CTICasesLeft Ventricular Distension on VA ECMO treated with Impella
Imaging findings
CT chest in a patient on VA ECMO shows retrograde contrast flow in the aorta up to the valve, contrast in the right heart, but none in the left ventricle or atrium. The left ventricle is severely dilated (overdistended) with dependent pulmonary edema. Post-operative radiographs show subsequent Impella placement.
Key takeaways
Veno-arterial (VA) ECMO increases left ventricular afterload, which can prevent the aortic valve from opening. This leads to blood stasis, progressive LV distension, and pulmonary edema. Unloading the left ventricle using a device like an Impella (ECMELLA configuration) is required to decompress the ventricle.
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