Three-dimensional intracardiac echocardiography is a feasible option to guide implantation of the Impella CP for left ventricular mechanical support and should be carefully considered in cases where other imaging modalities are unsuitable.

Clinicians must be aware of the limited human experience, the imaging limitations and the risks associated with this technique in order to avoid serious iatrogenic complications.

This translational interventional study demonstrated feasibility of three-dimensional intracardiac echocardiography with a wide azimuthal and elevation of 50° to provide adequate guidance for intracardiac implantation of the Impella CP percutaneous temporary left ventricular assist device in an ovine model.

The combination with two-dimensional intracardiac echocardiography modality further improved the quality of imaging and the precision of guidance for optimal Impella CP positioning.

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