Temporary PFO Closure to Mitigate Embolic Risk During Percutaneous Debulking of Large Tricuspid Valve Vegetations

Right-sided infective endocarditis (RSIE), commonly associated with intravenous drug use, presents management challenges in poor surgical candidates. The AngioVac system offers a minimally invasive alternative for vegetation debulking.

A 60-year-old man with recurrent RSIE presented with fevers, breathlessness, and Corynebacterium striatum bacteremia. Echocardiography revealed large tricuspid valve vegetations and severe tricuspid regurgitation. Preprocedural imaging identified a large patent foramen ovale (PFO) with right-to-left shunting, creating a high systemic embolization risk. A multidisciplinary team performed temporary PFO closure using an Amplatzer occluder followed by AngioVac vegetation extraction, resulting in significant clinical improvement.

This first reported case of combined percutaneous vegetation aspiration and temporary PFO closure highlights a hybrid approach that reduces embolic risk while achieving effective infection control.

The AngioVac system is a viable minimally invasive alternative for managing RSIE in patients at high surgical risk. Multidisciplinary collaboration enables novel hybrid strategies, such as temporary PFO closure, to reduce embolic risk.