Impella left ventricular assist device

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Recent cardiac catheterization in a patient with coronary artery disease and chest pain.

Patient Data

Age: 70 years
Gender: Male

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

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.

Annotated image

Impella LVAD is highlighted in yellow.

The stent is in blue.

Third image has no annotations to compare with.

Zoomed in and sharper with edge enhancement of image.

Case Discussion

This patient underwent coronary angiography via the right femoral route. Left heart catheterization showed coronary arteries unchanged from a prior catheter angiogram in 2010 with chronic right coronary artery (RCA) 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 a high risk given multiple other cardiac comorbidities.

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