**5. Conclusion**

RSIE is increasing particularly due to the incidence of patients with CIEDs and IVDU particularly due to the opioid epidemic (7–10). Medical management alone is these groups of patients leads to medical failure and can lead to further complications such as septic pulmonary emboli. Surgical intervention in TVE is associated with higher risk of recurrent infection, thromboembolic and bleeding complications and reoperation with valve replacement [6]. In addition, contemporary series have shown that valve repair is preferred over replacement especially in IVDUs [6, 36, 37]. In addition to current recommendations, the use of percutaneous aspirational techniques provide a unique and effective way to treat these patients. These techniques are evolving and may become standard of care involving a multidisciplinary approach and avoid the need for surgical intervention at the time of presentation and potentially allow for a greater chance of needing of having a repair rather than a replacement in patients with structural deterioration of their valve.
