS guided ablation was performed. If EAS failed to achieve complete PVI, touch up ablation was allowed at the discretion of the operator. Hemostasis was achieved by means of a figure of 8 suture. Procedure time was defined as initial groin puncture to groin closure. Follow-up included office visits at 3, 6 and 12 months including 72 h Holter monitoring. Results One-hundred AF patients (56% male, mean age 6810 years, 66% PAF) with normal LV ejection fraction (mean 60 ± 10%) and normal LA size (41 ± 6mm) underwent X3 EAS ablation. Of 382 PVs 378 (99%) were isolated with the X3 EAS. In 214 PVs (56%) single sweep isolation was achieved. First pass isolation and RAPID mode only PVI was achieved in 362 (95%) and 357 (94%), respectively. Single sweep isolation rates varied across PVs from 46% at LIPV to 64% at RSPV. The mean total procedure and fluoroscopy times were 43 ± 10 and 4 ± 2 mins, respectively. Safety data and the complete follow-up will be reported. Conclusion The new X3 EAS equipped with a motor driven laser generator allows for single sweep PVI in 56% of PVs. Almost all PVs (94%) may be isolated with RAPID mode only leading to a very high first pass isolation rate. Altogether, this leads to substantially faster procedure times compared to the predecessor EAS.

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An unpublished case of focal infection on a vascular endoprosthesis graft

Journal of Oral Medicine and Oral Surgery ◽

10.1051/mbcb/2017026 ◽

2018 ◽

Vol 24 (1) ◽

pp. 33-35

Author(s):

Corentin Buron ◽

Sylvie Boisramé ◽

Claire De Moreuil ◽

Alexandra Le Duc-Pennec ◽

Rozenn Le Berre

Keyword(s):

Superior Vena Cava ◽

Vascular Graft ◽

Superior Vena ◽

Vena Cava ◽

Prosthetic Graft ◽

Essential Elements ◽

Blood Cultures ◽

Associated Lesions ◽

Focal Infection

Observation: A patient with a prosthetic superior vena cava graft had complications of thrombosis and infection. The blood cultures were positive for Peptostreptococcus micros and Prevotella denticola. The latter are known to exist in oral cavities. Clinical and radiological examinations of the oral cavity revealed the presence of oral infectious foci. Commentary: Superior vena cava prosthetic graft infections of oral origin have not previously been described in the literature. The highlighting of oral infectious foci, their eradication, and the follow-up of patients who had been subject to a vascular graft procedures are essential elements in preventing any associated lesions.

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The Different Impacts on the Long-Term Survival of Tunneled Internal Jugular Hemodialysis Catheters Based on Tip Position and Laterality

Blood Purification ◽

10.1159/000454670 ◽

2017 ◽

Vol 43 (4) ◽

pp. 315-320 ◽

Cited By ~ 1

Author(s):

Vedran Premuzic ◽

Drazen Perkov ◽

Ranko Smiljanic ◽

Bruna Brunetta Gavranic ◽

Bojan Jelakovic

Keyword(s):

Superior Vena ◽

Vena Cava ◽

The Body ◽

Term Survival ◽

Catheter Tip ◽

Tip Position ◽

The Impact

Background/Aims: The aim of this study was to examine the impact of different catheter tip positions on the life of the catheter, dysfunction, infection, and quality of hemodialysis and possible differences between the access site laterality in jugular-tunneled hemodialysis catheters. Methods: Catheters were evaluated for the following parameters: place of insertion, time of insertion, duration of use, and reason for removal. In all patients, the catheter tip position was checked using an X-ray. Results: The mean duration of implanted catheters with the tip placed in the cavo-atrial junction and right atrium was significantly longer. There were no differences in catheter functionality at follow-up or complications based on catheter laterality for each catheter tip position. Conclusion: According to our results, the localization of the catheter tip in superior vena cava still remains the least preferable method. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth to which the catheter tip is inserted into the body.

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Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases

BioMed Research International ◽

10.1155/2020/9758302 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Qingbo Su ◽

Xiquan Zhang ◽

Hui Zhang ◽

Yan Liu ◽

Zhaoru Dong ◽

...

Keyword(s):

Right Atrium ◽

Superior Vena ◽

Vena Cava ◽

Right Atrial ◽

Pelvic Cavity ◽

Intravenous Leiomyomatosis ◽

Abdominal Incision ◽

Imaging Results ◽

The Right

Purpose. This study aimed to retrospectively review the diagnosis and surgical treatment of uterine intravenous leiomyomatosis (IVL). Methods. The clinical data of 14 patients with uterine IVL admitted to our hospital between 2013 and 2018 were retrospectively analyzed, including their demographics, imaging results, surgical procedures, perioperative complications, and follow-up results. Results. The tumors were confined to the pelvic cavity in 7 patients, 1 into the inferior vena cava, 4 into the right atrium, and 2 into the pulmonary artery (including 1 into the superior vena cava). Only one case was misdiagnosed as right atrial myxoma before the operation, which was found during the surgery and was treated by staging surgery; all the other patients underwent one-stage surgical resection. Three patients underwent complete resection of the right atrial tumor through the abdominal incision, and one patient died of heart failure in the process of resection of heart tumor without abdominal surgery. During the 6–60 months of follow-up, 4 patients developed deep venous thrombosis of the lower extremity, and 1 patient developed ovarian vein thrombosis and pulmonary embolism. After anticoagulation treatment, the symptoms disappeared. One patient refused hysterectomy and the uterine fibroids recurred 4 years after the operation. Conclusion. Specific surgical plans for uterine IVL can be formulated according to cardiac ultrasound and computed tomography (CT). For the first type of tumor involving the right atrium, the right atrium tumor can be completely removed through the abdominal incision alone to avoid thoracotomy. The disease is at high risk of thrombosis and perioperative routine anticoagulation is required.

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