Date of Presentation
5-4-2023 12:00 AM
College
School of Osteopathic Medicine
Poster Abstract
Introduction: Infectious endocarditis of the tricuspid valve is a common complication of intravenous drug use. Endocarditis caused by viridans streptococci can lead to heart valve vegetations which may be life threatening due to the potential for embolism and obstruction. Management of large valvular vegetations is often difficult due to the risks involved with open heart surgery, especially in patients with comorbid conditions. The AngioVac® device has been shown in rare cases to be effective at debulking vegetations without the need for invasive surgery.
Case Presentation: We present a patient with a history of intravenous heroin use disorder, hepatitis C, spinal abscesses, and chronic anemia who experienced worsening shortness of breath, generalized weakness, bilateral lower extremity edema, dysuria with dark urine, and blood on toilet paper. Workup revealed a 4.39 x 4.35 cm tricuspid valve vegetation, severe tricuspid regurgitation, acute renal failure, acute on chronic anemia, and thrombocytopenia from sepsis-induced disseminated intravascular coagulation. AngioVac® was used to aspirate the vegetation and effectively reduced the size to 3.75 x 2.31 cm. Follow up blood cultures revealed no growth after five days.
Discussion: This is the largest documented tricuspid valve vegetation with successful implementation of the AngioVac® to date. This therapy, in conjunction with intravenous antibiotics and hemodialysis, successfully sterilized the vegetation, prevented worsening presentation, and averted life-threatening complications, although severe tricuspid regurgitation persisted.
Conclusion: Based on the findings of this case, the AngioVac® device is a safe and effective treatment option for tricuspid valve endocarditis patients with large vegetation and severe comorbidities which contraindicate open heart surgery.
Keywords
AngioVac, Endocarditis, Tricuspid Valve, Streptococcus
Disciplines
Bacterial Infections and Mycoses | Cardiology | Cardiovascular Diseases | Equipment and Supplies | Medicine and Health Sciences | Surgery | Surgical Procedures, Operative
Document Type
Poster
Included in
Bacterial Infections and Mycoses Commons, Cardiology Commons, Cardiovascular Diseases Commons, Equipment and Supplies Commons, Surgery Commons, Surgical Procedures, Operative Commons
The AngioVac® Device Limits Lethal Complications of Sepsis and Severe Infective Endocarditis with a Large Tricuspid Valve Vegetation: A Case Report
Introduction: Infectious endocarditis of the tricuspid valve is a common complication of intravenous drug use. Endocarditis caused by viridans streptococci can lead to heart valve vegetations which may be life threatening due to the potential for embolism and obstruction. Management of large valvular vegetations is often difficult due to the risks involved with open heart surgery, especially in patients with comorbid conditions. The AngioVac® device has been shown in rare cases to be effective at debulking vegetations without the need for invasive surgery.
Case Presentation: We present a patient with a history of intravenous heroin use disorder, hepatitis C, spinal abscesses, and chronic anemia who experienced worsening shortness of breath, generalized weakness, bilateral lower extremity edema, dysuria with dark urine, and blood on toilet paper. Workup revealed a 4.39 x 4.35 cm tricuspid valve vegetation, severe tricuspid regurgitation, acute renal failure, acute on chronic anemia, and thrombocytopenia from sepsis-induced disseminated intravascular coagulation. AngioVac® was used to aspirate the vegetation and effectively reduced the size to 3.75 x 2.31 cm. Follow up blood cultures revealed no growth after five days.
Discussion: This is the largest documented tricuspid valve vegetation with successful implementation of the AngioVac® to date. This therapy, in conjunction with intravenous antibiotics and hemodialysis, successfully sterilized the vegetation, prevented worsening presentation, and averted life-threatening complications, although severe tricuspid regurgitation persisted.
Conclusion: Based on the findings of this case, the AngioVac® device is a safe and effective treatment option for tricuspid valve endocarditis patients with large vegetation and severe comorbidities which contraindicate open heart surgery.