Percutaneous Aspiration of a Large Pulmonary Valve Vegetation in a Nonsurgical Candidate

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.