Fatal visceral ischemia as a complication of intra-aortic balloon placement

We present a case of visceral ischemia due to an anatomic versus balloon length mismatch. An 80-year-old women underwent elective coronary artery bypass graft surgery. The direct post-operative period was complicated by low cardiac output, not responding to inotropic or vasopressor drugs. An intra-aortic balloon pump (IABP) was inserted during an explorative rethoracotomy. The first 3 days, an improvement of the hemodynamic function was seen. During this period, hepatic dysfunction, renal failure with need for hemodialysis and rising values of serum lactate were seen. A computed tomography (CT) of the chest and abdomen showed splenic infarction, ascites and signs of gastric and intestinal ischemia. The IABP was blocking the celiac trunk, the superior mesenteric artery and the renal arteries and was immediately removed. The patient died shortly after due to multiple organ failure. To prevent ischemic complications in smaller patients, we advise a follow-up CT after placement of the IABP.