Ismael A Salas de Armas1, Sachin Kumar1, Ahmed Almustafa1, Bindu Akkanti1, M Hakan Akay1, Manish K Patel1, Jayeshkumar Patel1, Keshava Rajagopal1, Juan Marcano2, Rajiv Goswami1, Igor D Gregoric1, Biswajit Kar3. 1. Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America. 2. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America. 3. Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America. Electronic address: Biswajit.Kar@uth.tmc.edu.
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.
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.