The AngioVac is a vacuum-based device introduced in 2012 to percutaneously remove undesirable material from the intravascular system. In scattered reports, the AngioVac has been used for removal of device-led vegetations and right-sided thrombi. In this article, we describe three cases of right-sided endocarditis treated with AngioVac: a mobile mass extending from the vena cava into the right atrium, large native tricuspid vegetations, and bioprosthetic tricuspid vegetations. This device shows benefit in reducing vegetation load, decreasing septic lung embolization, and reducing reinfection in active intravenous drug users. These cases exhibit the AngioVac's arrival as a new and exciting tool in endocarditis treatment, providing an alternative to open surgery and accessorizing antimicrobial treatment.

Introduction Primary cardiac lymphoma accounts for <2% of all primary cardiac tumours. It is uncommon in immunocompetent patients, often fatal and diagnosed at autopsy. Tumour usually involves the right heart chambers and pericardium. With advances in imaging, early diagnosis is possible and treatment including chemotherapy and surgery affords good prognosis. Case presentation We present a 50-year-old woman with abdominal pain and fevers for 5 days. Computed tomography of the abdomen showed splenic and renal infarcts but no mass or vegetation was noted on echocardiography. Thoracic computed tomography divulged a large left ventricular filling defect. Cardiac magnetic resonance imaging delineated a 3.5 × 4.5 cm anterobasal mass with frond-like projections and endocardial invasion without extracardiac involvement suggestive of a low-vascularity tumour. Echo-guided endomyocardial biopsy and minithoracotomy with needle biopsy were inconclusive. A sarcoid-protocol cardiac positron emission tomography-fluorodeoxyglucose scan showed focally elevated uptake in the basal anteroseptum without extracardiac uptake, supporting a malignant entity. This prompted open heart mass resection. Pathology revealed diffuse large B-cell lymphoma. Discussion Our case is a unique report of cardiac lymphoma isolated to the left ventricle. Location of the tumour and lack of specific imaging characteristics made it a diagnostic challenge. It underscores the importance of including lymphoma in the differential for intracardiac masses as it is responsive to chemotherapy. Additionally, it emphasizes the complementary role of imaging modalities and multidisciplinary team approach in diagnosis. Early diagnosis and therapy is the key to establishing successful outcomes.

Patent foramen ovale (PFO) is the most common type of inter‐atrial shunt, with prevalence as high as 30%. Detection of PFO has implications in patients with stroke, peripheral embolism, decompression illness, and other conditions. Transesophageal echo (TEE) with saline contrast injection is the current standard for PFO detection, but even with TEE, PFOs are sometimes missed. With advances in percutaneous PFO closure therapies and proven long‐term benefit of closure, accurate PFO detection takes on cardinal importance. Various provocative maneuvers to enhance PFO detection are in clinical use and have been studied. The Valsalva maneuver has long‐held position as the ideal provocation to unmask PFO, but other maneuvers such as cough, sniff, Müller's, and more have gained relevance. In this article, we will examine various maneuvers and discuss their utility in PFO detection.

Metaanalyses of trials comparing medical treatment versus surgical closure of patent foramen ovale (PFO) have shown that percutaneous closure is more effective for preventing recurrent thromboembolic events [1]. Common complications of any occluder device include device thrombus formation, transient ischemic attack, pericardial tamponade, device dislocation, arrhythmias, and endocarditis [1]. In this article, we take a closer look at endocarditis post-device implant. It is established that up to 6 months post-implant, there is a high likelihood of device infection because endothelialization is incomplete [2]. Late-onset (>6 months) endocarditis of any occluder device is exceptionally rare. There have been scattered reports of late endocarditis with the popular AMPLATZER (St. Jude Medical, St. Paul, MN, USA) device [2][3][4]. There has been one reported case of late endocarditis with the HELEX septal occluder (W.L. Gore & Associates, Newark, DE, USA)where the patient was treated with open-heart surgery [5]. Here, we present a case of delayed-onset right-and left-sided bacterial endocarditis of the HELEX devicemade even more remarkable by the resounding success of non-surgical management. Case reportA 50-year-old African American man presented to our medical center with weakness, fever, lethargy, and chills. His medical history was significant for a 4 mm PFO that was repaired in 2010 (five years prior to current admission, repair reason unknown), paroxysmal atrial fibrillation, type 2 diabetes mellitus with resultant foot ulcer, hypertension, chronic hepatitis B, chronic

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