RE: Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

Dear Editor,

We read with interest the article of Yavuz et al., “Reasons, procedures and outcomes in ventriculoatrial (VA) shunts: A single-center experience. ” The authors describe 10 patients who had repeated shunt dysfunction or infection, which were converted to a VA shunt.

In my personal experience of 1292 shunt operations spanning over a period of 40 years, there were 489 ventriculoperitoneal (VP) shunts and 186 VA shunts. The rest were revision of VP shunts in 410, VA in 66. The other operations were conversion of VA to VP and VP to VA.

Initially, in the early years, the VA shunt was performed, however, because of complications primarily related to jugular venous thrombosis and difficulty in reestablishing the site of the atrial implant, we shifted to VP shunt. Needless to say, we had a few patients who had quite a bit of trouble with VP shunt with repeated operations and had to be converted to VA shunt.

The entire operation of VA shunt placement is done by the neurosurgeon. By canalizing the common facial vein through a small incision under the angle of the right mandible, the distal end of the cardiac catheter is placed in the right atrium under electrocardiogram (EKG) control until the P wave become biphasic. With experience and good anesthetic monitoring, the operation can be performed in a short period of time.

In any event, we are happy that the authors have refocused again on the place of VA shunt in specific cases.