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

Division

South Atlantic

Hospital

Orange Park Medical Center

Document Type

Case Report

Publication Date

5-22-2026

Keywords

AngioVac, intravenous drug use, percutaneous vegetectomy, right-sided infective endocarditis, shock, tricuspid valve endocarditis

Disciplines

Cardiology | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: 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.

CASE SUMMARY: 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.

DISCUSSION: 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.

TAKE-HOME MESSAGES: 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.

Publisher or Conference

JAAD Case Reports

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