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Published in: Insights into Imaging 1/2023

Open Access 01-12-2023 | Intra-Aortic Balloon | Educational Review

CT and chest radiography in evaluation of mechanical circulatory support devices for acute heart failure

Authors: Abhishek Chaturvedi, Yonatan Rotman, Timothy Hoang, Greg Jew, Aniruddh Mandalapu, Craig Narins

Published in: Insights into Imaging | Issue 1/2023

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Abstract

Acute heart failure and cardiogenic shock are a major cause of morbidity and mortality in patients who have had recent cardiac surgery, myocardial infarct or pulmonary hypertension. The use of percutaneous mechanical circulatory support (MCS) devices before organ failure occurs can improve outcomes in these patients. Imaging plays a key role in identifying appropriate positioning of MCS devices for supporting ventricle function. These devices can be used for left ventricle, right ventricle or biventricular support. Fluoroscopy, angiography and echocardiography are used for implanting these devices. Radiographs and CT can identify both intra- and extra-cardiac complications. The cardiothoracic imager will see increasing use of these devices and familiarity with their normal appearance and complications is important.

Critical relevance statement

Chest radiographs and CT are useful for assessing the position of the mechanical cardiac support device used for treatment of acute heart failure. CT can identify cardiac and extra-cardiac complications associated with these devices.

