Cardiac shunt procedure

Über 7 Millionen englische Bücher. Jetzt versandkostenfrei bestellen Große Auswahl an Cardiac Science Preis. Super Angebote für Cardiac Science Preis hier im Preisvergleich Surgeons create a shunt to compensate for a patient's heart defect. A cardiac shunt is a condition where blood in the heart moves sideways before completing its circulatory path. In humans, this is usually an abnormal condition resulting from the presence of heart defects, or surgeons may create a shunt to compensate for heart defects

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  1. Shunt Procedure What is a shunt? A shunt is a hollow tube surgically placed in the brain (or occasionally in the spine) to help drain cerebrospinal fluid and redirect it to another location in the body where it can be reabsorbed
  2. Intracardiac Shunts Intracardiac shunts can be identified by measurements of the oxygen saturation in the great vessels and the cardiac chambers. For example, a significant step-up in saturation between the right atrium and right ventricle is likely to because the result of a ventricular septal defect
  3. Abstract Most patients with congenital heart disease have a cardiac shunt whose direction and magnitude can have a major impact on cardiorespiratory physiology and function. The dynamics of the shunt can be significantly altered by anesthetic management and must be understood in order to provide optimal anesthetic care
  4. istered within a few (usually three) hours of a heart attack. If this treatment isn't done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle. View an illustration of coronary arterie

Cardiovascular (cardiac) shunts are abnormal connections between the pulmonary and systemic circulations. Most commonly they are the result of congenital heart disease The UVS procedure is potentially a way to alleviate the right heart strain, which gives the patients more time, but also improves their symptoms. Transthoracic 2-dimensional echocardiogram of unidirectional-valved shunt (parasternal short axis view) showing the main pulmonary artery, unidirectional valved shunt, and descending aorta without. (August 2020) (Learn how and when to remove this template message) The Blalock-Thomas-Taussig shunt (commonly called the Blalock-Taussig shunt) is a surgical procedure used to increase blood flow to the lungs in some forms of congenital heart disease Left-to-right Intracardiac Shunts - Oximetry run Procedure of oximetry run  In performing the oximetry run, an end-hole catheter (e.g., Swan- Ganz balloon flotation catheter) or one with side holes close to its tip (e.g., a Goodale-Lubin catheter) can be used  The entire procedure should take less than 7 minutes.  If a sample cannot be obtained from a specific site because of ventricular premature beats, that site should be skipped until the rest of the run has been completed A cardiac shunt, or heart shunt, is abnormal communication between chambers or blood vessels that allows for the passage of blood. Many of the more common types of congenital heart defects are due to malformations that lead to shunting of blood. This allows for blood on one side of the heart to enter the other side through an abnormal channel

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A cardiac shunt is when blood follows a pattern that deviates from the systemic circulation, i.e., from the body to the right atrium, down to the right ventricle, to the lungs, from the lungs to the left atrium, down to the left ventricle and then out of the heart back to the systemic circulation Your VP shunt surgery will take place in the operating room while you're asleep. The surgery will take about 1 hour. Once you're asleep, the doctor will shave off some hair near the area where they'll make the incision (surgical cut) on your head. Your entire head won't be shaved Overview. Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a procedure used to diagnose and treat certain cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart

A shunt is an abnormal communication between the right and left sides of the heart or between the systemic and pulmonary vessels, allowing blood to flow directly from one circulatory system to the.. Blalock-Taussig Shunt. The first operation, a Blalock-Taussig shunt, creates a pathway for blood to reach the lungs. A connection is made between the first artery that branches off the aorta (called the right subclavian artery) and the right pulmonary artery A round tube or shunt routes blood either from the aorta (with a Blaylock-Taussig or BT shunt) or directly from the right ventricle (with a Sano shunt) to the pulmonary artery. The care team will decide which shunt is best for the baby. The shunt is a temporary fix

