Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device
Color Doppler Artifact Masking Iatrogenic Aortic Valve Injury Related to an Impella Device
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DOI：
10.1053/j.jvca.2018.09.035
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发表时间：
2019-06-01
影响因子：
2.8
通讯作者：
Naseem, Tariq
中科院分区：
文献类型：
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作者：
Hong, Edward;Naseem, Tariq
Impella（Abiomed，Danvers，MA）是一种微创跨瓣左心室辅助装置（LVAD），可有效卸载左心室（LV），尤其适用于静脉-动脉体外膜式氧合器（VA ECMO）环境中的室性心律失常患者。（1，2）在过去几年中，Impella器械在高风险经皮冠状动脉介入治疗和心源性休克中的应用显著增加，因为其相对容易植入导管室和手术室。尽管罕见，但器械穿过主动脉瓣（AV）可能导致医源性损伤。3这可能导致主动脉瓣返流（AR），在心源性休克的情况下具有显著的临床后果。由于使用彩色血流多普勒时器械会产生伪影，因此该AR在超声心动图诊断中可能具有挑战性。在该E挑战中，作者强调了认识到这些发现对于准确解释超声心动图在Impella LVAD难治性心源性休克管理中的重要性以及经食管超声心动图（TEE）的实用性。(C)2018由Elsevier Inc.出版
The Impella (Abiomed, Danvers, MA) is a minimally invasive transvalvular left ventricular assist device (LVAD) that effectively unloads the left ventricle (LV), especially in patients with ventricular arrhythmias in the setting of a venous-arterial extracorporeal membrane oxygenator (VA ECMO).(1,2) Utilization of the Impella device has increased significantly in the last few years for high-risk percutaneous coronary intervention and cardiogenic shock because of its relatively easy implantation in the catheterization lab and the operating room. Although rare, iatrogenic injury of the aortic valve (AV) can be caused by placement of the device across the AV.3 This can lead to aortic regurgitation (AR) with significant clinical consequences in the setting of cardiogenic shock. This AR can be challenging to diagnose echocardiographically because of the artifacts generated by the device when using color-flow Doppler. In this E-challenge, the authors emphasize the importance of recognizing these findings for accurate interpretation of the echocardiogram in the management of cardiogenic shock refractory to the Impella LVAD and the utility of transesophageal echocardiography (TEE). (C) 2018 Published by Elsevier Inc.