Myocardial Failure Caused by Traumatic Dissection of Left Coronary System?Ventricular Recovery with Temporary Circulatory Support

Abstract

We report a case of a patient suffering from massive myocardial infarction after traumatic dissection of the left coronary system. The dissection involved the left coronary artery including peripheral segments of the coronary circulation. The patient was revascularized; however, she could not be weaned from cardiopulmonary bypass thereafter. An Impella microaxial hemopump was implanted and the patient's left ventricular function markedly improved during the following days. Eight days later hemodynamics had stabilized far enough to explant the device, after explantation the patient remained hemodynamically stable and free of inotropic support. The report intends to emphasize the potential of the myocardium to recover even after extensive infarction under temporary ventricular support and takes the Impella microaxial hemopump into consideration as a device that is technically easy to implant with no injury to the ventricle and thus associated with good properties for weaning. Surgeons should consider the device as short-term support in borderline indications.

Percutaneous left ventricular assistance in post cardiac arrest shock: Comparison of intra aortic blood pump and IMPELLA Recover LP2.5

“…IMPELLA LP2.5 directly unloads the left ventricle, reduces myocardial workload and oxygen consumption and increases cardiac output and coronary and end organ perfusion. [13][14][15] Implantation was performed by interventional cardiologists. The pump was inserted via a 13-F sheath in the femoral artery and placed retrogradely through the aortic valve after coronary angiography or later at bedside in the ICU under transoesophageal echocardiography (TEE) control.…”

Assist devices for circulatory support in therapy-refractory acute heart failure

“…This device can be placed percutaneously or during heart surgery via the open chest, and is for short-term use only. The use of the Impella pump has also been reported in combination with ECMO support [37][38][39][40]. Placement of this device mandates exact positioning in regards to the aortic valve, to assure correct placement of the inflow and outflow orifices.…”