Transesophageal Echocardiography–Guided Percutaneous Aspiration of a Large Tricuspid Valve Vegetation in a Patient with Infective Endocarditis

Figures

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  Figure 1. Midesophageal 4-chamber view focused on the right ventricle (RV) in systole demonstrating a mass measuring 32 × 26 mm attached to the TV, predominately at the septal and anterior leaflets. See Video 1. LA, Left atrium; LV, left ventricle; RA, right atrium.

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  Figure 2. Three-dimensional data set of the TV seen en face from the right atrium in systole showing a large mass on the TV (red arrow). See Video 2. AL, Anterior leaflet; AV, aortic valve; PL, posterior leaflet; SL, septal leaflet.

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  Figure 3. Midesophageal 4-chamber view focused on the right ventricle (RV) in systole with color flow Doppler demonstrating mild TR around a mass attached to the TV. See Video 3. LA, Left atrium; LV, left ventricle; RA, right atrium.

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  Figure 4. Fluoroscopic image demonstrating the relative position of the AngioVac inflow cannula (red arrow) approaching from the right internal jugular vein and TEE probe (blue arrow) in the ME position.

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  Figure 5. Midesophageal modified bicaval view in systole demonstrating the AngioVac inflow cannula (blue arrow) directed toward the TV mass (red arrow). See Video 4. LA, Left atrium; RA, right atrium.

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  Figure 6. Midesophageal modified bicaval view in systole demonstrating the tip of the AngioVac inflow cannula (blue arrow) in contact with the mass (red arrow) attached to the TV during active cannula aspiration. See Video 5. LA, Left atrium; RA, right atrium.

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  Figure 7. Midesophageal modified bicaval view in systole demonstrating significant debulking of the TV mass and the tip of the AngioVac cannula (blue arrow) positioned near the TV. See Video 6. LA, Left atrium; RA, right atrium; RV, right ventricle.

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  Figure 8. Midesophageal 4-chamber view focused on the right ventricle (RV) in systole demonstrating significant reduction in size of the TV mass with residual components in the subvalvular apparatus of the TV. See Video 7. LV, Left ventricle; RA, right atrium.

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  Figure 9. Three-dimensional data set of the TV as viewed from the right atrium in systole showing successful debulking of the TV mass. See Video 8. AL, Anterior leaflet; AV, aortic valve; PL, posterior leaflet; SL, septal leaflet.

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  Figure 10. Midesophageal 4-chamber view focused on the right ventricle (RV) in systole with color flow Doppler demonstrating moderate central TR after debulking of the TV mass. See Video 9. LA, Left atrium; LV, left ventricle; RA, right atrium.

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  Figure 11. Components of the TV vegetation retrieved from the AngioVac extracorporeal circuit filter after successful debulking.