What is a Cardiac Shunt? (with pictures) - Info Bloo

The Shumacker-Mandelbaum's shunt was a shunt technique between the ascending aorta and either the right or left pulmonary artery or the main pulmonary artery. A graft composed of homologous aorta with a Dacron cuff at either end for end-to-side anastomoses was used During a shunt procedure, the surgeon makes a surgical cut in the left side of the chest. Once the child is older, the shunt is closed and the main repair in the heart is performed. Transposition of the great vessels repair: In a normal heart, the aorta comes from the left side of the heart, and the pulmonary artery comes from the right side A shunt study is a procedure to assess heart and lung blood circulation. Performing the test. You will sit in a comfortable chair on a mouthpiece wearing noseclips. You will breathe normally on the mouthpiece for approximately 20 minutes breathing 100 percent oxygen. An arterial blood gas will be taken from your wrist to be analyzed immediately In the Glenn procedure: The superior vena cava (SVC) (which brings blood back from the upper part of the body) is disconnected from the heart and connected directly to the pulmonary artery. The shunt placed during the Norwood procedure is removed A Blalock-Taussig (BT) shunt is a small tube, only a few millimeters wide, that is used to create a pathway for blood to go from the arterial circulation to the lungs. It is used to treat congenital heart defects that affect blood flow to the lungs

VP shunting is a surgical procedure that primarily treats a condition called hydrocephalus. This condition occurs when excess cerebrospinal fluid (CSF) collects in the brain's ventricles. CSF.. Transcatheter Potts Shunt For selected patients with progressive right heart failure caused by pulmonary arterial hypertension (PAH), the placement of a transcatheter Potts shunt can provide symptomatic relief Detail - Ventriculoperitoneal (VP) shunt placement. Before the Procedure. In order to help prevent infection, some of the hair on the patient's head may need to be shaved. The medical team will wash the head and body with special soap. They will cover the patient with sterile linen to maintain a sterile environment throughout the procedure

Objectives: This study aimed to compare pulmonary artery (PA) growth between patients who received a right ventricle-to-PA (RV-PA) shunt and those who received a modified Blalock-Taussig shunt (mBTS). Methods: All consecutive patients with hypoplastic left heart syndrome who underwent the Norwood I procedure between 2001 and 2017 were included in the study Left Heart Catheterization Indications and Limitations for Left Heart Catheterization This is the introduction of catheter(s) into the aorta, left ventricle and left atrium and includes cannulation of the coronary arteries and bypass grafts. It includes hemodynamic measurements, blood sampling and shunt determinations as part of the procedure However, patients with single ventricle anomalies will have a cardiac catheterization prior to the second surgery (Glenn shunt) and again before the third surgery (Fontan procedure). These cardiac catheterizations are done to look at the anatomy, particularly of the pulmonary arteries, and to obtain pressure measurements in the heart heart shunt procedure. A 48-year-old member asked: what's a shunt as far as the heart is concerned? Dr. Christopher White answered. 43 years experience Cardiology The Sano Shunt Over the last few years, a number of centers around the world have begun to adopt a modification of the Norwood procedure that involves a different type of shunt. Introduced by Shunji Sano, MD, who was trained in congenital cardiac surgery in Melbourne, Australia, and is now working in his home country of Japan, this new.

Shunt Procedure Johns Hopkins Medicine in Baltimore, M

Many patients will previously have had a bidirectional Glenn shunt. The Fontan is an open heart procedure during which the unoxygenated blood returning from the lower part of the body is diverted directly to the pulmonary (lung) artery without passing through the right ventricle. This may be achieved in several different ways all of which. Pathology. Blood can either be shunted from the systemic circulation to pulmonary circulation (i.e. 'left-to-right shunt') or between the pulmonary circulation and systemic circulation (i.e. 'right-to-left shunt') 1-4.Rarely, the shunted blood returns to the same cardiac chamber without traversing a capillary bed, termed a 'circular shunt' 5-7. Left-to-right shunt Additional evidence of the potential effect of interatrial shunting on right-side heart parameters was recently reported by Danial et al. 32 An interatrial shunt was created with a 2 mm balloon in a total of 22 rats (healthy n=11, HFpEF n=11), and this translated into a reduction in LA volume and pulmonary artery diameter in rats with HFpEF. Detail - Ventriculoperitoneal (VP) shunt placement. Before the Procedure. In order to help prevent infection, some of the hair on the patient's head may need to be shaved. The medical team will wash the head and body with special soap. They will cover the patient with sterile linen to maintain a sterile environment throughout the procedure

