Contemporary and Evolving Treatment of Tricuspid Endocarditis

The current treatment paradigm for right sided infective endocarditis is rapidly evolving. The existing recommendations for right sided infective endocarditis include medical therapy with surgical therapy used in certain situations. Surgical therapy is based on the size of the vegetation, presence of infective complications and certain causative organisms as well the retention of intracardiac devices. Unfortunately, medical therapy alone is usually not enough to clear the infection, especially when intravenous drug use is associated as the etiology. Intravenous drug use is associated with a high rate of recidivism in tricuspid valve endocarditis. Even with indications for surgery, these patients present an ethical dilemma as most of these patients will re-infect their valves post-surgery. This often provides little option than for the surgeon to re-operate in a setting with a higher risk of mortality and morbidity. We present an evolving technique of percutaneous extirpation of vegetation, allowing for rapid clearance of endocarditis, less chance of failure of medical therapy with a lower risk profile for complication.