Isolated pulmonary valve endocarditis treated with percutaneous aspiration: a case report and literature overview

Pulmonary valve infective endocarditis (PVIE) is a rare condition, accounting for a small proportion of right-sided endocarditis cases. It poses unique diagnostic and therapeutic challenges and requires a multidisciplinary approach.

We present the case of a 34-year-old male with obesity and a congenital ventricular septal defect, admitted to the intensive care unit for septic shock secondary to methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Klebsiella pneumoniae. Transesophageal echocardiography revealed two large vegetations on the pulmonary valve. Due to prohibitive surgical risk, percutaneous aspiration was performed using the 16 Fr Lightning Flash™ system, achieving partial vegetation reduction. Despite procedural success, the patient died from refractory septic shock.

PVIE is associated with congenital heart defects, intravenous drug use and intracardiac devices. Diagnosis is often delayed due to nonspecific clinical features. Management includes prolonged antibiotic therapy, with surgery or minimally invasive interventions reserved for severe cases. Percutaneous vegetation aspiration, though rarely reported, offers a minimally invasive alternative for patients unfit for surgery. This case highlights its technical feasibility. While promising, further evidence is needed to assess outcomes and long-term efficacy.