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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Electrocautery-Assisted Percutaneous Vacuum Aspiration of Dual Aortic Valve Fibroelastomas

  • Joshua H. Arnold1
  • Ereni Abuiata2
  • Jean-Luc Germany2
  • Khalil Ibrahim1
  • Hema Krishna1
  • Joaquim Spadoni Barboza3
  1. 1Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
  2. 2Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
  3. 3Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abstract

Objective: To describe a stepwise approach to electrocautery-assisted vacuum aspiration for percutaneous removal of multiple aortic valve papillary fibroelastomas (PFEs) using cerebral embolic protection.

Key Steps: Bilateral femoral arterial access; 22-F sheath (right femoral artery) and 16-F venous cannula (left femoral vein, extracorporeal membrane oxygenation). Bilateral cerebral embolic protection deployed via right radial approach into common carotids. A 20-mm snare (JR4 catheter) encircles the aspiration cannula. Once tumor engagement is confirmed, the snare is advanced over the cannula and connected to an electrocautery generator (70 W) to sever the stalk, facilitating aspiration. Repeated sequentially, one tumor at a time, to limit embolization risk.

Potential Pitfalls: Simultaneous multitumor engagement increases embolization risk, requiring single-tumor targeting. Papillary fibroelastomas are highly adherent to tissue and resistant to aspiration alone; cautery severance overcomes this. Cerebral protection must precede instrumentation of left-sided lesions.

Take-Home Message: Electrocautery-assisted vacuum aspiration with cerebral embolic protection is feasible approach for percutaneous removal of multiple aortic valve papillary fibroelastomas in nonsurgical candidates.

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Cite

BibTeXRIS
BibTeX
@article{arnold2026electrocauteryassisted,
  title = {{Electrocautery-Assisted Percutaneous Vacuum Aspiration of Dual Aortic Valve Fibroelastomas}},
  author = {Joshua H. Arnold and Ereni Abuiata and Jean-Luc Germany and Khalil Ibrahim and Hema Krishna and Joaquim Spadoni Barboza},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109885},
  url = {https://doi.org/10.1016/j.jaccas.2026.109885},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Electrocautery-Assisted Percutaneous Vacuum Aspiration of Dual Aortic Valve Fibroelastomas
AU  - Joshua H. Arnold
AU  - Ereni Abuiata
AU  - Jean-Luc Germany
AU  - Khalil Ibrahim
AU  - Hema Krishna
AU  - Joaquim Spadoni Barboza
PY  - 2026
DA  - 2026/08/20
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109885
UR  - https://doi.org/10.1016/j.jaccas.2026.109885
AB  - Objective: To describe a stepwise approach to electrocautery-assisted vacuum aspiration for percutaneous removal of multiple aortic valve papillary fibroelastomas (PFEs) using cerebral embolic protection.  Key Steps: Bilateral femoral arterial access; 22-F sheath (right femoral artery) and 16-F venous cannula (left femoral vein, extracorporeal membrane oxygenation). Bilateral cerebral embolic protection deployed via right radial approach into common carotids. A 20-mm snare (JR4 catheter) encircles the aspiration cannula. Once tumor engagement is confirmed, the snare is advanced over the cannula and connected to an electrocautery generator (70 W) to sever the stalk, facilitating aspiration. Repeated sequentially, one tumor at a time, to limit embolization risk.  Potential Pitfalls: Simultaneous multitumor engagement increases embolization risk, requiring single-tumor targeting. Papillary fibroelastomas are highly adherent to tissue and resistant to aspiration alone; cautery severance overcomes this. Cerebral protection must precede instrumentation of left-sided lesions.  Take-Home Message: Electrocautery-assisted vacuum aspiration with cerebral embolic protection is feasible approach for percutaneous removal of multiple aortic valve papillary fibroelastomas in nonsurgical candidates.
SN  - 2666-0849
ER  -