Tetralogy of Fallot is the most frequent cyanotic congenital heart disease. Usually, the condition is diagnosed and treated during the first year of life. Few reports of uncorrected tetralogy of Fallot reaching adulthood are found in the literature. Occasionally the pulmonary obstruction is relatively mild and the presentation is with minimal cyanosis. This particular situation is called "pink tetralogy" or "acyanotic tetralogy". For these adults surgical repair is still recommended, since the results of surgery are good and the operative risk is low. We report the case of a 55-year-old man with an uncorrected acyanotic tetralogy of Fallot diagnosed after right cardiac failure triggered by an acute onset of malaria.

Aims – The objective of this study was to evaluate the feasibility of a new technique for crossing the radial artery in case of severe refractory arterial spasm. Methods and Results – We conducted a prospective, non-randomized, single center study to evaluate a new technique „Pressure Facilitated Crossing” (PFC) that can facilitate radial artery crossing with coronary catheters by injecting saline solution directly by an automated pump system trough the introducer sheath. The primary endpoint was technical success which was defined as successful catheter passage after PFC. The secondary endpoint was the rate of access-site vascular complications. From January 2018 to December 2019, 22 patients with severe and refractory radial artery spasm, with an inability to advance coronary catheters, were prospectively included in a single center. The PFC technique was used as a bailout option and was successful in 21 patients (95%). No vascular complication was noted. Overall, this strategy was well tolerated despite a short-duration of pain during saline injection. Conclusion – In case of severe radial artery spasm during transradial access, the use of the PFC technique was effective and safe for crossing the radial artery with coronary catheters after failure of conventional approaches. This bailout method has the potential to decrease the need for vascular access conversion during transradial access.

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