Introduction <p>Ventriculoatrial shunting (VAS) using the Seldinger technique may be unfeasible in cases of venous thrombosis. This study describes an alternative approach: direct atrial placement via sternotomy.</p> Surgical technique <p>A sternotomy is performed with exposure of the pericardium and preparation of the right atrium. After tunneling, the distal catheter is cut into two parts and connected using a straight connector, securing it in the atrium. The atrium is then opened, the catheter is inserted, and it is fixed with the straight connector. Finally, the catheter enters the thoracic cavity through the sternal notch.</p> Discussion <p>Since 1967, open-access VAS has been of surgical interest. This study presents an adapted technique for pediatric patients, where securing the catheter with a plastic straight connector ensures its stability despite cardiac movement.</p> Conclusion <p>Although complex, VAS via thoracotomy is a valuable option for patients with anatomical challenges that limit the use of conventional techniques.</p>