Novel Fluoroscopic Evaluation of Incorrect Impella Placement

A 65-year-old man with newly diagnosed cardiomyopathy was found to have multivessel coronary artery disease. After he was deemed not to be a surgical candidate, Impella-supported percutaneous coronary intervention was successfully performed on his left main and left circumflex arteries. Although initially thought to be in the correct position by standard single plane fluoroscopy, the Impella catheter was shown with the use of additional non-standard fluoroscopic views to be oriented toward the mitral apparatus. Malrotation of the Impella microaxial flow pump catheter can lead to complications and suboptimal unloading. This case highlights a novel fluoroscopic technique for evaluation of incorrect Impella placement.