Impella left ventricular assist device

Case contributed by Dr Jayanth Keshavamurthy

Presentation

This a chest radiograph after cardiac catheterisation in a known patient with coronary artery disease and chest pain.

Patient Data

Age: 72
Gender: Male

Identify all the hardware in this patient. Are they in appropriate positions?

Modality: X-ray

Right internal jugular central venous catheter, endotracheal tube, enteric tube, triple lead left chest AICD and Impella left ventricular assist device (LVAD) all project in appropriate locations.

ECG leads and defibrillator pads overlie the patient.

The coronary artery stent is overlying the proximal LAD.

The cardiopericardial silhouette and mediastinal structures are stable.

Lungs are equally expanded bilaterally and demonstrate grossly stable, pulmonary parenchymal findings compared to the prior chest radiograph.

No pleural effusion or pneumothorax.

Modality: Annotated image

Impella LVAD is highlighted in yellow.

The stent is in blue.

Zoomed in and sharper with edge enhancement of image.

Last image has no annotations to compare with.

Case Discussion

This patient underwent coronary angiography via the right femoral route. Left heart catheterisation showed coronaries unchanged from prior cath in 2010 with right coronary artery (RCA) with chronic total occlusion and a calcific moderate proximal LAD lesion that was found to be significant on intravascular ultrasound (IVUS). Rotablation was performed to the proximal LAD and a drug eluting stent (DES) was placed into the proximal LAD. The procedure was done under Impella support that was placed via the left femoral access site (14 Fr sheath).

The Impella LVAD was placed before stenting the proximal LAD as the patient was felt to be high risk given multiple other cardiac comorbidities.

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Case Information

rID: 39058
Case created: 18th Aug 2015
Last edited: 17th Sep 2015
Inclusion in quiz mode: Included

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