JACC Case Rep. 2026 Mar 25:107641. doi: 10.1016/j.jaccas.2026.107641. Online ahead of print.
ABSTRACT
BACKGROUND: Management of intravenous drug use (IVDU)-associated tricuspid valve (TV) infective endocarditis (IE) is challenging when surgery is not feasible.
CASE SUMMARY: We report 4 high-risk patients with IVDU-associated TV IE complicated by persistent bacteremia and septic pulmonary emboli. All were poor surgical candidates given ongoing substance use or comorbidities, and all underwent percutaneous aspiration using AngioVac or Penumbra under transesophageal echocardiographic guidance, achieving vegetation debulking, bacteremia clearance, and clinical stabilization.
DISCUSSION: Transcatheter aspiration may serve as an alternative or adjunctive option in selected nonsurgical patients.
TAKE-HOME MESSAGES: Transcatheter aspiration is a management option for selected patients with TV IE who are not surgical candidates. It is important to understand the technical and clinical considerations guiding selection between AngioVac and Penumbra systems for tricuspid vegetation debulking and to appreciate the importance of a multidisciplinary approach when managing IE in patients with ongoing IVDU.
PMID:41879596 | DOI:10.1016/j.jaccas.2026.107641