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Case Reports
. 2024 Dec 18;29(24):102868.
doi: 10.1016/j.jaccas.2024.102868.

Transcatheter Aspiration of Tricuspid Vegetation

Akiva Brin  1 , Danny Dvir  1 , Emanuel Harari  2 , Shemy Carasso  1 , Yonit Wiener-Well  3 , Michael Glikson  1 , Tal Hasin  1
Affiliations
Case Reports

Transcatheter Aspiration of Tricuspid Vegetation

Akiva Brin et al. JACC Case Rep. .

Abstract

Objective: This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.

Key steps: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

Potential pitfalls: Avoid leaflet and annular injury and account for potential embolization.

Take-home messages: Endovascular aspiration using the aspiration system is an advanced therapeutic approach for high-risk patients with right-sided IE. The aggregative knowledge about transcatheter aspiration of tricuspid vegetation suggests a safe and effective procedural profile.

Keywords: endocarditis; right-sided catheterization; tricuspid valve.

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Conflict of interest statement

Dr Dvir has served as a consultant for Inari Medical, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
A 24-F Introducer Sheath That Allows Large-Bore Venous Access Via the Femoral Vein
Figure 2
Figure 2
Transesophageal Echocardiogram Showing a Mass on the Tricuspid Valve AV = aortic valve; RV = right ventricle; V = vegetation.
Figure 3
Figure 3
Triever20 Curve The Triever20 Curve (Inari Medical) is a catheter with a customizable angled tip for precise catheter placement by telescoping through the Triever24 (Inari Medical). The catheter has working length of 105 cm and an aspiration flow rate of 104 cm3/s.
Figure 4
Figure 4
Biplane Guidance of the Aspiration System Position Above the Vegetation Cath. = aspiration catheter; V = vegetation.
Figure 5
Figure 5
A Mass Aspirated From the Tricuspid Valve
Figure 6
Figure 6
Fever Charts During the Patient’s Hospital Stay
See this image and copyright information in PMC

References

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