Temporary PFO Closure to Mitigate Embolic Risk During Percutaneous Debulking of Large Tricuspid Valve Vegetations

BACKGROUND: Right-sided infective endocarditis (RSIE), commonly associated with intravenous drug use, presents management challenges in poor surgical candidates. The AngioVac system offers a minimally invasive alternative for vegetation debulking. CASE SUMMARY: A 60-year-old man with recurrent RSIE presented with fevers, breathlessness, and Corynebacterium striatum bacteremia. Echocardiography revealed large tricuspid valve vegetations and severe tricuspid regurgitation. Preprocedural imaging identified a large patent foramen ovale (PFO) with right-to-left shunting, creating a high systemic embolization risk. A multidisciplinary team performed temporary PFO closure using an Amplatzer occluder followed by AngioVac vegetation extraction, resulting in significant clinical improvement. DISCUSSION: This first reported case of combined percutaneous vegetation aspiration and temporary PFO closure highlights a hybrid approach that reduces embolic risk while achieving effective infection control. TAKE-HOME MESSAGES: The AngioVac system is a viable minimally invasive alternative for managing RSIE in patients at high surgical risk. Multidisciplinary collaboration enables novel hybrid strategies, such as temporary PFO closure, to reduce embolic risk.