Iftikhar Imran, Khan Hamid Sharif, Kayani Azhar Mahmood, Shahzad Hassan
Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi.
J Coll Physicians Surg Pak. 2015 Oct;25 Suppl 2:S78-80. doi: 10.2015/JCPSP.S78S80.
Impella 2.5 is a temporary left ventricular assist device that is being increasingly used in high risk Percutaneous Coronary intervention (PCI). It reduces the cardiac workload and provides assistance to myocardium and vital organs in states of severe left ventricular dysfunction and cardiogenic shock. We report the first case of successful percutaneous coronary stenting performed in a high risk patient using impella 2.5. A 65-year old diabetic and hypertensive male with a known double vessel coronary artery disease and a reduced left ventricular function (ejection fraction, 20%) was admitted with intractable angina. He was on optimal medical treatment for 2 months. His coronary angiogram done 2 months back had revealed double vessel coronary artery disease (subtotally occluded co-dominant left circumflex and moderate 60% stenosis in left anterior descending artery and a normal co-dominant right coronary artery). He was considered a high risk both for Coronary Artery Bypass Graft (CABG) surgery and PCI due to co-morbidities and reduced left ventricular function. As he had failed a trial of optimal medical therapy and the cardiac surgeon's reluctance for surgery, the patient and his family was counseled for high risk PCI with left ventricular assist device using the impella 2.5.
Impella 2.5是一种临时左心室辅助装置，在高危经皮冠状动脉介入治疗（PCI）中使用越来越多。它可减轻心脏负荷，并在严重左心室功能不全和心源性休克状态下为心肌和重要器官提供辅助。我们报告首例使用Impella 2.5在高危患者中成功进行经皮冠状动脉支架置入术的病例。一名65岁患有糖尿病和高血压的男性，已知患有双支冠状动脉疾病且左心室功能降低（射血分数为20%），因顽固性心绞痛入院。他接受了2个月的最佳药物治疗。2个月前进行的冠状动脉造影显示双支冠状动脉疾病（共同优势的左旋支完全闭塞，左前降支中度60%狭窄，共同优势的右冠状动脉正常）。由于合并症和左心室功能降低，他被认为进行冠状动脉旁路移植术（CABG）手术和PCI均具有高风险。由于他的最佳药物治疗试验失败且心脏外科医生不愿进行手术，因此向患者及其家属建议使用Impella 2.5进行带左心室辅助装置的高危PCI。
