title: Accurate placement of the distal end of a ventriculoatrial shunt catheter using Alphacard: direct intraoperative comparison with fluoroscopy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Benjamin Franklin Medical Center, Free University of Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Hammersen
authors.forename: T A
authors.initials: TA
authors.lastname: Pietilä
authors.forename: M
authors.initials: M
authors.lastname: Brock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006325:Heart Atria; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome