Percutaneous Vegetectomy for Severe Right-Sided Infective Endocarditis Complicated by Cardiac Arrest and Multiorgan...

Right-sided infective endocarditis (RSIE) is a life-threatening condition predominantly affecting the tricuspid valve. For patients with prohibitive surgical risk, percutaneous vegetectomy (PV) is emerging as a viable alternative.

A 38-year-old man with active intravenous drug use presented with cardiac arrest, profound shock, and multiorgan dysfunction. Echocardiography revealed a large tricuspid valve vegetation (2.0 × 3.1 cm) with severe regurgitation. Because of high surgical risk, he underwent salvage PV using the AngioVac system. The procedure achieved 90% debulking, leading to marked hemodynamic improvement and successful weaning of vasoactive agents. He was subsequently discharged to complete antimicrobial therapy pending reassessment for definitive surgery.

Although PV is increasingly used for RSIE, data regarding its use in extreme hemodynamic instability remain limited. Our case highlights its utility as a temporizing, life-saving intervention to reduce microbial burden and provide critical source control when definitive surgical debridement is not feasible.

PV is a viable rescue strategy for RSIE in high-risk patients. It provides critical source control to stabilize hemodynamics and bridge patients to recovery or definitive surgery.