Minimally Invasive Aspiration of Tricuspid Valve Vegetation in Recurrent Methicillin-Susceptible Staphylococcus aureus Endocarditis.

BACKGROUND

Right-sided infective endocarditis (IE), especially in intravenous drug users, presents a management challenge when patients decline surgery. Percutaneous aspiration techniques have emerged as less-invasive alternatives.

CASE SUMMARY: A 32-year-old male with a history of intravenous drug use presented with persistent methicillin-susceptible Staphylococcus aureus bacteremia and septic pulmonary emboli. Transesophageal echocardiography revealed a 1.5-cm mobile tricuspid vegetation. Despite surgical recommendation, the patient declined open-heart intervention. Under transesophageal echocardiography guidance, percutaneous aspiration was performed using a Penumbra FLASH catheter with guidewire assistance to optimize engagement. The procedure successfully debulked the vegetation, resulting in bacteremia clearance without complications.

DISCUSSION: Catheter-based vegetectomy is gaining traction as a salvage or bridge-to-surgery strategy in IE. This case uniquely demonstrates the adjunctive use of a coronary guidewire to enhance catheter steering and efficacy-an innovation not widely described in literature.

TAKE-HOME MESSAGES: Percutaneous aspiration may provide effective source control in tricuspid IE when surgery is not an option. Guidewire-assisted catheter navigation may improve procedural outcomes.