1/1 Traditional treatment of large vegetations of the right side of the heart= invasive surgical valvulotomy/valvulectomy.
1/2 Recently endovascular approach has been used as an alternative for removal of large vegetation/s in the right side of the heart with good clinical successful.
1/3 One such device is the Percutaneous Angiovac Aspiration System
1/4 Evidences shows that AgioVac guided removal of vegetation/s is effective in removing large right sided intracardiac vegetation/s. https://pubmed.ncbi.nlm.nih.gov/30843269/ 
AngioVac for extraction of venous thromboses and endocardial vegetations: A meta-analysis - PubMed

AngioVac is a viable option for extracting right-sided vegetations and right atrial/caval venous thrombi. Rates of successful extraction and mortality are significantly worse for PE.

https://pubmed.ncbi.nlm.nih.gov/30843269/
1/5 We present a case of a 42 yo male patient with the diagnosis of MSSA bacteremia with a large vegetation on the TV measuring 3.6 cm x 1.07 cm and diffuse bilateral septic emboli to the lungs.
1/6 Successful removal of TV Vegetation using AngioVac
1/6 Successful removal of TV Vegetation using AngioVac
1/6 Successful removal of TV Vegetation using AngioVac
1/6 Successful removal of TV Vegetation using AngioVac
1/7 TEE after the removal of the vegetation from the RV
Utilities of AngioVac has been studies in multiple case series. At this time, it remains attainable treatment option in patients who are critically ill and with right heart masses.
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