ArticleJACC. Case reports2025
Minimally Invasive Aspiration of Tricuspid Valve Vegetation in Recurrent Methicillin-Susceptible Staphylococcus aureus Endocarditis.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRight-sided infective endocarditis (IE), especially in intravenous drug users, presents a management challenge when patients decline surgery. Percutaneous aspiration techniques have emerged as less-invasive alternatives. CASE SUMMARY: A 32-year-old male with a history of intravenous drug use presented with persistent methicillin-susceptible Staphylococcus aureus bacteremia and septic pulmonary emboli. Transesophageal echocardiography revealed a 1.5-cm mobile tricuspid vegetation. Despite surgical recommendation, the patient declined open-heart intervention. Under transesophageal echocardiography guidance, percutaneous aspiration was performed using a Penumbra FLASH catheter with guidewire assistance to optimize engagement. The procedure successfully debulked the vegetation, resulting in bacteremia clearance without complications. DISCUSSION: Catheter-based vegetectomy is gaining traction as a salvage or bridge-to-surgery strategy in IE. This case uniquely demonstrates the adjunctive use of a coronary guidewire to enhance catheter steering and efficacy-an innovation not widely described in literature. TAKE-HOME MESSAGES: Percutaneous aspiration may provide effective source control in tricuspid IE when surgery is not an option. Guidewire-assisted catheter navigation may improve procedural outcomes.
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