Graphical abstract

Key points

  • IABP upper/distal marker should be 2–3 cm distal to the ostia of the left subclavian artery.
  • Inlet of Impella CP should be 3.5 cm below the aortic valve.
  • The Impella 5.5 does not have a pigtail portion. The inlet should be about 5 cm below the aortic annulus.
  • Impella RP inlet port should be in the right atrium or inferior vena cava, the pigtail portion should be positioned in the main pulmonary artery.
  • Protek Duo inflow is in the right atrium or right ventricle. The outflow is in the main pulmonary artery.
Appendix
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Literature
2.
go back to reference Teuteberg JJ, Chou JC (2014) Mechanical circulatory devices in acute heart failure. Crit Care Clin 30(3):585–606CrossRefPubMed Teuteberg JJ, Chou JC (2014) Mechanical circulatory devices in acute heart failure. Crit Care Clin 30(3):585–606CrossRefPubMed
3.
go back to reference Benjamin EJ et al (2019) Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 139(10):e56–e528CrossRefPubMed Benjamin EJ et al (2019) Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 139(10):e56–e528CrossRefPubMed
4.
go back to reference Kirklin JK et al (2008) INTERMACS database for durable devices for circulatory support: first annual report. J Heart Lung Transplant 27(10):1065–1072CrossRefPubMed Kirklin JK et al (2008) INTERMACS database for durable devices for circulatory support: first annual report. J Heart Lung Transplant 27(10):1065–1072CrossRefPubMed
5.
go back to reference Boehmer JP, Popjes E (2006) Cardiac failure: mechanical support strategies. Crit Care Med 34(9 Suppl):S268–S277CrossRefPubMed Boehmer JP, Popjes E (2006) Cardiac failure: mechanical support strategies. Crit Care Med 34(9 Suppl):S268–S277CrossRefPubMed
6.
go back to reference Patterson T, Perera D, Redwood SR (2014) Intra-aortic balloon pump for high-risk percutaneous coronary intervention. Circ Cardiovasc Interv 7(5):712–720CrossRefPubMed Patterson T, Perera D, Redwood SR (2014) Intra-aortic balloon pump for high-risk percutaneous coronary intervention. Circ Cardiovasc Interv 7(5):712–720CrossRefPubMed
7.
go back to reference Kapur NK et al (2017) Mechanical circulatory support devices for acute right ventricular failure. Circulation 136(3):314–326CrossRefPubMed Kapur NK et al (2017) Mechanical circulatory support devices for acute right ventricular failure. Circulation 136(3):314–326CrossRefPubMed
8.
go back to reference Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC (2016) IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg 11(1):122CrossRefPubMedPubMedCentral Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC (2016) IABP: history-evolution-pathophysiology-indications: what we need to know. J Cardiothorac Surg 11(1):122CrossRefPubMedPubMedCentral
9.
go back to reference Kim JT et al (2007) The carina as a useful radiographic landmark for positioning the intraaortic balloon pump. Anesth Analg 105(3):735–738CrossRefPubMed Kim JT et al (2007) The carina as a useful radiographic landmark for positioning the intraaortic balloon pump. Anesth Analg 105(3):735–738CrossRefPubMed
10.
go back to reference Rastan AJ et al (2010) Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 122(11 Suppl):S92–S99PubMed Rastan AJ et al (2010) Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 122(11 Suppl):S92–S99PubMed
13.
go back to reference Beregi JP, Mauroy B, Willoteaux S, Mounier-Vehier C, Rémy-Jardin M, Francke JP (1999) Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation. Eur Radiol 9(7):1330–1334CrossRefPubMed Beregi JP, Mauroy B, Willoteaux S, Mounier-Vehier C, Rémy-Jardin M, Francke JP (1999) Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation. Eur Radiol 9(7):1330–1334CrossRefPubMed
14.
go back to reference Glazier JJ, Kaki A (2019) The Impella device: historical background, clinical applications and future directions. Int J Angiol 28(2):118–123CrossRefPubMed Glazier JJ, Kaki A (2019) The Impella device: historical background, clinical applications and future directions. Int J Angiol 28(2):118–123CrossRefPubMed
16.
go back to reference Amin AP et al (2020) The evolving landscape of Impella use in the united states among patients undergoing percutaneous coronary intervention with mechanical circulatory support. Circulation 141(4):273–284CrossRefPubMed Amin AP et al (2020) The evolving landscape of Impella use in the united states among patients undergoing percutaneous coronary intervention with mechanical circulatory support. Circulation 141(4):273–284CrossRefPubMed
17.
go back to reference O’Neill WW et al (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126(14):1717–1727CrossRefPubMed O’Neill WW et al (2012) A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 126(14):1717–1727CrossRefPubMed
18.
go back to reference Montisci A, Bertoldi LF, Price S, Hassager C, Møller J, Pappalardo F (2021) Intensive care unit management of percutaneous mechanical circulatory supported patients: the role of imaging. Eur Heart J Suppl 23(Supplement_A):A15–A22CrossRefPubMedPubMedCentral Montisci A, Bertoldi LF, Price S, Hassager C, Møller J, Pappalardo F (2021) Intensive care unit management of percutaneous mechanical circulatory supported patients: the role of imaging. Eur Heart J Suppl 23(Supplement_A):A15–A22CrossRefPubMedPubMedCentral
20.
go back to reference Herlihy JP, Loyalka P, Jayaraman G, Kar B, Gregoric ID (2009) Extracorporeal membrane oxygenation using the TandemHeart System’s catheters. Tex Heart Inst J 36(4):337–341PubMedPubMedCentral Herlihy JP, Loyalka P, Jayaraman G, Kar B, Gregoric ID (2009) Extracorporeal membrane oxygenation using the TandemHeart System’s catheters. Tex Heart Inst J 36(4):337–341PubMedPubMedCentral
21.
go back to reference Montisci A, Sala S, Maj G, Cattaneo S, Pappalardo F (2022) Comprehensive evaluation of Impella RP((R)) in right ventricular failure. Future Cardiol 18(4):285–298CrossRefPubMed Montisci A, Sala S, Maj G, Cattaneo S, Pappalardo F (2022) Comprehensive evaluation of Impella RP((R)) in right ventricular failure. Future Cardiol 18(4):285–298CrossRefPubMed
22.
go back to reference Pieri M, Pappalardo F (2018) Impella RP in the treatment of right ventricular failure: what we know and where we go. J Cardiothorac Vasc Anesth 32(5):2339–2343CrossRefPubMed Pieri M, Pappalardo F (2018) Impella RP in the treatment of right ventricular failure: what we know and where we go. J Cardiothorac Vasc Anesth 32(5):2339–2343CrossRefPubMed
23.
go back to reference Anderson MB et al (2015) Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 34(12):1549–1560CrossRefPubMed Anderson MB et al (2015) Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 34(12):1549–1560CrossRefPubMed
24.
go back to reference Anderson M et al (2018) Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. J Heart Lung Transplant 37(12):1448–1458CrossRefPubMed Anderson M et al (2018) Outcomes of patients with right ventricular failure requiring short-term hemodynamic support with the Impella RP device. J Heart Lung Transplant 37(12):1448–1458CrossRefPubMed
25.
26.
go back to reference Condello I, Nasso G, Vernice A, Speziale G (2022) Protek Duo cannula potential advantages in minimally invasive aortic valve replacement. J Card Surg 37(4):1130CrossRefPubMed Condello I, Nasso G, Vernice A, Speziale G (2022) Protek Duo cannula potential advantages in minimally invasive aortic valve replacement. J Card Surg 37(4):1130CrossRefPubMed
27.
go back to reference Vijayakumar N, Badheka A, Chegondi M, Mclennan D (2021) Successful use of Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricular support for acute respiratory distress syndrome in an adolescent with complex congenital heart disease. Perfusion 36(2):200–203CrossRefPubMed Vijayakumar N, Badheka A, Chegondi M, Mclennan D (2021) Successful use of Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricular support for acute respiratory distress syndrome in an adolescent with complex congenital heart disease. Perfusion 36(2):200–203CrossRefPubMed
28.
go back to reference Ravichandran AK, Baran DA, Stelling K, Cowger JA, Salerno CT (2018) Outcomes with the tandem Protek Duo dual-lumen percutaneous right ventricular assist device. ASAIO J 64(4):570–572CrossRefPubMed Ravichandran AK, Baran DA, Stelling K, Cowger JA, Salerno CT (2018) Outcomes with the tandem Protek Duo dual-lumen percutaneous right ventricular assist device. ASAIO J 64(4):570–572CrossRefPubMed
30.
go back to reference Mukku VK, Cai Q, Gilani S, Fujise K, Barbagelata A (2012) Use of Impella ventricular assist device in patients with severe coronary artery disease presenting with cardiac arrest. Int J Angiol 21(3):163–166CrossRefPubMedPubMedCentral Mukku VK, Cai Q, Gilani S, Fujise K, Barbagelata A (2012) Use of Impella ventricular assist device in patients with severe coronary artery disease presenting with cardiac arrest. Int J Angiol 21(3):163–166CrossRefPubMedPubMedCentral
Metadata
Title
CT and chest radiography in evaluation of mechanical circulatory support devices for acute heart failure
Authors
Abhishek Chaturvedi
Yonatan Rotman
Timothy Hoang
Greg Jew
Aniruddh Mandalapu
Craig Narins
Publication date
01-12-2023
Publisher
Springer Vienna
Published in
Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1186/s13244-023-01469-8

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