Abstract 4138030: Eustachian Valve Endocarditis Successfully Extracted Using the Angio-Vac Aspiration System

Introduction: Eustachian valve endocarditis is a rare right-sided endocarditis that is often poorly visualized on transthoracic echocardiography (TTE). Here is a case of eustachian valve endocarditis first identified on TTE. It was refractory to intravenous antibiotic therapy and was successfully treated using the AngioVac aspiration system for percutaneous debulking. Case: A 36-year-old female with a past medical history of depression, intravenous heroin use, and substance-induced mood disorder presented with altered mental status and respiratory distress. She was found to have methicillin-sensitive staphylococcus aureus (MSSA) bacteremia, a gluteal abscess, multiple septic pulmonary emboli, and a left-sided empyema. She was started on broad-spectrum antibiotics that were narrowed to cefazolin. Her gluteal abscess was drained, and a left-sided chest tube was placed with pleural cultures growing MSSA. TTE demonstrated a mass on the eustachian valve. Subsequent transesophageal echocardiography (TEE) demonstrated two echogenic masses adherent to the eustachian valve, one measuring 17 by 9 millimeters and one measuring 15 by 8 millimeters, consistent with eustachian valve endocarditis. Despite appropriate antibiotic therapy, she continued to have intermittent fevers with persistently positive blood cultures. The patient underwent TEE-guided extraction of the eustachian valve vegetation using the AngioVac aspiration system. TEE at the end of the case demonstrated complete removal of her eustachian valve masses. Blood cultures cleared post-procedure, and she was eventually discharged to acute rehabilitation. Conclusion: In cases of eustachian valve endocarditis refractory to appropriate antibiotic therapy, the AngioVac aspiration system offers an option for percutaneous extraction of eustachian valve vegetations.