Ventricular rupture during the removal of Impella 5.5 in a patient with fulminant myocarditis

Ventricular perforation or rupture caused by Impella (Abiomed Inc., Danvers, MA, USA) is extremely rare. The Japanese registry of Impella usage reported that the incidence of perforation was 0.02 % in all Impella cases. Herein, we report a rare case of fulminant myocarditis that survived cardiac insufficiency with the combination therapy of veno-arterial extracorporeal membrane oxygenation and Impella 5.5 and left ventricular free wall rupture following Impella removal with emergent surgery. It should be emphasized that the rupture occurred in an unexpected situation. The transesophageal echocardiography-guided removal led to the immediate identification of the cardiac tamponade and consequent survival.

Ventricular rupture due to Impella implantation is likely to occur under several conditions: the use of Impella 5.5, friable ventricular wall structure, and the proximity of the device tip to the wall structure. In cases with these factors, extra caution must be observed during the insertion and removal of the device as these entail a greater risk of ventricular injury.