Image Focus 709 IMAGE FOCUS doi:10.1093/ehjci/jey017 Online publish-ahead-of-print 16 March 2018 .................................................................................................................................................... Yuvrajsinh J. Parmar, Craig Basman, Chad Kliger, Priti Mehla, and Itzhak Kronzon* Department of Cardiovascular Medicine, Lenox Hill Hospital – Northwell Health, 100 East 77th St., 2nd Floor Noninvasive Cardiology, New York, NY 10075, USA * Corresponding author. Tel: 11 (212) 434 6119; Fax: 11 (212) 434 2111. E-mail: firstname.lastname@example.org A 49-year-old woman with a history of intravenous drug abuse presents from an outside hospital with methicillin-sensitive Staphylococcus aureus bacteraemia found to have a large tricuspid valve vegetation measuring 2.5 cm 1.2 cm with moderate to severe tricuspid regurgita- tion on transthoracic echocardiogram (TTE) and evidence of septic emboli on chest computed tomography. Fevers persisted despite intravenous antibiotic therapy and repeat TTE showed enlarging vegetation measuring 3.5 cm 1.2 cm (see Supplementary data online, Video S1). Cardiothoracic surgery was consulted for possible surgical intervention; however, the patient expressed the desire for continued intravenous drug use despite adequate counselling. She was therefore deemed high surgical risk, and it was subsequently decided that the AngioVac system would be used for debulking the vegetation. Aspiration with the AngioVac catheter was successfully performed with fluo- roscopic and transoesophageal echocardiographic guidance (Panels A–D,see Supplementary data online, Videos S2–S4). The residual mass size dramatically decreased to 0.8 cm 0.6 cm and the patient was treated with long-term intravenous antibiotics. Although tricuspid valve vegetations have relatively high survival rates, larger vegetations can result in significant morbidity and mortality. Often, surgeons are reluctant to operate on tricuspid valve in patients with continued intravenous drug use given the high reinfection and reoperation rates. The debulking of tricuspid valve vegetations has been reported in the literature and albeit small in number, results have been promising. Vegetectomy using the AngioVac system may be an alternative approach to surgery; however, long-term follow up is needed. (Panel A) TEE four-chamber view demonstrating large vegetation (white arrow) on the septal leaflet of the tricuspid valve. (Panel B) TEE bicaval view showing AngioVac aspiration catheter (red arrow) placed in the superior vena cava and large vegetation on the tricuspid valve (blue arrow).(Panel C) TEE four chamber view after debulking of the vegetation. (Panel D) Schematic representation of the AngioVac system with the AngioVac cannula, filter, centrifugal pump console, and reinfusion cannula. Itzhak Kronzon and Chad Kliger receive consulting fees from Philips. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: email@example.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/709/4939526 by Ed 'DeepDyve' Gillespie user on 17 June 2018
European Heart Journal – Cardiovascular Imaging – Oxford University Press
Published: Mar 16, 2018
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