A straying tip of the IMPELLA® in the left ventricle apical wall detected by transgastric long-axis view by transesophageal echocardiography. Note the massive pericardial effusion (arrow head) and the two highly echogenic parallel lines indicating the tip of the IMPELLA® and the thinning left ventricular apical wall (small arrow). Left ventricle anteroseptal wall was not depicted probably because of acoustic shadow of the IMPELLA® (asterisk)