European Journal of Echocardiography Advance Access published online on February 7, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen002
Functional mitral stenosis: a rare complication of the Impella assist device
Division of Cardiology, Kantonsspital Luzern, CH-6000 Luzern 16, Switzerland
Received 18 May 2007; accepted after revision 18 November 2007.
* Corresponding author. Tel: +41 41 205 52 08; fax: +41 41 205 22 34. E-mail address: paul.erne{at}ksl.ch
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Abstract |
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In patients with left ventricular output failure, the Impella left ventricular assist device increases the total cardiac output despite a drop in the 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 haemodynamics of the patients 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