Decreasing Disease Burden of Right Heart Endocarditis Using Angiovac Technology in Patients Who Cannot Tolerate Surgical Interventions

Abstract

INTRODUCTION:The AngioVac device was designed with the purpose to percutaneously remove undesirable material from the intravascular system. AngioVac procedures have recently become popular for decreasing vegetative burden in patients with infective endocarditis who are poor surgical candidates. CASE PRESENTATION:A 26-year-old female with a previous history of intravenous drug use, MSSA bacteremia, and noncompliance presented with acute hypoxic respiratory failure and refractory septic shock. She was found to have multiple cavitary lesions on CT angiography of the chest (Figure 1A) which was consistent with septic emboli. Transesophageal echocardiogram revealed large valvular vegetations on the anterior and septal tricuspid valve leaflets measuring approximately 2cm x2cm with a component of the leaflet having independent mobility (Figure 1B). Despite directed antibiotic therapy, her clinical status continued to deteriorate. Subsequently, a decision was made to perform vegectomy with AngioVac for debulking and decreasing the disease burden. Vegectomy was performed successfully (Figure 1C and 1D) with significant improvement.DISCUSSION: Endocarditis of the right-heart circulation is most commonly managed with antimicrobial therapy. Surgical indications for complicated infective endocarditis include: large vegetations (=20 mm in diameter), recurrent septic pulmonary emboli, presence of a highly resistant organism, and/or persistent bacteremia. In certain instances, where surgical intervention is not appropriate for conditions such as unstable right heart endocarditis, AngioVac has been utilized to decrease the vegetative burden.CONCLUSIONS: AngioVac use for the purpose of right heart endocarditis is gaining attention, however, further studies needs to be done on the efficacy and safety for this new possible indication.