Transcatheter Vacuum-Assisted Mass Extraction on a Mitral Bioprosthesis

An 84-year-old woman with a history of mitral valve replacement, ascending aorta replacement, and pacemaker implantation presented with malaise and progressive shortness of breath. Transthoracic echocardiography and transesophageal echocardiography revealed a left ventricular ejection fraction of 10% to 15% and a floating mass on the mitral prosthesis. She was suspected to have bioprosthetic endocarditis, despite being afebrile and having negative blood cultures. Reoperative mitral valve replacement was considered but deemed too high risk, and a transseptal aspiration of a mass was performed to mitigate systemic embolization risk. Postprocedural transesophageal echocardiography showed no residual mass and a well-functioning bioprosthesis. The pathologic examination revealed extensive fibrin accompanied by inflammation and a fibroblastic reaction. Vacuum-assisted aspiration using the AngioVac has been well described for right-sided intracardiac structure, but left-sided mass extraction has rarely been reported. This successful case illustrates a transcatheter treatment option in an otherwise inoperable patient.