title: A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis.
abstract: Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient's condition, and he was ultimately able to undergo definitive surgery.
authors.affiliation: 1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
authors.forename: George
authors.initials: G
authors.lastname: Makdisi
authors.affiliation: 1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Casciani
authors.affiliation: 1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wozniak
authors.affiliation: 1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Roe
authors.affiliation: 1 Division of Cardiovascular Surgery, 2 Department of Radiology, 3 Department of Pulmonary and Critical Care, Indiana University Health, Indianapolis, IN 46202, USA.
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Hashmi
keywords: AngioVAC; Endocarditis; debulking; tricuspid valve; vegetation