While infants with a Blalock shunt grow, the heart is in a state of volume overload, which promotes pulmonary vascular development . The modern Fontan procedure involves connecting the SVC and IVC to the right pulmonary artery (Figs 5 -8). These connections originally were performed at the same time, which in many patients resulted in a. A central shunt is an anastomosis between the ascending aorta and the main pulmonary artery, made of prosthetic or other materials ; it is also known as the Mee's shunt .The internal mammary artery is used to create a systemic-to-pulmonary artery shunt after failure of a previous Blalock-Taussig's shunt; this offers the advantage of growth and flow adaptation, eliminates the risk of prosthetic. Aortopulmonary shunt ,cont. II- Modified Blalock-Taussig shunt (MBT Shunt) • It consists of Interposition of a polytetrafluoroethelene (GORE-TEX) tube graft between the subclavian or innominate artery and the right or left pulmonary artery . • It is the most commonly performed shunt procedure. 9. Classic & Modified Blalock-Taussig shunts 10 Any surgical procedure carries risks. Inserting a stent may require accessing arteries of the heart or brain. This leads to an increased risk of adverse effects Hospitals charge an average of $135,984 for this heart surgery. Here, two first-year medical students practice an aortic valve replacement procedure on a pig's heart. 1

Cardiac Shunt - an overview ScienceDirect Topic

Understanding cardiac shunt

Rather than open-heart surgery, a PFO closure procedure does not involve incisions in the chest, the heart being stopped, or the prolonged recovery needed after open-heart surgery. Rather the heart is reached via the insertion of catheters typically in a leg vein, maneuvered to the heart, and then used to insert or implant a medical device Heart failure- This is due to the increase in the amount of blood returning to your heart through the shunt or TIPS. The heart may be unable to return blood fast enough back to your body and it may cause heart failure. If you have history of heart failure notify your doctor before having the procedure Placement of a shunt is a very safe procedure. However, complications can occur during or after the procedure. Risks associated with any surgical procedure include excessive bleeding and infection

Heart Procedures and Surgeries American Heart Associatio

Blalock-Taussig (BT) Shunt: This procedure usually occurs within the first week of life. In this surgery, the surgeon inserts an artificial tube to provide blood flow to the lungs. There is still mixing of oxygen poor and oxygen rich blood through the hole between the top chambers of the heart. Glenn Procedure:. Tricia Christensen Date: February 05, 2021 Children who receive a Glenn shunt may require a heart transplant in the future.. The Glenn shunt is one surgery that may be performed on children with congenital heart defects who have a single ventricle profile. Usually this means that the right ventricle or left ventricle is much smaller than normal or impaired in other ways and is unable to. Fontan Procedure. Fontan procedure is a heart surgery used to correct single ventricle type heart defects in children. The defect it helps to correct is one where oxygen-rich and oxygen-poor blood mixes and does not circulate properly. It is usually the third surgery for single ventricle palliation. Learn mor Off-pump procedures are often classified as a minimally invasive cardiac surgery, or MICS because they do not involve cardiopulmonary bypass. For many reasons, a patient may be a good candidate for one type of procedure or the other, but off-pump procedures offer many potential benefits

1. Right and left heart catheterization. 2. Coronary arteriography. 3. Oxygen saturation run for shunt study. PREOPERATIVE DIAGNOSIS: Probable intracardiac shunting. POSTOPERATIVE DIAGNOSIS: Intracardiac shunting with a Qp:Qs of 2.13:1 at the interatrial level. Normal coronary arteries. COMPLICATIONS: None. PROCEDURE IN DETAIL During the initial staged repair of hypoplastic left heart syndrome (HLHS), there is a need to create pulmonary blood flow.This can be done in a number of ways, using a Blalock-Taussig shunt or a Sano shunt modification.. The Sano shunt modification is performed together with the Norwood procedure by the pediatric cardiothoracic surgeons at Norton Children's Heart Institute, affiliated with. Glenn shunt: A surgical operation for children born with cyanotic heart disease (blue babies), in which a large vein (the superior vena cava) is anastomosed (connected) to the right pulmonary artery so that blood bypasses the malformed right chambers of the heart and is shunted directly into the lungs to be oxygenated. The operation was created by William W. L. Glenn (1914-2003), then chief.

