Percutaneous Mechanical Aspiration Thrombectomy–Assisted Management of Right-Sided Infective Endocarditis During Pregnancy

BACKGROUND: Infective endocarditis in pregnancy is associated with high rates of maternal and fetal morbidity and mortality. There are no guidelines to address the management of endocarditis in pregnancy. CASE SUMMARY: A 31-year-old woman at 19 weeks of gestation with a history of intravenous drug use presented with abdominal pain and dyspnea. She was diagnosed with infective endocarditis with a 2-cm tricuspid valve vegetation and severe regurgitation. Her blood cultures remained positive on hospital day 7 despite antibiotics, at which time she underwent mechanical aspiration thrombectomy of the vegetation. DISCUSSION: This minimally invasive approach allowed for significantly less time on cardiopulmonary bypass than with open surgery and minimized maternal and fetal risks. Larger series and prospective data are needed to clarify the role of mechanical aspiration thrombectomy as a potential first-line intervention for pregnant patients who are poor surgical candidates. TAKE-HOME MESSAGES: 1) Infective endocarditis in pregnancy, while rare, has high maternal and fetal mortality rates, and management is complicated by limited evidence and absence of pregnancy-specific guidelines and 2) open-heart surgery with cardiopulmonary bypass poses significant risks during pregnancy; mechanical aspiration thrombectomy can be an effective alternative for nonsurgical candidates.