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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Real-time 3D Transesophageal Echocardiography for the Placement of Ventriculoatrial Shunt: A Case Series and
Jason Chui1, Keith MacDougall2, Wai Ng2
1Departments of Anesthesia & Perioperative Medicine.
Insights
Combining 2D ultrasound and 3D transesophageal echocardiography (TEE) for ventriculoatrial (VA) shunt placement significantly reduces surgical times compared to fluoroscopy. This approach offers a safer and more efficient method for managing hydrocephalus.
Area of Science:
- Neurosurgery
- Medical Imaging
- Anesthesiology
Background:
- Ventriculoatrial (VA) shunts manage hydrocephalus when other methods fail.
- Distal catheter placement in VA shunts is technically challenging.
- Fluoroscopy-guided and transesophageal echocardiography (TEE)-guided techniques are debated.
Purpose of the Study:
- To compare the efficacy of 2D ultrasound-guided internal jugular vein catheterization with 3D TEE-guided distal VA shunt placement against the conventional fluoroscopy-guided technique.
- To evaluate procedure time, safety, and precision.
Main Methods:
- Retrospective review of 18 VA shunt insertion procedures in 10 patients.
- Utilized 2D ultrasound for internal jugular vein access and 3D TEE for distal catheter placement.
- Compared outcomes with fluoroscopy-guided procedures.
Main Results:
- The combined 2D ultrasound and 3D TEE technique reduced surgical time by an average of 22 minutes (91 vs. 113 minutes).
- No complications were reported for either technique.
- Patients had a mean age of 50 years, BMI of 35, and prior failed shunts.
Conclusions:
- Combined 2D ultrasound and 3D TEE is feasible, efficient, and safe for VA shunt insertion.
- This technique allows for faster procedures and precise catheter confirmation.
- 3D TEE enables repeated confirmation of distal catheter position, potentially improving patient safety.
Background:
Ventriculoatrial (VA) shunts are used to manage hydrocephalus and idiopathic intracranial hypertension when peritoneal drainage of cerebrospinal fluid is not feasible. The technique of distal catheter placement during VA shunt insertion is controversial, especially between fluoroscopy-guided and transesophageal echocardiography (TEE)-guided techniques.
Methods:
We retrospectively reviewed our utilization of 2-dimensional (2D) ultrasound-guided internal jugular vein catheterization combined with 3-dimensional (3D) TEE-guided distal VA shunt placement and compared it to the conventional fluoroscopy-guided technique.
Results:
Ten patients underwent 18 VA shunt insertion procedures between November 2012 and October 2022. The patients had a mean (SD) age of 50 (19) years, body mass index of 35 (14) m/kg², and minimal comorbidities. All had previously undergone failed ventriculoperitoneal shunt procedures. The use of 2D ultrasound to guide internal jugular vein catheterization and 3D TEE to guide distal catheter placement resulted in 22-minute shorter surgical times compared with the fluoroscopy-guided technique (91 minutes vs. 113 minutes, respectively). No complications were noted with either technique.
Conclusions:
The combined use of 2D ultrasound and 3D TEE allowed for faster procedure times and more precise distal catheter confirmation, contributing to a more streamlined surgical procedure. This small case series underscores the feasibility, efficiency, and safety of anesthesiologist-delivered combined 2D ultrasound and 3D TEE during VA shunt insertion. The use of 3D TEE allows repeated confirmation of distal catheter position and has potential to improve patient safety during rare but complex VA shunt insertion procedures.
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