Recommended Citation
Arman HE, Zidan A, Fischer W, Allaqaband SQ, Jain R, Solis J. When MAC Attacks: Stroke-Driven Discovery and Percutaneous Removal of a Mobile Mitral Annular Mass via Transseptal AngioVac with Cerebral Protection. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
An 84-year-old woman with CAD, cardiomyopathy, hypertension, and diabetes presented with recurrent embolic strokes despite dual antiplatelet therapy. Initial TEE showed severe MAC without thrombus. No atrial fibrillation was detected. After another stroke, repeat TEE revealed a new mobile mass on the posterior mitral annulus. Deemed high-risk for surgery, she underwent transseptal AngioVac aspiration. At one-month follow-up, she remained neurologically intact and functional. Angiography and/or Other Diagnostic Tests: MRI showed multifocal embolic strokes. TTE showed severe MAC with mobile echodensity. TEE showed a 1.8 x 0.8 cm mobile posterior mitral annular mass, likely caseous MAC. CT consistent with severe MAC, imaging limited by calcification and motion artifact. Rhythm monitoring showed no atrial fibrillation. Blood cultures were negative.
Description:
Under general anesthesia, right radial arterial and bilateral femoral venous access were obtained. A Sentinel cerebral protection device was deployed into bilateral carotid arteries. Using TEE and fluoroscopic guidance, transseptal puncture was performed, followed by balloon dilation of the septum. An 18 Fr AngioVac cannula was advanced via the right femoral vein, carefully navigated across the septum into the left atrium, and positioned adjacent to the posterior mitral annular mass. Under continuous TEE visualization, controlled aspiration dislodged and removed the mass completely. Postprocedural TEE confirmed full extraction with mild residual mitral regurgitation. Hemostasis was achieved using Perclose ProGlide and figure-of-eight sutures. The patient was transferred to CICU and discharged home on postoperative day two without complications.
Discussion:
This case demonstrates the feasibility, safety, and efficacy of transseptal AngioVac aspiration of a mobile mitral annular mass causing recurrent embolic strokes. It highlights a minimally invasive alternative for high-risk, surgically ineligible patients.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
When MAC Attacks: Stroke-Driven Discovery and Percutaneous Removal of a Mobile Mitral Annular Mass via Transseptal AngioVac with Cerebral Protection
Introduction/Background:
An 84-year-old woman with CAD, cardiomyopathy, hypertension, and diabetes presented with recurrent embolic strokes despite dual antiplatelet therapy. Initial TEE showed severe MAC without thrombus. No atrial fibrillation was detected. After another stroke, repeat TEE revealed a new mobile mass on the posterior mitral annulus. Deemed high-risk for surgery, she underwent transseptal AngioVac aspiration. At one-month follow-up, she remained neurologically intact and functional. Angiography and/or Other Diagnostic Tests: MRI showed multifocal embolic strokes. TTE showed severe MAC with mobile echodensity. TEE showed a 1.8 x 0.8 cm mobile posterior mitral annular mass, likely caseous MAC. CT consistent with severe MAC, imaging limited by calcification and motion artifact. Rhythm monitoring showed no atrial fibrillation. Blood cultures were negative.
Description:
Under general anesthesia, right radial arterial and bilateral femoral venous access were obtained. A Sentinel cerebral protection device was deployed into bilateral carotid arteries. Using TEE and fluoroscopic guidance, transseptal puncture was performed, followed by balloon dilation of the septum. An 18 Fr AngioVac cannula was advanced via the right femoral vein, carefully navigated across the septum into the left atrium, and positioned adjacent to the posterior mitral annular mass. Under continuous TEE visualization, controlled aspiration dislodged and removed the mass completely. Postprocedural TEE confirmed full extraction with mild residual mitral regurgitation. Hemostasis was achieved using Perclose ProGlide and figure-of-eight sutures. The patient was transferred to CICU and discharged home on postoperative day two without complications.
Discussion:
This case demonstrates the feasibility, safety, and efficacy of transseptal AngioVac aspiration of a mobile mitral annular mass causing recurrent embolic strokes. It highlights a minimally invasive alternative for high-risk, surgically ineligible patients.
Affiliations
Aurora St. Luke's Medical Center