Left ventricular rupture after Impella® placement during high risk percutaneous coronary intervention

Ismael A. Salas de Armas, Sachin Kumar, A. Almustafa, B. Akkanti, M. Hakan Akay, Manish K. Patel, Jayeshkumar Patel, Keshava Rajagopal, Juan Marcano, R. Goswami, Igor D. Gregoric, Biswajit Kar

Research output: Contribution to journalArticlepeer-review

Abstract

Ventricular perforation is a rare complication during a high-risk percutaneous coronary intervention (PCI) when supported by Impella® (Abiomed). However, instrumentation of the left ventricle several days after transmural infarct potentially increases susceptibility for perforation. While a patient is on Impella support, physicians should review ventriculograms carefully to detect perforation and should consider the presence of a decompressed ventricle, the absence of normal systolic pressure and the movement of contrast from the ventricle into the aorta bypassing the left ventricular ejection. Immediate removal of the Impella if a perforation occurs must be avoided. Retrieving the device would risk a catastrophic bleed, while alternative repair techniques are available. Here, we describe a patient with a left ventricle perforation that occurred during a high-risk PCI supported by an Impella device. Annotated summary: The repair of a left ventricle perforation during high-risk PCI in a patient who had an unrecognized left ventricular perforation is described. Physicians are encouraged to carefully review ventriculograms to identify the subtle changes that can indicate a perforation. Further, immediate removal of the temporary LVAD should be avoided to minimize the risk of catastrophic bleeds.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Keywords

  • Impella
  • Left ventricle
  • Percutaneous coronary intervention
  • Ventricular perforation
  • Ventricular rupture
  • Ventriculogram

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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