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| CASE REPORT |
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| Year : 2023 | Volume
: 7
| Issue : 1 | Page : 15-16 |
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A rare complication of intra-aortic balloon pump
Mohamed A Aboughanima1, AbdelHameed ElSayed2, Amr A Arafat3
1 Department of Adult Intensive Care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
2 Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
3 Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| Date of Submission | 27-Nov-2022 |
| Date of Acceptance | 24-Dec-2022 |
| Date of Web Publication | 28-Mar-2023 |
Correspondence Address:
Amr A Arafat
Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Building 6, Makkah Al Mukarramah Branch Road, As Sulimaniyah, Riyadh 12233
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sccj.sccj_28_22
Intra-aortic balloon pump (IABP) is commonly used for circulatory support in patients with cardiogenic shock. IABP is associated with several complications; however, IABP rupture was rarely reported. We present a female patient with acute myocardial infarction and ventricular septal rupture. The patient underwent transcatheter device closure of the ventricular septum and IABP insertion. After 4 days of insertion, we encountered a failure to cycle alarm. The IABP was removed with difficulty, and a leak coming from the shaft near the bifurcation was found. This case highlighted the importance of early detection of IABP rupture to avoid entrapment and further complications.
Keywords: Intra-aortic balloon, percutaneous mechanical support devices, rupture
How to cite this article:
Aboughanima MA, ElSayed A, Arafat AA. A rare complication of intra-aortic balloon pump. Saudi Crit Care J 2023;7:15-6 |
| Introduction | |  |
Percutaneous circulatory support plays a vital role in managing cardiogenic shock after acute myocardial infarction.[1] Intra-aortic balloon pump (IABP) improves left ventricular unloading and augments diastolic coronary blood flow.[2] Despite the modest effect of IABP compared with other circulatory support devices, IABP is simple to use and has a good safety profile. On the other hand, IABP is associated with several complications, including limb ischemia, rupture, and entrapment.[3] We reported a case of IABP rupture that was managed with early IABP removal.
| Case Report | | |
Female patients aged 78 years had acute myocardial infarction complicated by ventricular septal rupture. The patient had urgent transcatheter device closure of the ventricular septal defect and intra-aortic balloon insertion (Maquet, San Jose, CA, US). After 4 days of IABP insertion, we encountered a failure to cycle alarm. There was no leak in the connection, and the mark of the helium container indicated an adequate level. Despite that, we changed the console twice.
Balloon rupture was a possibility, but we could not detect any blood in the helium compartment of the tube. The treating team decided to take the balloon out. However, there was difficulty in removing the balloon. Repeated aspiration and negative pressure were used to deflate the balloon, and a sheath was inserted to facilitate removal without injuring the artery. The balloon was taken out and no blood clots were detected on the balloon.
We put the balloon underwater and checked for any leaks, but there was no leak. However, we noticed that on injecting air, the balloon does not inflate very well, and applying pressure on the balloon leads to a loss of its volume [[Figure 1] and Video 1]. We put the whole balloon shaft underwater to find a leak coming from the shaft near the bifurcation. The patient had a smooth recovery with no complications related to the IABP insertion site.
| Discussion | | |
Despite the safety profile of IABP compared to other mechanical-assisted devices, it is associated with major complications that can be life-threatening.[3] The reported complications with IABP include limb ischemia, aortic dissection, bleeding, and rarely rupture and entrapment.[4],[5]
In our patient, IABP rupture was diagnosed due to a malfunctioning balloon with failure to inflation. In such cases, the treating team should check for any leak from connections or empty hilum containers, which were negative in our case. Although there was no blood inside the lumen, balloon rupture was highly suspected. Therefore, the team decided to remove the IABP to avoid potential complications. IABP rupture could lead to entrapment, and forceful removal might damage the iliac or femoral arteries.[6] The balloon came out from our patient with difficulty but without vascular or limb complications. Few cases were published about managing entrapped IABP; however, our case shows that early recognition and prompt removal using sheaths are vital to avoid complications during removal. Delayed diagnosis could lead to balloon entrapment and increase the possibility of surgical removal of the balloon. Unusual sites of ruptures, such as the shaft, should be suspected when no blood is found inside the balloon.
| Conclusions | | |
Early diagnosis and removal of the ruptured intra-aortic balloon are essential to avoid vascular complications and the need for surgical removal.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Wernly B, Seelmaier C, Leistner D, Stähli BE, Pretsch I, Lichtenauer M, et al. Mechanical circulatory support with impella versus intra-aortic balloon pump or medical treatment in cardiogenic shock – A critical appraisal of current data. Clin Res Cardiol 2019;108:1249-57.  |
| 2. | Ahmad Y, Sen S, Shun-Shin MJ, Ouyang J, Finegold JA, Al-Lamee RK, et al. Intra-aortic balloon pump therapy for acute myocardial infarction: A meta-analysis. JAMA Intern Med 2015;175:931-9. |
| 3. | Parissis H, Soo A, Al-Alao B. Intra aortic balloon pump: Literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg 2011;6:147. |
| 4. | Lewis PA, Mullany DV, Townsend S, Johnson J, Wood L, Courtney M, et al. Trends in intra-aortic balloon counterpulsation: Comparison of a 669 record Australian dataset with the multinational benchmark counterpulsation outcomes registry. Anaesth Intensive Care 2007;35:13-9. |
| 5. | Siriwardena M, Pilbrow A, Frampton C, MacDonald SM, Wilkins GT, Richards AM. Complications of intra-aortic balloon pump use: Does the final position of the IABP tip matter? Anaesth Intensive Care 2015;43:66-73. |
| 6. | Sabzi F, Zokaei AH, Moloudi AR, Dabiri S. Intra-Aortic balloon pump entrapment in a nonatherosclerotic common iliac artery. Open J Cardiovasc Surg 2011;4:5-7. |
[Figure 1]
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