Endocarditis and coronary artery fistula: a case report

Coronary artery fistulae are rare abnormal congenital communications between a coronary artery and a cardiac chamber or great vessel. The majority of adult patients are asymptomatic, and it is most commonly discovered incidentally on coronary angiography. We present the case of a 50-year-old woman, with a known fistula connecting the right coronary artery (RCA) and right atrium (RA), presenting with aortic valve endocarditis and pulmonary emboli. We detail the presentation and echocardiographic findings of aortic valve endocarditis with extension of the vegetation into the RA via the giant RCA fistula. We describe the clinical course including initial therapy, embolization of the right atrial vegetation to the lungs, and ultimately successful surgical correction after prolonged antibiotic therapy. Patients with coronary artery fistulae are susceptible to potentially serious complications including myocardial ischaemia, shunting and in this case infective endocarditis. We review the literature and discuss timings for corrective intervention.