Figure Legends:

Figure 1: Intraprocedural Intracardiac echocardiography (ICE): ICE image of echogenic mass (arrow) attached to the tricuspid valve with Penumbra Lightning aspiration system directly above it(A). After aspiration the vegetation is no longer present(B). Similarly, a right ventricular mass (arrow head) is seen before(C) and after aspiration(D).
Figure 2: Pre and post procedural TEE imaging.
Figure 3: Example of Aspirated Material.
Supplemental Video: ICE imaging of aspiration of vegetations utilizing the Penumbra aspiration system.