Endovascular approach from radial artery for pulmonary artery stenosis after BT shunt operation

A 27-year-old lady presented with severe cyanosis and fatigue. Her room air oxygen saturation was 75%. She was Known case of complex congenital heart disease as Double-outlet right ventricle (tetralogy of Fallot type) with long segment of pulmonary artery atresia and large VSD which was not possible for biventricular repair. She underwent palliative modified Blalock–Taussig (BT) shunt surgery when she was 2 y/o. She had no follow up until Echocardiography and CT angiography revealed patent left BT shunt but severe left pulmonary artery stenosis adjacent to shunt.
Based on CT angiographic images, left radial artery approach was selected. By applying 6F guiding catheter, support catheter, 0.035 hydrophilic wire, V18 wire, 0.014 BMW it was possible to deploy coronary Sapphire balloon and 6m Express renal stent which are compatible with 6F guiding catheter and 0.014 wire. The O2 saturation increased to 86% after the procedure.