Unmasking Severe Tricuspid Valve Regurgitation After Percutaneous Debulking of Large Tricuspid Vegetation

Abstract

A 27-year-old man admitted with tricuspid valve endocarditis with a large vegetation, persistent bacteremia, and pulmonary and systemic septic embolization was deemed not a suitable surgical candidate. He underwent percutaneous vegetation debulking using the AngioVac system. The patient defervesced post-operatively with clinical improvement but with abruptly worsened tricuspid regurgitation. ( Level of Difficulty: Beginner. )

Outcomes and survival of patients undergoing percutaneous vegetectomy for right heart endocarditis

“… Successful removal Stable on d/c with no f/u Prabhudas-Stryckera et al [4] 2 cm SVC mass and aortic root abscess N/A Successful removal of 75 % of SVC mass. Stable on d/c with no f/u Mercado-Alamo et al [5] . 2.6x 1 cm TV vegetation Multiple comorbidities Successful removal Patient left against medical advice Koney et al, 2019 [6] 2 cm mass on TV HD instability Successful removal Stable d/c and on f/u visit Thiagaraj et al, 2017 [7] TEE: 4.5 cm SVC, 1.3 × 0.9 cm MV leaflet vegetation Prevent septic emboli Successful removal Stable on d/c and on f/u 2.2 × 1.7 cm anterior and 1.2 × 0.4 cm posterior TV leaflet vegetation HD instability, vegetation size, worsening valvular function, prevent septic emboli Successful removal Patient expired.…”

“… Candida tropicalis. Mercado-Alamo et al [5] . 27/M Hep C, Polysubstance abuse, IVDU Fever, malaise and fatigue.…”

Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis

“…Thereby, we had a total of 10 case reports [ 21 - 30 ], which we included in our study. All the patients included in these studies had blood cultures positive for either MSSA or MRSA.…”

“…The other comorbidity cases were attributed to hypertension with five patients [ 21 , 22 , 24 , 26 ] and type 2 diabetes mellitus also with five patients [ 21 , 22 , 24 , 26 , 28 ]. The three patients diagnosed with chronic hepatitis C have also reported a history of intravenous drug use [ 22 , 23 , 30 ]. We also noted two patients with hyperlipidemia, one patient with hypothyroidism, and one patient who was recently diagnosed with anal carcinoma.…”

Severe Tricuspid Valve Endocarditis

“…The patient was deemed to not be a surgical candidate owing to severe lung injury. Therefore, successful percutaneous aspiration of the large mobile masses of tricuspid vegetations was performed ( Figure 2 ), a method noted to have high rates of procedural success and low mortality ( 1 , 2 , 3 ). Intraprocedural TEE confirmed trivial echodensity remaining on the tricuspid valve with stable severe TR ( Videos 5 and 6 ).…”