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs. Fatty deposits can build up inside the arteries and block blood flow. Angioplasty and stent placement - peripheral arteries: MedlinePlus Medical Encyclopedi Potts shunt is an older surgical procedure recently revitalized in the treatment of severe pulmonary hypertension (PH). In patients with PH, the pulmonary arteries shrink, making the right side of the heart work harder as it makes the higher pressure needed to force blood through narrowed arteries

Cardiovascular shunts Radiology Reference Article

A Novel Shunt Approach Shows Promise for End-Stage

Unlike open heart surgery, the catheter procedure doesn't cause any scarring and is associated with just a small bruise in the groin. Recovery is very quick. This procedure is undertaken in specialist units that treat congenital heart problems in children and a small number of additional adult centres Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits. A dental examination before cardiac surgery is recommended so that dental treatment can be completed. The Blalock Taussig shunt is done when the heart is not delivering enough blood enriched with oxygen to the rest of the body. Fontan procedure. The Fontan procedure is an open heart surgical procedure used in children with a defect in the structure of the heart and great vessels which are present at birth

A second operation, a Glenn shunt, often performed at about 4 to 12 months of age, replaces the Blalock-Taussig shunt with another connection to the pulmonary artery. In this operation, the Blalock-Taussig shunt is removed, and the superior vena cava (the large vein that brings oxygen-poor blood from the head and arms back to the heart) is. The Cove Point Foundation Congenital Heart Resource Center is the world's largest resource for information on pediatric and adult congenital heart disease. Cove Point contains comprehensive information on all congenital heart defects, including Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Hypoplastic Left Heart Syndrome (HLHS), and Tetralogy of Fallot (ToF) The shunt is designed to regulate LAP, the cause of worsening symptoms that lead to over 3 million hospitalizations a year. It is intended to prevent episodes of elevated LAP and is thus expected to provide symptom relief, decrease hospitalization, increase exercise tolerance, improve quality of life and perhaps even extend survival The surgical Blalock-Taussig (BT) shunt has historically been the more common procedure for infants with ductal-dependent pulmonary blood flow, while the transcatheter patent ductus arteriosis.

Blalock-Taussig shunt - Wikipedi

A portosystemic shunt causes a bypass of blood from the gastrointestinal tract directly into the systemic circulation, avoiding the normal detoxifying process that happens in the liver and reducing nutrient input into the liver. Liver shunts can be congenital defects (failure of closure of the ductus venosus or inappropriate vascular development) or acquired (development of extra vessels. Causes and Risk Factors. The causes of heart defects such as hypoplastic left heart syndrome among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes.These types of heart defects also are thought to be caused by a combination of genes and other risk factors, such as things the mother comes in contact with in the environment or what the.

of the shunt, and estimation of the amount of shunt. Other imaging tests include: transesophageal echo (TEE), cardiac CT, and cardiac MRI (CMR). These may be done if an echocardiogram is inconclusive or if supportive information is required. Cardiac catheterization (and to a lesser extent, CMR) can be performed to give a more accurat Shunt Detection and Quantification William Grossman Mauro Moscucci Detection, localization, and quantification of intracardiac shunts are an integral part of the hemodynamic evaluation of patients with congenital heart disease. In most cases, an intracardiac shunt is suspected on the basis of the clinical evaluation of the patient before catheterization

surgical approach of cyanotic congenital heart disease

The Current Procedural Terminology (CPT ®) code 33767 as maintained by American Medical Association, is a medical procedural code under the range - Shunting Procedures on the Heart and Pericardium. Subscribe to Codify and get the code details in a flash Ventriculoatrial shunting (VAS) is a procedure used to treat hydrocephalus that allows the cerebrospinal fluid (CSF) to flow from the brain to the atrium of the heart. Ventriculoatrial shunting (VAS) placement is indicated for patients with hydrocephalus in whom other treatment modalities and procedures have failed Ventriculoatrial shunt (VAS) placement enables cerebrospinal fluid (CSF) to flow from the cerebral ventricular system to the atrium of the heart. This procedure is indicated for hydrocephalus, which is among the most common conditions encountered in neurosurgical practice. There are multiple potential anatomic configurations for CSF shunts The study was designed to analyze the results of central shunt procedure using Gore‐Tex grafts for treatment of patients with complex congenital heart diseases. Methods. A Gore‐Tex graft was implanted using an end‐to‐side anastomosis technique connecting the aorta with the pulmonary artery Tricia Christensen Date: January 31, 2021 A BT shunt can be helpful with certain heart defects.. Many agree that the Blalock-Taussig shunt (BT shunt) was one of the most important developments in the history of pediatric cardiology and cardiothoracic surgery. It is a palliative surgery that creates a connection between the pulmonary artery and a systemic artery like the carotid, or more.

