Transradial Coronary Angioplasty in an Achondroplastic Patient with Chronic Total Occlusion (CTO): First Case Report

Verma, Bhupendra; Singh, Amrita; Saxena, A.; Kumar, M.

doi:10.5530/jcdr.2018.3.33

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…With respect to percutaneous interventions in patients with achondroplasia, our systematic review of available interventions in this population demonstrates safe and effective use of these techniques to alleviate and treat cardiovascular conditions in these patients. Studies have noted technical difficulties with endovascular access of the coronary arteries using the transradial approach due to short limbs, elbow angles and kyphoscoliosis (16,17). Obtaining arterial access has also been noted to be challenging with respect to accessing the femoral vessels, and one study noted ultrasonographic assistance was required (14).…”

Section: Discussionmentioning

confidence: 99%

“…Obtaining arterial access has also been noted to be challenging with respect to accessing the femoral vessels, and one study noted ultrasonographic assistance was required (14). Determination of radial versus femoral access should be determined on a case-by-case basis with the two reports of radial access noting their choice was based on complexity of intervention required (17,18). Further studies are necessary to elucidate the benefits and disadvantages of each technique.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac interventions in patients with achondroplasia: a systematic review

Sukhavasi¹,

O’Malley²,

Maynes³

et al. 2020

J Thorac Dis

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Patients with achondroplasia and other causes of dwarfism suffer from increased rates of cardiovascular disease relative to the remainder of the population. Few studies have examined these patients when undergoing cardiac surgery or percutaneous intervention. This systematic review examines the literature to determine outcomes following cardiac intervention in this unique population. An electronic search was performed in the English literature to identify all reports of achondroplasia, dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14 articles with 14 cases met inclusion criteria. Patientlevel data was extracted and analyzed. Median patient age was 55.5 [interquartile ranges (IQR), 43.8, 59.8] years, median height 102.0 [98.8, 112.5] cm, median BMI 32.1 [27.0, 45.9], and 57.1% (8/14) were male.Of these 14 patients, nine had the following documented skeletal abnormalities: 66.7% (6/9) had scoliosis, 66.7% (6/9) had kyphosis, 11.1% (1/9) had lordosis, 11.1% (1/9) pectus carinatum and 11.1% (1/9) spinal stenosis. Coronary artery disease was present in 53.8% (7/13), and 30.8% (4/13) patients previously suffered a myocardial infarction. Of the eight patients who underwent cardiac surgery, 37.5% (3/8) underwent multivessel coronary artery bypass grafting, 37.5% (3/8) underwent aortic valve replacement, 25.0% (2/8) underwent type A aortic dissection repair, and the remaining 12.5% (1/8) underwent pulmonary thromboendarterectomy. Six patients underwent percutaneous intervention. Median cardiopulmonary bypass time was 136.5 [110.0, 178.8] minutes. Median arterial cannula size was 20.0 [20.0, 24.0] Fr. Bicaval cannulation was performed in all cases describing cannulation strategy (5/5). Median superior vena cava cannula size was 28.0 [28.0, 28.0] Fr, and inferior vena cava cannula size was 28.0 [28.0, 28.0] Fr. Nomortality was reported with a median follow up time of 6.0 [6.0, 10.5] months. In conclusion, Common cardiac procedures can be performed with reasonable safety in this patient population. Operative adjustments may need to be made with respect to equipment to accommodate patient-specific needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac interventions in patients with achondroplasia: a systematic review

Sukhavasi¹,

O’Malley²,

Maynes³

et al. 2020

J Thorac Dis

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“…Engagement of the RCA was performed using a 6 Fr, 4 curve Judkins right (JR4) catheter while VL 3.0 guide was used to engage the left system [9]. Trans-radial coronary angioplasty was also performed in another case [10]. A multi-vessel percutanous trans-luminal coronary angioplasty (PTCA) in achondroplasia patient has been reported in a 46-year-old male with achondroplasia.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, there was a significant mortality benefit in patients allocated to the trans-radial access site. With respect to PCI in patients with achondroplasia, technical difficulties were noted regarding the endovascular access of the coronary arteries using the trans-radial approach due to short limbs, elbow angles, and kyphoscoliosis [10]. Femoral access is also challenging as well, with respect to femoral artery access issues and local bleeding complications, and ultra-sonographic guidance may be required [8,11].…”

Section: Discussionmentioning

confidence: 99%

A case of successful coronary angioplasty in an achondroplasia patient with total occlusion of an anomalous right coronary artery (case report)

Ali

Albashir

Elawad

et al. 2020

BMC Cardiovasc Disord

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Background: Coronary interventions in patients of achondroplasia have been reported rarely in the medical literature. Due to short stature and kyphoscoliosis, endovascular access (Cannulation) of the coronary arteries is usually extremely difficult in such patients. Case presentation: A 33 years old patient, a known case of achondroplasia, presented with epigastric pain for 3 h duration to a university hospital, Sudan. Her height was 95 cm and her weight was 38 Kg. A trans-femoral approach for coronary angioplasty was preferred. After it has been extremely difficult to cannulate the left system at first, the cannulation has been performed successfully using 5F, JL3.5 catheter. The angiogram depicted total occlusion of the proximal right coronary artery which was found to be originating from the left coronary sinus of the aorta. Successful trans-femoral coronary angioplasty has been performed with stent placement, and no complications encountered. During her last follow up, 1 year after the procedure, she appeared to be free of symptoms and with no further ischemic attacks or procedure-related complications. Conclusions: To the best of our knowledge, this is the first reported case of successful coronary angioplasty in achondroplasia patient in whom the occluded artery is an anomalous coronary artery. Literature review, description of the achondroplasia, development of the coronary arteries and the hypothesized theory for the anomaly have been described in this case report. The PCI performed has also been clearly and comprehensively described.

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Left Main Coronary Artery Bifurcation Coronary Intervention in a Patient with Achondroplasia with Multivessel Coronary Artery Disease

Das

Banerjee

Kumar

et al. 2022

Indian Journal of Medical Specialities

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We report a rare case of critical coronary artery disease in a 62-year-old male with achondroplasia. There is a paucity of case reports of association of achondroplasia with coronary artery disease. Left main coronary artery (LMCA) bifurcation lesion carries the highest risk of mortality out of all types of coronary artery lesions and patients with achondroplasia have two-fold more mortality as compared to the general population. That is why achondroplasia patients may be having more sudden cardiac death with the most catastrophic LMCA bifurcation lesion before they undergo revascularization. It may be the plausible explanation behind no literature description of LMCA bifurcation lesion in patients with achondroplasia. Our case is the first literature description of LMCA bifurcation lesion with successful intervention in achondroplasia. The present case will also provide a detailed insight into the association of achondroplasia with coronary artery disease without the presence of conventional cardiac risk factors.

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Transradial Coronary Angioplasty in an Achondroplastic Patient with Chronic Total Occlusion (CTO): First Case Report

Cited by 3 publications

References 6 publications

Cardiac interventions in patients with achondroplasia: a systematic review

Cardiac interventions in patients with achondroplasia: a systematic review

A case of successful coronary angioplasty in an achondroplasia patient with total occlusion of an anomalous right coronary artery (case report)

Left Main Coronary Artery Bifurcation Coronary Intervention in a Patient with Achondroplasia with Multivessel Coronary Artery Disease

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