IVUS-Guided Pulmonary Artery Hemodynamic Sensor Implantation: A Novel Contrast-Sparing Strategy
Nishant Trivedi1, Shreya Srivastava2, Sydney Arus3
1Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Peconic Bay Medical Center, Riverhead, New York, USA.
Objective:
This case report describes a novel insertion technique of a hemodynamic sensor (CardioMEMS), avoiding the need for intravenous contrast in patients with baseline renal dysfunction.
Key Steps:
Intravascular ultrasound (IVUS) was employed to both visualize and direct the placement of the CardioMEMS. IVUS, along with fluoroscopy, were used to identify the left pulmonary artery as well as guide and confirm sensor placement.
Potential Pitfalls:
The use of IVUS requires the operator to be familiar with identifying the appropriate target of the left pulmonary artery on ultrasound imaging. In addition, the introduction of IVUS in complex anatomy or a heavily calcified vessel may increase the risk of complications, including vessel perforation, dissection, and thrombosis.
Take-Home Messages:
IVUS is a feasible technique for CardioMEMS placement, minimizing the need for contrast. This is of particular importance in patients with heart failure and renal dysfunction, placing them at high risk for progression to renal failure.
