CTICasesMalpositioned Impella Device
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Imaging findings
Chest radiographs and CT show an Impella ventricular assist device in place, alongside an ECMO cannula. The Impella catheter tip is positioned across the aortic valve, but the catheter is slightly malpositioned, with the pigtail tip and intake port located too close to the aortic valve plane rather than deeper in the mid-cavity of the left ventricle.
Key takeaways
The Impella is a catheter-mounted microaxial flow pump designed to provide circulatory support. For optimal function, the intake port must reside deep in the left ventricular cavity (below the aortic valve) and the output port must be in the ascending aorta (above the valve). Malposition can lead to diminished flow, suction events against the ventricular wall, or aortic valve damage. Position is typically confirmed with echocardiography or radiography.
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