Mizuno Akito, Kawamoto Shuji, Uda Shuji, Tatsumi Kenichiro, Takeda Chikashi, Tanaka Tomoharu, Fukuda Kazuhiko
Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
JA Clin Rep. 2021 Apr 26;7(1):38. doi: 10.1186/s40981-021-00444-w.
The IMPELLA® is a minimally invasive left ventricular assist device. We report a case in which transesophageal echocardiography (TEE) was useful in diagnosis of left ventricular rupture after IMPELLA® insertion.
A 75-year-old man presented to the emergency room with chest pain and underwent percutaneous coronary intervention for 100% stenosis of the left anterior descending branch #7. An IMPELLA® was inserted to stabilize the circulation, but hypotension persisted. Transthoracic echocardiography revealed increased pericardial effusion and suspicion of free wall left ventricular rupture, leading to emergency surgery. TEE revealed the IMPELLA® straying into the left ventricle apical wall and cardiac tamponade. Hemorrhage was observed from the thinning free wall and the tip of the IMPELLA® was palpable. The IMPELLA® was removed and the left ventricular wall was repaired.
The IMPELLA® requires implantation of the tip in the left ventricle, but it should be noted that a fragile ventricular wall can be easily perforated.
Impella®是一种微创左心室辅助装置。我们报告一例经食管超声心动图（TEE）有助于诊断Impella®植入术后左心室破裂的病例。
一名75岁男性因胸痛就诊于急诊室，因左前降支7段100%狭窄接受了经皮冠状动脉介入治疗。植入Impella®以稳定循环，但低血压持续存在。经胸超声心动图显示心包积液增加，怀疑左心室游离壁破裂，遂进行急诊手术。TEE显示Impella®误入左心室心尖壁并导致心脏压塞。观察到变薄的游离壁有出血，且可触及Impella®的尖端。移除Impella®并修复左心室壁。
Impella®需要将尖端植入左心室，但应注意脆弱的心室壁容易被穿孔。
