Abstract
Background /importance
The safety of direct cardiac shunts has been historically described in the pediatric population before the introduction of silastic catheters but are rarely utilized in modern practice. Herein, we describe several technical nuances regarding the placement of a direct ventriculoatrial catheter in a pediatric patient, including the creation of a sternal divot to accommodate for the movement of the catheter during growth.
Clinical presentation
We report a complex case of a 2-year-old former premature infant with multiple systemic congenital abnormalities, including tracheal atresia (type 2), complete atrioventricular septal defect status post repair, and shunted hydrocephalus. She developed multiple shunt malfunctions secondary to abdominal malabsorption and shunt infections.
Conclusion
Multiple options for distal shunt placement, including the atrium via open and endovascular techniques, the abdomen, gallbladder, and pleura, were considered, but the direct cardiac placement was felt to be the safest option given the patient’s coexisting conditions. Placement requires a multidisciplinary team. Special consideration should be made for linear growth in children.
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Cyril Tankam and Varun Padmanaban performed the literature review, prepared the figures, and wrote the main manuscript. Jessica Lane, Julia Pazniokas, Joseph B. Clark, and Elias Rizk assisted in the literature review, preparation of the figures, and writing of the manuscript. All authors reviewed the manuscript and approved the document for submission.
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Tankam, C.S., Padmanaban, V., Pazniokas, J. et al. Direct ventriculoatrial shunt in a pediatric patient: case report and technical note. Childs Nerv Syst 39, 255–259 (2023). https://doi.org/10.1007/s00381-022-05717-y
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DOI: https://doi.org/10.1007/s00381-022-05717-y