[Aspiration-based endocarditis debridement of a competent tricuspid valve in a high-risk case of tricuspid valve endocarditis secondary to cardiac device-related infective endocarditis].

INTRODUCTION

The incidence of tricuspid valve endocarditis secondary to cardiac device-related infective endocarditis is rising, probably due to an increasing number of implantations. We describe a novel therapy approach using standard cardiology diagnostic catheter guided by periinterventional transesophageal echocardiographic imaging for aspiration-based endocarditis debridement of the tricuspid valve in a high-risk-patient.

HISTORY: A 65-year-old patient presented with right-heart endocarditis associated with cardiac device-related infective endocarditis. He had a history of ischemic cardiomyopathy, 3-vessel coronary artery disease and was successfully resuscitated one year ago with subsequent implantation of an implantable cardioverter-defibrillator (ICD).

FINDINGS AND DIAGNOSIS: Echocardiography revealed typical endocarditis vegetations on the defibrillator lead and the tricuspid valve. Moreover peripheral septic embolism was suspected.

THERAPY AND COURSE: The cardioverter-defibrillator was explanted and extensive antiinfective therapy was established as the patient was in a state of persistent bacteremia and prolonged septic shock. Open heart surgery was dismissed due the patient´s increased risk of mortality. After interdisciplinary consensus an aspiration-based endocarditis debridement of the tricuspid valve with maintained valve-functionality using a standard cardiology was carried out.

CONCLUSION

Aspiration-based endocarditis debridement in right-heart endocarditis in high-risk patients using a standard cardiology diagnostic catheter can be an alternative to open heart surgery. However, larger clinical studies are needed to define the safety and prognostic benefit of an interventional catheter approach in infective endocarditis.