Imaging for Temporary Mechanical Circulatory Support Devices

Percutaneous mechanical circulatory support for the anesthesiologist: indications, management, and basic physiological principles

“…Other complications include cannula migration with resultant distribution of deoxygenated blood to the systemic circulation, air embolism, cardiac tamponade, and development of iatrogenic interatrial shunt. Unlike the Impella, however, aortic stenosis, LV thrombus, and ventricular septal defect are not contraindications to placement of the TandemHeart 4…”

“…Of note, the distal end of the outflow lumen is multiperforated and should be located in the PA ~3 to 4 cm past the pulmonic valve. This is often best visualized in the upper esophageal short-axis view of the ascending aorta 4…”

“…The initial survey for venous cannula insertion should specifically look for structures that may affect function of the circuit (large interatrial aneurysm, atrial septal defect, patent foramen ovale, prominent Chiari network, or multiple implanted leads). Particularly, a thrombus or stenosis of the SVC or IVC should be excluded 4,20. Next, the surgeon or proceduralist will pass a guide wire from the access venous vessel.…”

“…ME bi-caval and modified bi-caval views can be used to confirm the location in the RA, ensuring it does not direct toward the RV or cross through a patent foramen ovale. When appropriate positioning of the guide wire has been established, the cannula will be advanced after a series of dilators and should be visualized at the cavoatrial junction 4. Due to the location of the arterial cannula in the distal aorta, there is little visualization that is required; however, some proceduralists may ask to visualize the guide wire in the descending aorta.…”

“…It is also prudent to rule out aortic dissection before cannula placement as an iatrogenic dissection can occur in up to 4% of patients undergoing arterial access procedures. These dissections have been associated with higher morbidity and mortality than naturally occurring dissections 4…”