生体弁僧帽弁腫瘤の経皮的デブリーディング：再発性感染性心内膜炎における弁機能の温存

Infective endocarditis involving a prosthetic mitral valve carries high morbidity, especially when complicated by embolic events. Repeat surgery is often not feasible in high-risk patients.

An 81-year-old man with a mitral valve bioprosthesis presented with recurrent infective endocarditis due to Streptococcus mutans, with enlarging vegetations and embolic strokes. Given prohibitive surgical risk, he underwent successful percutaneous debulking using the AngioVac system via transseptal approach under transesophageal echocardiographic and fluoroscopic guidance. Long-term suppressive antibiotics were continued. At the 30-month follow-up, the valve was structurally intact with no evidence of recurrent endocarditis.

This case highlights the utility of AngioVac debulking of left-sided prosthetic valve vegetations in nonsurgical candidates. Successful imaging-guided aspiration minimized embolic risk and preserved valve function.

Vacuum-assisted debulking with AngioVac via a transseptal approach is a viable option in high-risk patients with prosthetic mitral valve endocarditis, offering an alternative to reoperation.