Successful Debulking of Tricuspid Valve Vegetation Using Suction Filtration and Veno-Venous Bypass

Abstract

Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.

Crisis in the Chest: Acute Chest Syndrome as a Sequela of Tricuspid Valve Endocarditis

“…A meta-analysis by Narayanan et al [6] found that in patients who had surgical intervention at seven days or less, the odds ratio (OR) of all-cause mortality was 0.61 (95% confidence interval (CI): 0.39 to 0.96, p=0.034), and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI: 0.48 to 0.86, p=0.003) compared with conservative management. The European Society of Cardiology (ESC) guidelines recommend surgery for right-sided IE in patients receiving appropriate antibiotic therapy who have acute severe tricuspid regurgitation resulting in right ventricular dysfunction, recurrent pulmonary emboli requiring ventilatory support or with large (>20 mm) residual tricuspid vegetations, or involvement of left-sided structures [7,8].…”

A Fatal Case of Native Valve Endocarditis with Multiple Embolic Phenomena and Invasive Methicillin-Resistant Staphylococcus aureus Bacteremia: A Case Report from the Maldives

“…We also compared other case reports that match the case presented in Table S3 [ 35 , 36 ]. At presentation to the hospital, the presented case with IE was in a critical condition affecting the valve on the left side of the heart.…”