The longest survivors of a Fontan operation, currently adults, were frequently less than ideal candidates for this type of surgery, with many significant residua and sequelae related to the cardiac malformation and palliative procedures. A shunt procedure undertaken from the 1960s to the 1980s was evaluated by its long term relief of cyanosis Blood flow to the distal pulmonary arteries is reestablished by a modified Blalock-Taussig (preferred in neonates), bidirectional Glenn shunt, or an extracardiac cavopulmonary Fontan procedure (preferred in adults) [1, 2]

Assessment of shunt by cardiac catheterizatio

  1. Phoenix Cardiac Surgery believes excellence in patient care resides at the intersection of Experience, Innovation, and Compassion.. We take pride in providing heart patients access to the latest advances in medicine, combined with the knowledge you need to make informed, confident decisions regarding your care
  2. The cardiac catheterization procedure to place a heart stent is much less invasive than heart bypass surgery, but it still carries a significant risk of complications like bleeding.In general, you can expect to return to work and normal activities in as few as three days. However, heart stent recovery time varies widely from person to person
  3. For procedure planning of a transcatheter Potts shunt creation, morphological data presented here are very important and provide additional information to the previously published imaging analysis of adult patients by Guo et al.3 Boudjemline and colleagues used variable CT techniques, including a 3D model, to improve the understanding of the.
  4. Open-heart surgery generally is done to repair primum or sinus venosus ASDs. Your child is given medicine so that he or she will sleep through the surgery and not feel any pain. During the surgery, the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. He or she then repairs the defect with a special patch that covers the hole
  5. Cardiac: Complications Management Following Surgery A BT shunt is a systemic to pulmonary shunt which is a palliative procedure usually performed in neonates to establish a reliable pulmonary blood flow in patients with obstructed pulmonary blood flow e.g. tricuspid atresia, pulmonary atresia and severe Tetralogy of Fallot

Left-to-Right Cardiac Shunts (Heart) Types and Symptoms

Division of Nuclear Medicine Procedure / Protocol _____ MYOCARDIAL - RIGHT-TO-LEFT SHUNT CPT CODE: 78428 UPDATED: MARCH 2011 _____ Indications: Right to left shunt studies are performed in patients suspected or known right to left shunt. This may happen with some forms of congenital heart disease like Tetralogy of Fallot or with a late ASD Beating Heart Surgery Off-pump coronary artery bypass (OPCAB) uses local stabilization of the heart that allows the surgeon to operate while the heart still beats. In contrast, conventional bypass surgery stops the heart and puts the patient on a heart-lung machine during the bypass procedure

A global clinical trial is investigating if an interatrial shunt could represent a new option to relieve left atrial hypertension caused by chronic heart failure. The interventional trial will compare safety and efficacy of the V-Wave shunt device to traditional medication management. Advanced heart failure patients often experience difficulty breathing and frequent hospitalization due to. Kawashima operation: functional modification of bidirectional Glen shunt with left superior The Glenn shunt is a mid-stage procedure for the Fontan circulation. The Kawashima procedure is used for congenital heart disease with a single effective Technically it is very similar to the Bidirectional Glenn procedure used to direct Norwood procedure. V-Wave Shunt for Relief of Heart Failure Symptoms Cleared in EU. March 9th, 2020. Medgadget Editors Cardiac Surgery, Cardiology

