Right heart endocarditis (RHE) is a significant issue among drug addicts [1]. Intravenous antibiotics serve as the primary treatment for RHE. However, in cases that are resistant or complicated with valve dysfunction, cardiac surgery may be necessary [2]. We present a case where the vegetation on the tricuspid valve was removed percutaneously using a vacuum-assisted device in a patient with recurrent RHE despite antibiotic treatment. The illness was successfully treated, and there was no relapse during the 12-month observation period.
A 22-year-old male drug addict was admitted for recurrent RHE. For a year, he had been treated three times for relapses of tricuspid endocarditis. Despite the temporary success of antibiotic therapy, the disease returned after a few months. During that period, echocardiography showed growing pedunculated vegetation (measuring finally 2.5 × 1.2 cm) attached to the anterior tricuspid leaflet, with only mild-to-moderate tricuspid regurgitation (Figure 1A, B, Supplementary material, Video S1).
Since valve function did not significantly deteriorate and after discussion with the Heart Team, we decided to remove the vegetation percutaneously as prophylaxis against recurrent endocarditis. To achieve this, we used the AngioVac system (AngioDynamics, Latham, NY, US), which consists of a venous drainage cannula and a re-infusion (venous return) cannula that are connected to the extracorporeal circuit and centrifugal pump [3, 4].
The AngioVac drainage cannula was inserted through the right internal jugular vein via the DrySeal 26F Sheath (Gore Medical, Newark, DE, US) (Figure 1C, Supplementary material, Video S2), while the 18 F reinfusion cannula was inserted into the right femoral vein. The centrifugal pump (RotaFlow ECMO system, Maquet Cardiovascular, Wayne, NJ, US) generated a flow of up to 5 liters per minute, and the vegetation was successfully removed (Figure 1D–F, Supplementary material, Video S3).
The tricuspid regurgitation remained mild to moderate. Both jugular and femoral vascular access were percutaneously closed with Proglides. During the 12-month follow-up, the patient had no symptoms or signs of infection relapse. Furthermore, he received treatment at a drug addiction center and remained drug-free.
This case demonstrates that percutaneous removal of vegetation material is a safe and feasible option for right heart endocarditis in patients without significant valvular damage. It also highlights the effectiveness of percutaneous aspiration, making it a promising option for minimally invasive intracardiac material removal.
Supplementary material
Supplementary material is available at https://journals.viamedica.pl/kardiologia_polska.
Article information
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