During the past 4 years, we have used percutaneous placement of the atrial catheter in 39 patients who have undergone ventriculoatrial shunting. The age range of our patients has been from 9 to 74 years of age, with routine indications existing. Both subclavian and internal jugular venous access have been utilized, with the latter being our preferred route of access for reasons of safety. Average operative time has been approximately 35 to 40 minutes. Both traditional and split-sheath introducer catheters have been used. Patient follow-up has been up to 4 years. Intraoperative complications have been limited to puncture of the carotid artery on two occasions; neither affected the ultimate performance of the procedure. Postoperative complications have been limited to those peculiar to shunt procedures in general and have required revision in four instances. One patient suffered an infection secondary to shunting. The benefits of this procedure seem to include safety, decreased operative site exposure, and decreased operative time, all factors that may contribute to a lower than normal infection rate and may warrant consideration of this procedure in adolescents and adults for whom ventriculoatrial shunting is indicated.