The Impella device is a miniaturized ventricular assist device that is being increasingly
used to increase the safety and efficacy of high-risk coronary interventions and to
treat patients with acute myocardial infarction complicated by cardiogenic shock.
The device has a miniaturized rotary pump mounted on a 9F catheter with a pigtail
conformation. The pump draws blood from the left ventricular cavity and expels it
into the ascending aorta and systemic circulation. We report a patient who, following
insertion of an Impella device, developed angiographically documented left ventricular
perforation with marked hemodynamic instability. Our successful management of this
patient is described and potential mechanisms responsible for the perforation are
discussed.
Keywords
left ventricular perforation - impella device - ventricular assist device - cardiac
surgery - high risk coronary intervention - tamponade - complication
