title: Perforation of the Anterior Mitral Leaflet After Impella LP 5.0 Therapy in Cardiogenic Shock.
abstract: A 52-year old man was admitted with out-of-hospital cardiac arrest, and he was resuscitated after 100 minutes. The initial hemodynamic condition was critical due to cardiogenic shock (left ventricular ejection fraction 10 % and mean arterial pressure 60 mmHg on inotropics). Acute coronary angiography did not reveal any new lesions. Due to persistent hemodynamic instability, mechanical support with Impella LP 5.0 was decided. The surgical procedure guided by fluoroscopy and transesophageal echocardiography was uncomplicated. The hemodynamic improved subsequently and after 17 days of intensive care, and additional 30 days of hospitalization, the patient was ready for discharge. Routine echocardiography prior to discharge revealed severe mitral regurgitation due to perforation of anterior mitral leaflet, a finding not observed in the previous echocardiograms. The patient was discharged to close follow up of the severe mitral regurgitation and future surgical intervention is likely. Therefore, close monitoring of mitral valve is necessary and explanation may be required if valve dysfunction is observed, as repositioning of the Impella system is not possible.
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus Denmark. Electronic address: asheft@rm.dk.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Eftekhari
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjær
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus Denmark.
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby, Aarhus Denmark.
authors.forename: Sten Lyager
authors.initials: SL
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus Denmark.
authors.forename: Evald Høj
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus Denmark.
authors.forename: Steen Hvitfeldt
authors.initials: SH
authors.lastname: Poulsen
mesh_terms: D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000293:injuries*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology*; D012770:Shock, Cardiogenic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*