Non-surgical extirpation of a non-infectious expanding tricuspid valve mass by percutaneous aspiration thrombectomy

Abstract

Marantic endocarditis refers to a noninfectious lesion, usually in the aortic and mitral valves, that is most commonly seen in advanced malignancy and systemic lupus erythematosus. Inflammatory conditions, including antiphospholipid syndrome (APS), are a rare etiology making up less than 20% of reported cases. The condition is thought to be due to a hypercoagulable state and found postmortem with rates in autopsy series ranging from 0.9% to 1.6%. In comparison to infective endocarditis, marantic endocarditis has a greater tendency for valve vegetations to embolize. Common treatment modalities include anticoagulation or valve replacement. Although percutaneous aspiration thrombectomy of right-sided heart chamber thrombi exists, there are limited reports demonstrating its use with regards to treatment of right-sided endocarditis. We present the case of an older male with a history of Factor V Leiden and APS who was admitted due to a rapidly expanding mass on the tricuspid valve (TV). Despite serial blood cultures being negative, the patient received adequate antibiotic therapy for more than 4 weeks. Transthoracic echocardiogram showed an enlarged TV vegetation with an increased diameter from 10 to 30 mm over 6 weeks. Due to the patient's high operative risk and concern for embolization complications, a multidisciplinary decision was made to perform percutaneous aspiration thrombectomy of the TV vegetation. Subsequent biopsy of the lesion confirmed it was noninfectious and nonmalignant. Thus, the patient was started on systemic anticoagulation for prevention of thromboembolic events.

Keywords: aspiration thrombectomy; hypercoagulable; nonbacterial thrombotic endocarditis; percutaneous coronary intervention.