Journal of JCIC

There are few experiences among children regarding utilization of Impella® for left ventricular unloading during acute left ventricular failure. In present case, we achieved survival in a 12-year-old male patient with body surface area of 1.04 m²—among the smallest reported to date—following fulminant myocarditis utilizing mechanical circulatory support in combination with Impella® CP and veno-arterial extracorporeal membrane oxygenation. Upon insertion of Impella® CP, one should consider minimum size requirements for 1. arterial diameter over 5.0 mm, 2. aortic arch width over 57 mm, and 3. Left ventricular length over 85 mm. Present case satisfied device access artery diameter, however, we chose to insert the device through a graft with two-stage diameter (6 mm and 8 mm, 8 mm was distal side) anastomosed to femoral artery and refrained inserting distal shaft into femoral artery but kept within the graft. The aortic arch width of approximately 50 mm by echocardiography resulted in device kink at the connecting part between motor and catheter shaft, in an acute angle. In preventing device kink, insertion of the device through either subclavian artery or brachial artery in more obtuse angle should be considered. We recognize present case showed important findings in applying Impella® CP with crucial devices for small stature children.