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European Journal of Echocardiography Advance Access originally published online on March 30, 2008
European Journal of Echocardiography 2008 9(3):412-413; doi:10.1093/ejechocard/jen029
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Functional mitral stenosis: a rare complication of the Impella assist device

Stefan Toggweiler, Peiman Jamshidi and Paul Erne*

Division of Cardiology, Kantonsspital Luzern, CH-6000 Luzern 16, Switzerland

Received 18 May 2007; accepted after revision 18 November 2007; online publish-ahead-of-print 30 March 2008.

* Corresponding author. Tel: +41 41 205 52 08; fax: +41 41 205 22 34. E-mail address: paul.erne{at}ksl.ch


  Abstract

In patients with left ventricular output failure, the Impella left ventricular assist device increases total cardiac output despite a drop in output provided by the left ventricle itself. We present a patient with cardiogenic shock after myocardial infarction in whom an Impella recover 2.5 was implanted. Correct placement was ensured by fluoroscopy, pressure and current signals displayed on the console of the system, and transthoracic echocardiography. On follow-up, the Impella device was dislocated with the shaft of the device lying on the anterior mitral leaflet causing a functional mitral stenosis evident by an increased transmitral diastolic flow gradient. After removing the device, the patients' haemodynamics improved within minutes. Other than a mild regurgitation, mitral valve was without pathological findings. Although infrequent, this case shows a possible complication of the Impella ventricular assist device and highlights the importance of periodical echocardiographic surveillance, especially in patients who show a poor response to therapy.

Keywords: Impella; Functional mitral stenosis; Cardiogenic shock; Left ventricular assist device; Echocardiography


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