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

Adrian Mercado-Alamo; Hemindermeet Singh; Howard Rosman; Rajendra H. Mehta; Thomas LaLonde; Amir Kaki

doi:10.1016/j.jaccas.2020.05.035

July 22, 2020JACC Case ReportsOpen Access

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

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Structured PICO

P

Population

A 27-year-old man with tricuspid valve endocarditis, large vegetation, persistent bacteremia, and pulmonary and systemic septic embolization, deemed not a suitable surgical candidate (n=1).

I

Intervention

Percutaneous vegetation debulking using the AngioVac system.

O

Outcome

Clinical status and tricuspid valve function post-operatively.

Percutaneous debulking of large tricuspid vegetations using the AngioVac system can achieve clinical improvement but may result in abruptly worsened tricuspid regurgitation.

Implication

AngioVac may aid infection control in tricuspid endocarditis; hypothesis-generating for post-procedural TR management and larger studies.

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.)