{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:00:49Z","timestamp":1791460849882,"version":"4.3.4"},"reference-count":13,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Right-sided infective endocarditis (RSIE) is a difficult clinical problem, particularly among people who inject drugs (PWID), in whom large tricuspid vegetations may be complicated by severe regurgitation and septic pulmonary embolization. We describe a woman in her twenties with tricuspid valve infective endocarditis and bilateral cavitary pulmonary lesions consistent with septic emboli, in whom the vegetation enlarged from 18 \u00d7 11 mm to 18 \u00d7 20 mm and tricuspid regurgitation (TR) progressed from moderate to severe (vena contracta 12 mm, effective regurgitant orifice area 1.5 cm2, regurgitant volume 110 mL) over ten days of empirical anti-staphylococcal therapy. Surgery was considered by an individualized Heart Team assessment of the complete clinical course, but the patient declined open-heart surgery. After multidisciplinary Heart Team discussion, transesophageal echocardiography (TEE)-guided percutaneous aspiration with the AngioVac system was undertaken as an individualized debulking and source-control strategy, not as an equivalent alternative to surgery. Under general anesthesia, bilateral femoral venous access was obtained and seven aspiration passes retrieved four large vegetation fragments, with no residual intracardiac mass on completion TEE. Culture of the aspirated material yielded Serratia marcescens and Escherichia coli, neither of which was covered by the empirical regimen, which was replaced by susceptibility-guided ciprofloxacin and co-trimoxazole; ceftazidime was added when Pseudomonas aeruginosa was later isolated from blood. Residual regurgitation arose from a flail, prolapsing posterior leaflet rather than from mass effect\u2014a finding that may reflect pre-existing infective leaflet destruction, leaflet injury during aspiration, or both\u2014and was quantitatively reduced three to four weeks after the procedure (vena contracta 6 mm, effective regurgitant orifice area 0.55 cm2, regurgitant volume 36 mL); at six months it was moderate-to-severe and stable, with preserved right ventricular function (TAPSE 30 mm) and no recurrent vegetation. This case supports a potential diagnostic and therapeutic role for AngioVac-assisted debulking as an individualized adjunct in highly selected patients with RSIE who refuse surgery, with the caveat that aspiration reduces vegetation and embolic burden without correcting the underlying valvular lesion.<\/jats:p>","DOI":"10.3390\/diagnostics16193248","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:26:53Z","timestamp":1791458813000},"page":"3248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Removal of a Tricuspid Valve Vegetation Using the AngioVac System in a Young Woman Who Injects Drugs"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-7457","authenticated-orcid":false,"given":"Tomasz","family":"Skowerski","sequence":"first","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3140-1806","authenticated-orcid":false,"given":"Andrzej","family":"Ku\u0142ach","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Grabka","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Pysz","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Structural Heart Diseases, School of Medicine in Katowice, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Kudzia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza","family":"Adamczyk-Filipek","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rados\u0142aw","family":"Goco\u0142","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Smolka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-6340-6355 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jacc.2025.06.054","article-title":"Outcomes of percutaneous mechanical aspiration in right-sided infective endocarditis: A multicenter registry","volume":"86","author":"Hibbert","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","first-page":"499","article-title":"Percutaneous mechanical aspiration: A game changer for infective endocarditis?","volume":"42","author":"Hassan","year":"2026","journal-title":"Can. J. Cardiol."},{"key":"ref_4","first-page":"101269","article-title":"Percutaneous mechanical aspiration in infective endocarditis: Applications, technical considerations, and future directions","volume":"3","author":"Yucel","year":"2024","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4508","DOI":"10.1093\/eurheartj\/ehad653","article-title":"Tricuspid Valve Academic Research Consortium definitions for tricuspid regurgitation and trial endpoints","volume":"44","author":"Hahn","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1161\/CIR.0000000000001090","article-title":"Management of infective endocarditis in people who inject drugs: A scientific statement from the American Heart Association","volume":"146","author":"Baddour","year":"2022","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2012974","DOI":"10.1001\/jamanetworkopen.2020.12974","article-title":"Risk of new bloodstream infections and mortality among people who inject drugs with infective endocarditis","volume":"3","author":"Tan","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"ofaf036","DOI":"10.1093\/ofid\/ofaf036","article-title":"Emergence of infective endocarditis due to Serratia spp.: Results of a multicenter cohort","volume":"12","author":"McCrary","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofad052","DOI":"10.1093\/ofid\/ofad052","article-title":"Epidemiology and clinical outcomes of non-HACEK gram-negative infective endocarditis","volume":"10","author":"Shah","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke\u2013International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: Updating the modified Duke criteria","volume":"77","author":"Fowler","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","first-page":"464","article-title":"Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the National Inpatient Sample database\u20142016\u20132020","volume":"103","author":"Haddad","year":"2024","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_12","first-page":"1161","article-title":"Pulmonary valve infective endocarditis fully removed by the percutaneous approach with AngioVac: First report on 6-month follow-up","volume":"82","author":"Stefaniak","year":"2024","journal-title":"Pol. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.jvir.2020.09.012","article-title":"Endovascular removal of thrombus and right heart masses using the AngioVac system: Results of 234 patients from the prospective, multicenter Registry of AngioVac Procedures in Detail (RAPID)","volume":"32","author":"Moriarty","year":"2021","journal-title":"J. Vasc. Interv. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3248\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:38:58Z","timestamp":1791459538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":13,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193248"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193248","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]}}}