Successful ventricle to direct heart shunt placement as a salvage cerebrospinal fluid diversion technique - Case report

Eric M. Thompson, Stephen G. Giles, Howard K. Song, Zachary N. Litvack, Kiarash J. Golshani, Andrew N. Nemecek

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The authors report a complex case in a 35-year-old woman who underwent shunt placement at birth for myelomeningocele. She had previously undergone more than 30 shunt revisions, with placement of the distal catheter in the peritoneum multiple times, and also in the pleura, the gall bladder, and the upper venous system. All shunts had failed and the possible placement sites were now anatomically hostile. A median sternotomy was performed as the next option. The catheter was placed directly into the appendage of the right atrium and secured with a pursestring suture. One month postoperatively, the patient presented with a large pericardial effusion after the distal catheter migrated out of the atrium and into the pericardial space. A repeat sternotomy was performed to drain the pericardial CSF collection. The catheter was reinserted into the atrial appendage, and a tunnel was created in the atrial wall to fix the device more securely. At 1 year postoperatively, the patient had no further symptoms of shunt obstruction or cardiac tamponade, and imaging studies suggested that the shunt system was functional. The authors report the first successful ventricle to direct heart shunt in an adult.

Original languageEnglish (US)
Pages (from-to)521-524
Number of pages4
JournalJournal of Neurosurgery: Pediatrics
Issue number6
StatePublished - Jun 2009


  • Cerebrospinal fluid diversion
  • Direct heart shunt
  • Hydrocephalus salvage treatment

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology


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