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. 2022 Apr 8;17:e05. doi: 10.15420/icr.2021.11

Figure 1: Impella Position.

Figure 1:

Correct positioning of the Impella CP, Impella 2.5 and Impella 5.0 across the aortic valve and into the left ventricle. The radiopaque marker should be positioned across the aortic valve annulus, allowing an approximate distance of 3.5 cm from the aortic valve annulus to mid-inlet for the Impella CP, 2.5 and 5.0 devices (left). The device extends a further 5.5 cm from mid-inlet to the tip of the pigtail catheter. On transthoracic echocardiography (TTE), two echogenic double lines of the cannula indicate either end of the Impella inlet. Reverberation artefacts on TTE posterior to the cannula may also assist in identification of the inlet. Correct placement of the Impella 5.5 catheter is 5.5 cm from the aortic valve annulus to mid-inlet of the inflow cage. This is deeper due to the lack of pigtail on the Impella 5.5 catheter. Ao = aorta; LV = left ventricule; MV = mitral valve; RV = right ventricle.