Endocarditis of the forgotten valve: vacuum-assisted aspiration (AngioVac) of the eustachian valve: a case report

BACKGROUND: Eustachian valve endocarditis (EVE) is a rare entity that traditionally has been treated with antibiotics or surgery, if refractory to antibiotic treatment. CASE SUMMARY: A 64-year-old man presented with right shoulder pain and new-onset hypoxia. His blood cultures were positive for methicillin-sensitive staphylococcal aureus (MSSA) 1 month ago and he was treated with antibiotics at that time. Blood cultures during this admission were again positive for MSSA. Trans-oesophageal echocardiogram showed a large independently mobile echogenic density consistent with vegetation (3.0 × 1.6 cm) on the eustachian valve (EV). The patient was a poor surgical candidate due to his multiple co-morbidities, and therefore, a non-invasive procedure called AngioVac(®) was selected. DISCUSSION: In the setting of infective endocarditis refractory to antibiotics, the large-bore percutaneous mechanical aspiration (AngioVac(®), AngioDynamics, Latham, NY, USA) system is gaining increasing momentum as the treatment of choice over standard surgical intervention for debulking large vegetations. AngioVac(®) has provided a minimally invasive and effective measure especially in those unable to tolerate surgery. The novel percutaneous technique is linked to great success in right-sided endocarditis, with the tricuspid valve accounting for a majority of the cases. However, in rare instances, the EV may be involved. To our knowledge, we report the first case of EVE treated with AngioVac(®).