Entrapment of the Impella heart pump in the mitral subvalvular apparatus

Figure 1. Impella entrapment in the mitral subvalvular apparatus in a patient with acute myocardial infarction and cardiogenic shock. A) - C) Coronary angiography. D) Cinefluoroscopy of the Impella in situ. E) TTE (parasternal long-axis view) - Impella abutting mitral valve (arrow). F) TEE showing flail P3 scallop (arrow). G) Colour TEE showing severe eccentric MR. H) 3D-TEE showing flail A3/P3 scallops. I) Ruptured chordae tendineae.

A 47-year-old man presented with witnessed out-of-hospital cardiac arrest at his wedding and anterior ST-elevation myocardial infarction. Initial blood pressure was 90/60 mmHg with pulse of 115 beats/minute. Coronary angiography showed 100% thrombotic ...