SHM Converge Scientific Abstract ePoster Gallery-Vacuumed, Vanquished, and Discharged: Modern Percutaneous Therapy for High-Risk Tricuspid Endocarditis

Pdf Summary

This case report describes a 42-year-old man with active IV drug use who presented with 5 days of severe back pain and fever. Workup revealed MSSA bacteremia, bilateral septic pulmonary emboli, L5-S1 spondylodiscitis with epidural abscess, and septic sacroiliitis. Echocardiography showed a large, mobile native tricuspid valve vegetation measuring 2.5 × 0.9 cm.<br /><br />Because the patient had high embolic burden and ongoing infectious source control needs, invasive treatment was indicated. However, conventional open-heart surgery was considered less favorable due to active IVDU, concern for reinfection, postoperative adherence challenges, and the complexity of his disseminated infection. After multidisciplinary review, the team chose percutaneous aspiration and debulking with AlphaVac instead of open tricuspid valve surgery.<br /><br />The procedure achieved near-complete removal of the vegetation on repeat echocardiography. The patient completed 6 weeks of antibiotics and made a full clinical recovery.<br /><br />The key message is that meeting criteria for invasive management does not automatically mean open surgery is the best option. In carefully selected high-risk patients with right-sided infective endocarditis, percutaneous debulking can provide effective source control while avoiding the morbidity of sternotomy and valve replacement. This approach may be especially useful when surgical risk is increased by factors such as active substance use, risk of reinfection, or difficulty with follow-up.

Asset Subtitle

Haseeb Moiz

Meta Tag

Author List Chaya Levine, Gregory Cunn, Haseeb Moiz, Maham Waheed

Category Clinical Vignettes

Concept Right-sided Infective Endocarditis

Concept Tricuspid Valve Endocarditis

Concept Vegetation

Concept Septic Pulmonary Emboli

Concept Open Tricuspid Valve Surgery

Distinguished Non-Finalist

Presenter Organization Maimonides Medical Center

Presenting Author Haseeb Moiz

Track Adult

Keywords

right-sided infective endocarditis

tricuspid valve vegetation

MSSA bacteremia

percutaneous debulking

AlphaVac

intravenous drug use

septic pulmonary emboli

spondylodiscitis

epidural abscess

septic sacroiliitis

Right-sided Infective Endocarditis

Tricuspid Valve Endocarditis

Vegetation

Septic Pulmonary Emboli

Open Tricuspid Valve Surgery