Partial Impella support (performance level 2) contributed to the successful spontaneous closure of a persistent pseudoaneurysm in a 69-year-old woman with left ventricular summit perforation.
Case Report (n=1)
Partial Impella support may be a useful adjunct in the multifactorial management of left ventricular pseudoaneurysms complicating catheter ablation.
BACKGROUND: Impella is effective for left ventricular (LV) rupture after myocardial infarction. However, its role in managing LV perforation during catheter ablation in structurally normal hearts, particularly at the LV summit, remains unclear. CASE SUMMARY: A 69-year-old woman developed LV perforation due to a steam pop during ablation for premature ventricular contractions. After emergency surgery, the pseudoaneurysm persisted despite intra-aortic balloon pump (IABP) support and multifactorial management. The IABP was then replaced with Impella CP, and the pseudoaneurysm later closed spontaneously. The patient recovered without sequelae. DISCUSSION: LV summit perforation caused by steam pops is challenging to manage because of the anatomical complexity and tissue fragility. Although the favorable outcome was likely multifactorial, Impella support may still have contributed to the overall management strategy despite the small, nondilated LV and support being limited to performance level 2 (P2). TAKE-HOME MESSAGE: Pseudoaneurysm after LV perforation may be managed with multifactorial therapy, including partial Impella support.
Miyazawa et al. (2026) conducted a case report in Left ventricular summit perforation (n=1). Impella CP vs. Intra-aortic balloon pump (prior therapy) was evaluated on Pseudoaneurysm closure and clinical recovery. Partial Impella support (performance level 2) contributed to the successful spontaneous closure of a persistent pseudoaneurysm in a 69-year-old woman with left ventricular summit perforation.