Using Echocardiography for Impella® Positioning

It is important to confirm Impella CP® positioning with echocardiography.

The first parasternal long-axis transthoracic echo (TTE) video shows proper Impella CP positioning. You can see that the Impella CP is placed across the aortic valve (AoV) in the left ventricle (LV). The bright “railroad tracks” outline the cannula. As you follow the cannula into the ventricle, you can visualize the inlet area, the teardrop, and the pigtail. The inlet is positioned freely in the left ventricular cavity, free from the mitral valve (MV) and papillary muscle obstruction and approximately 3.5 cm below the aortic valve annulus, indicating proper Impella CP position.

The second TTE video shows improper placement of Impella CP. The cannula is too deep into the left ventricle and not sitting freely in the ventricular space. The pigtail is not directed toward the apex and is in the papillary muscle. The inlet area is too close to the ventricular wall and abutting the papillary muscle, which can obstruct the inflow of blood. The outlet area is too close to the aortic valve annulus and therefore likely not adequately supporting the patient.