Electrocautery-Assisted Percutaneous Vacuum Aspiration of Dual Aortic Valve Fibroelastomas.

OBJECTIVE

To describe a stepwise approach to electrocautery-assisted vacuum aspiration for percutaneous removal of multiple aortic valve papillary fibroelastomas (PFEs) using cerebral embolic protection.

KEY STEPS: Bilateral femoral arterial access; 22-F sheath (right femoral artery) and 16-F venous cannula (left femoral vein, extracorporeal membrane oxygenation). Bilateral cerebral embolic protection deployed via right radial approach into common carotids. A 20-mm snare (JR4 catheter) encircles the aspiration cannula. Once tumor engagement is confirmed, the snare is advanced over the cannula and connected to an electrocautery generator (70 W) to sever the stalk, facilitating aspiration. Repeated sequentially, one tumor at a time, to limit embolization risk.

POTENTIAL PITFALLS: Simultaneous multitumor engagement increases embolization risk, requiring single-tumor targeting. Papillary fibroelastomas are highly adherent to tissue and resistant to aspiration alone; cautery severance overcomes this. Cerebral protection must precede instrumentation of left-sided lesions.

TAKE-HOME MESSAGE: Electrocautery-assisted vacuum aspiration with cerebral embolic protection is feasible approach for percutaneous removal of multiple aortic valve papillary fibroelastomas in nonsurgical candidates.