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  • Impella percutaneous left ventricular assist device for severe acute ischaemic mitral regurgitation as a bridge to surgery

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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Impella percutaneous left ventricular assist device for severe acute ischaemic mitral regurgitation as a bridge to surgery
  1. Bilal Jalil1,
  2. Karim El-Kersh1,
  3. Jarrod Frizzell2,
  4. Shozab Ahmed3
  1. 1Deratment of Medicine, Division of Pulmonary and Critical Care Medicine, University of Louisville, Louisville, Kentucky, USA
  2. 2Department of Medicine, Division of Cardiovascular Medicine, Interventional Cardiology, St. Vincent Hospital, Indianapolis, Indiana, USA
  3. 3Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Karim El-Kersh, karimelkersh{at}yahoo.com

Summary

Ischaemic papillary muscle rupture causing acute severe mitral regurgitation (MR) has a dramatic presentation and a very high mortality. Emergent surgical repair improves outcomes, which necessitates robust preoperative stabilisation. Here we discuss a patient with cardiogenic shock with an acute severe MR that was deemed very high risk for emergent valve replacement due to haemodynamic instability and respiratory failure. A percutaneous left ventricular assist device Impella 2.5 (Abiomed, Danvers, MA) drastically improved clinical status, and the patient underwent a successful surgical mitral valve replacement soon after placement of the temporary assist device. Our case highlights that percutaneous ventricular assist devices may help to stabilise patients with severe acute ischaemic MR, and it can serve as a bridge to surgery in high risk patients.

  • Cardiovascular medicine
  • Interventional cardiology
  • Valvar diseases
  • Adult intensive care
  • Ischaemic heart disease

https://doi.org/10.1136/bcr-2017-219749

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    Footnotes

    • Contributors All authors contributed to this manuscript. BJ drafted the initial manuscript and approved the final manuscript as submitted. KE-K contributed in writing and editing the manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. JF contributed in the manuscript concept, drafting, editing the manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. SA contributed in drafting the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.