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Updated: Apr 30, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Step-by-Step Femoral-Femoral Percutaneous Mechanical Aspiration Debulking of Anterior Tricuspid Valve Vegetation
M Rodd Amar1, Ramiz Kara2, Havish Kantheti1
1Department of Internal Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA.
Objective:
To outline a reproducible femoral-femoral venovenous AngioVac approach for debulking a large anterior tricuspid valve vegetation in a nonsurgical patient with persistent methicillin-sensitive Staphylococcus aureus bacteremia.
Key Steps:
1) Confirm target and orientation with intraprocedural transesophageal echocardiography. 2) Obtain bilateral femoral venous access (large-bore aspiration/drainage and separate venous return). 3) Prime and completely de-air the circuit before activation. 4) Deploy the curved aspiration cannula in the right atrium and align coaxially to the vegetation using transesophageal echocardiography and fluoroscopy. 5) Start low flow and titrate (≈2.5-3.0 L/min) with short, controlled aspiration passes until substantial debulking.
Potential Pitfalls:
Possible complications include air entrainment, suction before full cannula deployment, poor coaxial alignment, large-bore access bleeding, arrhythmia, hemolysis, and incomplete source control.
Take-Home Message:
Femoral-femoral venovenous access can optimize alignment to tricuspid valve anterior leaflet vegetations and facilitate debulking when surgery is not feasible.
