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The timeline and treatment course for the patient.
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Figure 2 presents the timeline and treatment course for the patient.
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Fluoroscopic images of the Impella (Abiomed, Danvers, MA) assisted cell infusion procedure. (A) The Impella device is sited in the left ventricle showing the inlet and outlet port either side of the aortic annulus. (B) Coronary angiography is performed, identifying the left anterior descending and left circumflex coronary arteries with the Impella in situ. (C) Coronary angiogram showing the cell infusion procedure in the left anterior descending artery. Arrows indicate the position of the over-the-wire balloon in the proximal left anterior descending artery through which the cells are infused after the guide wire is removed.
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Once the Impella device was sited (Figure 3A) and continuous flow was established (approximately 3.4 L/min), the BMMNCs were infused into the coronary arteries using recognized angioplasty techniques. A sheath was inserted into the radial artery and 6-F Judkins guide catheters were used to cannulate the left main and right coronary arteries consecutively (Figure 3B). For each artery (LAD, LCx, right coronary), an over-the-wire balloon (0.5 mm smaller than the vessel's diameter) was inserted over a 0.014 inch guide wire (Figure 3C).
Impella read out and changes in physiological parameters during the cell infusion procedure. (A) Screen capture of the Impella console during the intracoronary cell infusion during a balloon occlusion of the coronary artery. The red upper panel is a measurement of blood pressure from the Impella device and demonstrates maintenance of mean arterial pressure despite a reduction in pulsatile flow. The green middle panel demonstrates the load on the Impella motor. The bottom left panel demonstrates an Impella Flow of 3.4 L/min. (B) Schematic representation of changes in blood pressure during the Impella-assisted cell infusion procedure. Systolic blood pressure (sBP), diastolic blood pressure (dBP) and mean arterial pressure (MAP) are shown before, during and after Impella activation. The dotted line represents the time at which cells were infused whilst the Impella was running. Note that Impella device augmented the MAP at the time of cell infusion. (C) Schematic representation of changes in heart rate and O2 saturation during the Impella-assisted cell infusion procedure. The dotted line represents the time at which cells were infused whilst the Impella was running.
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Cardiac output was supplemented by the Impella device at 3.4 L/min to counteract the reduction in blood pressure seen on the trace when the balloons were inflated (Figure 4).
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