What question did this study set out to answer?

To evaluate a novel percutaneous aspiration technique for large pulmonary valve vegetations in high-risk patients.

May 15, 2026

Percutaneous Aspiration of a Large Pulmonary Valve Vegetation in a Nonsurgical Candidate: A Novel Approach.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Pulmonary valve endocarditis (n=1). Intervention: Percutaneous mechanical aspiration using the Inari FlowTriever system. Primary outcome: Vegetation removal and infection clearance.

FJFiras JalyWitten/Herdecke University HPHolger Priebe‐BrämerWitten/Herdecke University BDBoris DickmannWitten/Herdecke University

Resultado clave

Percutaneous mechanical aspiration using the Inari FlowTriever system enabled near-complete removal of a >30-mm pulmonary valve vegetation and sustained infection clearance in an inoperable patient.

Puntos clave

To evaluate a novel percutaneous aspiration technique for large pulmonary valve vegetations in high-risk patients.
Patient: 77-year-old man with significant comorbidities and large pulmonary valve vegetation.
Intervention: Utilized transesophageal echocardiography for guidance and performed aspiration with FlowTriever system.
Outcome assessment included echocardiographic clearance and recovery status post-procedure.
Achieved near-complete removal of the >30-mm vegetation with immediate echocardiographic confirmation.
Post-procedure, patient required short-term vasopressor support due to transient inflammatory response.
Follow-up indicated sustained infection clearance without recurrence.

Diseño del estudio

Tipo

Case Report (n=1)

Multicéntrico

PICO estructurado

Población

1 77-year-old man with chronic obstructive pulmonary disease, diabetes, persistent fever, Streptococcus gallolyticus bacteremia, and a >30-mm mobile pulmonary valve vegetation, deemed high operative risk.

Intervención

Percutaneous mechanical aspiration using the Inari FlowTriever system (Triever20 Curve catheter) under transesophageal echocardiographic guidance.

Resultado

Vegetation removal and infection clearance

Percutaneous mechanical aspiration using the FlowTriever system may be a feasible and potentially lifesaving alternative for debulking large pulmonary valve vegetations in patients with prohibitive surgical risk.

Resumen

BACKGROUND: Pulmonary valve endocarditis is rare, and large vegetations usually require surgery; however, operative risk may be prohibitive in frail patients. CASE SUMMARY: A 77-year-old man with chronic obstructive pulmonary disease and diabetes presented with persistent fever and Streptococcus gallolyticus bacteremia. Echocardiography demonstrated a >30-mm mobile pulmonary valve vegetation. Surgery was declined because of high operative risk. Under transesophageal echocardiographic guidance, percutaneous mechanical aspiration using the Inari FlowTriever system was performed. The Inari Triever20 Curve catheter enabled directional engagement and near-complete en bloc removal with immediate echocardiographic clearance. The postprocedural course was complicated by transient systemic inflammatory response syndrome requiring short-term vasopressor support, with full recovery on continued antibiotic therapy. Follow-up confirmed sustained infection clearance without recurrence. DISCUSSION: This case demonstrates the feasibility of adapting mechanical thrombectomy systems for percutaneous debulking of pulmonary valve endocarditis when surgery is not an option. TAKE-HOME MESSAGE: Percutaneous aspiration of valvular vegetations using the FlowTriever system may represent a lifesaving alternative for selected inoperable patients.

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