Minimally invasive echo-guided placement of the cardiac tube in a ventriculoatrial shunt during pregnancy: Technical note

OBJECTIVE: We describe a minimally invasive echo-guided placement of the cardiac tube in a ventriculoatrial shunt in a young pregnant woman, in order to avoid any radiological procedure. METHODS: We used a central venous catheter placement kit for percutaneous echo-guided right internal jugular vein puncture located by a 7.5 mHz microlinear probe. Through the catheter, the distal portion of the shunt device was positioned into the internal jugular vein to the right atrium using ultrasound control by a 2.5 to 3.5 mHz probe in a four-chamber transthoracic view. RESULTS: Sonographic guidance in percutaneous placement of a vertebral artery shunt is a safe and fast minimally invasive technique that improves success rates and decreases complications such as incidental puncture of the carotid artery and pneumothorax. The use of a two-dimensional echocardiographic apparatus in a four-chamber transthoracic view is an accurate and simple method to verify the position of the distal tip of the shunt in the mid-right atrium with no risks for the patient. CONCLUSION: The use of these two techniques allows a minimally invasive, safe, accurate, and complete x-ray-free procedure.