Fontan procedure. The third and last of the staged congenital heart surgeries performed to treat hypoplastic left heart syndrome (HLHS) and other single ventricle heart defects is the Fontan cardiac procedure. It is usually performed between the ages of 18 months and three years Surgical developments. The organized study of congenital heart disease (CDH) began with the establishment of Dr Helen Taussig's pediatric cardiology clinic at Johns Hopkins Hospital in Baltimore in 1930[] and the publication of Dr Maude Abbott's incredible atlas describing 1000 CHD cases in 1936.[] The first surgical procedure was ligation of a patent ductus arteriosus (PDA) performed by. The proposed update includes five new codes for cardiovascular procedures, including a primary and add-on code set for transcatheter intracardiac shunt (TIS) creation. It also includes eight new. It is included in the spectrum of conditions that can result in a cardiac circulation with a functionally single ventricle. Left untreated, HLHS is invariably lethal. Advances in palliative surgical procedures (Norwood procedure, bidirectional cavopulmonary shunt, modified Fontan procedure) have increased the survival rate in children with HLHS Pulmonary blood flow can then be established by placement of a modified BT shunt. This is essentially the Norwood procedure used for hypoplastic left heart syndrome. Whatever operation is necessary in the newborn period, children can expect to undergo further heart surgery by the age of 3 to 6 months

Glenn shunt

Cardiac shunt - Wikipedi

Hybrid Procedure: Variation of the Norwood procedure but avoids cardiopulmonary bypass and sometimes performed on higher risk patients.Combines procedures via cardiac catheterization as well as sternotomy/OR; Unobstructed Systemic Blood Flow Instead of creating a neoarorta, you stent the PDA to provide systemic blood flow; Unobstructed pulmonary venous return (you need complete mixing into. The blue tube is known as a Modified Blalock-Taussig Shunt. The Damus-Kaye-Stansel Procedure is one of several surgical operations used in Double Inlet Left Ventricle congenital heart disease cases where complications have arisen, obstructing the flow of blood through the aorta to the body This is achieved with a ventriculoatrial shunt (VA Shunt). This procedure is also well tolerated and carries similar risks to a VP shunt. Though the risk to the abdominal organs is eliminated, there is a slightly higher risk of bloodstream infections or heart valve infection (endocarditis). Also, there is a higher risk in patients with cardiac. A Glenn shunt is the second of three surgeries — following the Norwood procedure and preceding the Fontan procedure — that Phoenix Children's Hospital uses to treat a severe form of congenital heart disease called hypoplastic left heart syndrome. Hypoplastic left heart syndrome occurs in babies born with a functioning right ventricle and a small, underdeveloped, nonfunctioning left ventricle

Role of imaging in the evaluation of single ventricle withPulmonary Valve Replacement in Adult Congenital Cardiac

Cardiac catheterization (also called heart catheterization) is a diagnostic and occasionally therapeutic procedure that allows a comprehensive examination of the heart and surrounding blood vessels. It enables the physician to take angiograms, record blood flow, calculate cardiac output and vascular resistance, perform an endomyocardial biopsy. A shunt can be created in about 90% of patients (90 out of 100 patients). This means that doctors cannot create a shunt for 10 out of 100 patients. Your doctor will know during surgery if a shunt will work for you The Heart Center team performs hundreds of heart procedures each year. Our volumes, which are based on cardiac procedures and the number of cardiothoracic surgeries performed during the last four years, can be found here.In 2020, the Heart Center performed 910 cardiac surgeries, 14 heart transplants and 1,034 catheterization lab visits In addition, by being a low-pressure shunt, it does not carry the risk of causing lung blood vessel thickening and hardening. Bi-Direction Glenn Shunt Surgery Cardiac Surgery Videos: Bidirectional Glenn Procedure. These pages contain video links to clear images of actual procedures and surgeries made available solely for educational purposes This highly-complex heart surgery is performed on children born with a single heart ventricle. To correct this defect, a two-staged heart surgery is often required within the first three years of life. The first surgery is the Glenn procedure and the second surgery is the Fontan procedure. The goal of the Fontan is to add a shunt to allow blood. Surgery: What to Expect - Implanting a Ventriculo-peritoneal Shunt Normal Pressure Hydrocephalus Overview Your healthcare team will walk you through the surgical process for shunt implantation, which includes important steps before, during, and after the procedure

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