PICC-associated tricuspid valve endocarditis in pregnancy managed with AngioVac

We report the case of a 21-year-old woman at 29 weeks and four days of gestation who presented with one-week history of severe epigastric pain, pleuritic chest pain, dyspnoea, and chills. A peripherally inserted central catheter line had been placed at 14 weeks of gestation for outpatient management of hyperemesis gravidarum. Initial investigations included a transthoracic echocardiogram which revealed a large tricuspid valve vegetation with mild tricuspid regurgitation and CT pulmonary angiogram which identified multiple septic pulmonary emboli. Blood cultures grew methicillin-susceptible Staphylococcus aureus. Despite appropriate antimicrobial therapy, they remained bacteraemic and underwent percutaneous mechanical debulking of tricuspid valve infective endocarditis using an AngioVac aspiration thrombectomy device. Their clinical course post-AngioVac was complicated by the development of multiple pulmonary emboli and suspected left-sided empyema. They delivered by caesarean section at 32 weeks and one day of gestation due to maternal health reasons.