radial cath in Tetralogy of Fallot patient

[mossyfiber12]

We did a radial cath on a patient with Tetralogy of fellow who previously had a B-T shunt (R subclav A to R PA) and Waterston shunt (Asc Ao to main PA). Question that has been puzzling me is why we shouldn't be able to access the Asc Ao via this radial cath

The Subclav A to R PA shunt shouldn't preclude you from entering the arch. The question is why can't you guide the catheter to the arch and down the descending Aorta.

I have looked at the B-T shunt in Netter's but I am still puzzled. Can anyone explain this to me?

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[Militarydoc1]

confused by the question. you did a radial cath on a patient w/ a bt shunt, but you couldn't get the catheter down there? are you asking in general or specific to your case? to answer your question, you should be able to get a catheter to the ascending aorta assuming there's no obstruction at the anastomosis or some other vascular anomaly. the presence of a bt shunt isn't prohibitive to my knowledge.
radial cases in general can be more technically challenging to the frustration of interventionalists b/c of more hinge points/tortuosities and the presence of vascular/radial anomalies. your difficulty in getting to the ascending aorta may have been for reasons beyond just the presence of a bt shunt, unless the angle of the catheter kept favoring it which usually can be overcome.

 

[mossyfiber12]

Yea I couldn't figure it out. Would a Waterston shunt cause you to not come down the ascending aorta and access the coronaries? or for that matter, prevent you in anyway from going up the arch and down the descending aorta? She doesn't have any stenosis or coarctation as an etiology of obstruction. She had two of the below illustrated surgeries.

 

[Militarydoc1]

disclaimer, i'm not a congenital guy, but to my knowledge with the current blalock taussig shunts that utilize a graft, you should be able to access the ascending aorta with either left or right radial approach. the presence of a waterston shunt should also not be prohibitive either. I would imagine you just have to be careful to make sure the catheter is not going down the PA. maybe your guy had the old bt shunt where the subclavian artery is ligated, but you should still be able to access the ascending aorta from the contralateral radial approach...unless both were ligated