Accurate placement of the distal end of a ventriculoatrial shunt catheter using Alphacard: direct intraoperative comparison with fluoroscopy.

Abstract

Surgical insertion of a ventriculoatrial shunt requires accurate placement of the atrial catheter in the right atrium in order to prevent postoperative complications. Fluoroscopy is the standard method for monitoring correct positioning of the catheter. This paper reports a prospective study in 50 patients with the aim of comparing electrocardiographic monitoring of the catheter position by means of Alphacard with concomitant intraoperative fluoroscopic examination. The Alphacard was evaluated in terms of accuracy, time requirement, and ease of handling. The mean postoperative follow-up period was 54 (range 42-66) months. Reliable control of the catheter position was possible by means of electrocardiographic guidance in all 50 patients (100%) by fluoroscopy in 49 cases (98%). The average time required for intra-operative monitoring of the catheter position was 55 (40-70) seconds for electrocardiography as compared to 8 (5-12) minutes for fluoroscopy. None of the patients showed obstruction of the atrial catheter during the postoperative follow-up period. Alphacard offers an excellent alternative for monitoring the position of the tip of an atrial catheter because it requires little equipment and time. In terms of reliability, it is comparable or even superior to fluoroscopy.