Clinical Images

Intraaortic Balloon Pump Rupture

Nino Mihatov, MD1 and David M. Dudzinski, MD, JD2

Nino Mihatov, MD1 and David M. Dudzinski, MD, JD2

Abstract: Intraaortic balloon pump (IABP) rupture is a rare complication, with overall reported incidence of 1%. It is thought to be related to abrasion of balloon material against atherosclerotic plaques during or after placement. The presented case demonstrates the presence of blood within the IABP driveline, which is a key indicator of rupture.

J INVASIVE CARDIOL 2015;27(9):E203

Key words: intraaortic balloon pump, complications, percutaneous coronary intervention

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Case Report

A 76-year-old female with coronary and peripheral artery disease and prior bypass surgery presented with non-ST elevation myocardial infarction complicated by pulmonary edema. Percutaneous intervention on the culprit circumflex vein graft was performed with right femoral artery intraaortic balloon pump (IABP) support. Nine hours later, acute hypotension developed and blood was noted in the IABP driveline (Figure 1), which was indicative of balloon rupture. The IABP was urgently extracted with surgical support available in the event of balloon entrapment or femoral laceration. 

IABP rupture, a rare complication with overall reported incidence of 1%,1 is thought to be related to abrasion of balloon material against atherosclerotic plaques during or after placement. As the console may not always alarm immediately, presence of blood within the IABP driveline is a key indicator of rupture.2,3 Peripheral vascular disease, female sex, and age have been identified as independent predictors of IABP complications.1 Prompt recognition and urgent removal of the ruptured IABP remain mainstays of management. Delay in removal allows thrombus to form around the IABP, increasing risks of entrapment and peripheral embolization of thrombi. In the event of delayed recognition of rupture or resistance to attempts at manual removal, surgical exploration is warranted.

References

  1. Ferguson JJ 3rd, Cohen M, Freedman RJ Jr, et al. The current practice of intraaortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol. 2001;38:1456-1462.
  2. Fitzmaurice GJ, Collins A, Parissis H. Management of intraaortic balloon pump entrapment: a case report and review of the literature. Tex Heart Inst J. 2012;39:621-626.
  3. Nishida H, Koyanagi H, Abe T, et al. Comparative study of five types of IABP balloons in terms of incidence of balloon rupture and other complications: a multi-institutional study. Artif Organs. 1994;18:746-751.

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From the 1Department of Medicine and 2Departments of Cardiology, Echocardiography, and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript submitted April 6, 2015 and accepted April 8, 2015.

Address for correspondence: Nino Mihatov, MD, Massachusetts General Hospital, Harvard Medical School, Department of Medicine, 55 Fruit Street, GRB 740, Boston, MA 02114. Email: nmihatov@partners.org

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