Our first adjustable valve



  • first adjustable gravitational valve for the treatment of adult and pediatric hydrocephalus

  • more protection against over-drainage complications due to position-dependent function and infinitely variable pressure setting from 0-20 cmH2O

  • MRI compatible up to 3 Tesla: no X-ray control after MRI necessary, no additional radiation exposure for the patient

  • quick and easy adjustment

  • "Active-Lock" mechanism: protected against unintentional adjustment by means of exposure to magnets found in daily life, such as those used in smartphones, toys, induction cookers or safety barriers at the airport

  • Precise precision mechanics

  • Robust and durable through the use of titanium



The proGAV is a position-dependent valve. This means that the opening pressure varies depending on the body position of the patient. It consists of a ball-cone valve with an adjustable opening pressure, and a fixed pressure gravitational unit. In order to configure the proGAV according to the patient´s individual needs, the surgeon determines the opening pressure required for both the horizontal and vertical positions.

Horizontal Position

When the patient moves to the horizontal position, the gravitational unit opens completely. Thus, there is no longer any resistance to the flow of the CSF and the gravitational unit has no effect at all while the patient is lying down. The opening pressure of the proGAV is defined solely by the adjustable unit. 

The setting of the opening pressure is determined by the clinical needs of the patient. The range of the adjustable unit is defined from 0 to 20 cmH2O.

As long as the IVP (intraventricular pressure) is under the defined opening pressure the adjustable unit is closed and the CSF-drainage is prevented. If the patient's IVP increases and rises above the defined opening pressure, the spring pressure of the ball-cone unit will eventually be overcome and the sealing ball will move away from the cone. Now the proGAV is open and CSF is drained. 


Vertical Position

As soon as the patient moves into an upright position the gravitational unit closes and therefore the total opening pressure of the proGAV is significantly increased. The flow of CSF is blocked until the sum of the intraventricular and hydrostatic pressures exeeds the total opening pressure of the proGAV. In this case the gravitational unit opens and the drainage of CSF is possible. The opening pressure of the gravitational unit increases steadily as the patient moves to the upright position. This provides effective protection against over-drainage.



The patented adjustment and verification instruments allow easy, fast and uncomplicated treatment at any location, without having to expose the patient to X-ray radiation. The unique "Active-Lock" mechanism protects the proGAV against accidental re-adjustment by external magnetic fields.

Due to the wide range of opening pressures 0-20 cmH2O (0-20 cmH2O) available on the proGAV, there are numerous possible treatment options.

Furthermore the range of angular rotation for adjustment is 300°, ensuring excellent adjusting precision.


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First, locate the proGAV by feeling the implatation location. The proGAV VERIFICATION COMPASS is an auxiliary instrument for locating the proGAV.
As the proGAV VERIFICATION COMPASS is held above the valve, the floating disc aligns over the adjustable unit of the proGAV. The current opening pressure setting can be read from the compass scale.


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Position the proGAV VERIFICATION TOOL central over the valve. The marking and the readout display on the proGAV VERIFICATION TOOL must be in line with the proximal (ventricular) catheter. Press the trigger button to see the actual opening pressure setting displayed on the readout.


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Select the appropriate opening pressure on the proGAV ADJUSTMENT TOOL.

Position the proGAV ADJUSTMENT TOOL centrally over the valve as described in the user manual. The marking and the readout display of the proGAV ADJUSTMENT TOOL must be in line with the proximal (ventricular) catheter. Unlock the rotor ("Active-Lock") by applying mild pressure on the trigger button and then check the setting with the proGAV VERIFICATION TOOL.

Learn more about the proGAV adjustment tools
About the Tools


proGAV® adjustable unit


The set pressure level of the proGAV can be reliably checked at any time without additional X-ray examination with the proGAV test instrument.

For identification in the X-ray image we recommend the use of the MIETHKE App. Here the valve can be individually adjusted according to the X-ray image and a template can be used to reliably read off which pressure setting the proGAV represents in the X-ray image (in the picture on the right: 5 cmH2O).

The selection of the appropriate pressure level of the proGAV depends on several factors, including the patient's age, degree of activity, size and stature of the patient. For further Information, pleae refer to our recommendation of pressure levels.


The MIETHKE App shows clearly and quickly understandable how our valves work:

+ Influence of the body position on the opening pressure: The motion sensor of the smartphone simulates the body position of the patient: upright - inclined - lying.

+ Pressure stage recognition in the X-ray image: Every set or preset pressure stage is shown here and can be easily recognized by means of templates.

+ Simulation of adjustability: Valves can be easily adjusted with the finger and thus help to understand what is happening inside the valve.

+ View into the inside of MIETHKE valves: All valves allow a view of their construction and thus the influence of the cerebrospinal fluid flow on the functioning can be shown in an easily understandable way.

+ free for Apple and Android



Product downloads


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The product finder quickly filters the relevant criteria using targeted, short questions.

We consider the individual patient situation, surgical technique and treatment plan. The questions are designed in such a way that the list of results provides a maximum of three product recommendations.




Thoralf Knitter

Director Product Development

Roland Schulz

Director Product Management

Thammo Weise

Product Management

Andreas Bunge

Product Management

Michaela Funk-Neubarth

Head of Marketing & HR

Jan Mügel

Product Management

Josefine Kehl

Deputy Director Marketing

August von Hardenberg

Management Consultant

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B. Braun and MIETHKE - Together for a better life with hydrocephalus

We have a long and intensive partnership with B. Braun in the field of neurosurgery. We are driven by a common vision: to improve the lives of hydrocephalus patients around the world with innovative solutions.

Our partnership is an exciting combination of B. Braun's nearly 180 years of expertise as one of the world's leading medical device and pharmaceutical companies and our agility as an innovative company and technology leader in gravitation-based shunt technology. 

Our strong partner in neurosurgery: