Incidental Finding of Coronary Artery Fistula in Infective Endocarditis Patient: A Case Report

Coronary Artery Fistula in Infective Endocarditis

Abstract

Introduction
Coronary artery fistula (CAF) is a rare congenital anomaly, often discovered incidentally. Although frequently asymptomatic, it may lead to serious complications, particularly when associated with infective endocarditis.

Case Presentation
A 26-year-old woman presented with dizziness and left-sided weakness. She was diagnosed with embolic stroke secondary to infective endocarditis. Preoperative transesophageal echocardiography revealed a CAF originating from the right coronary artery and draining into the right atrium. The patient underwent successful aortic valve replacement with a bioprosthetic valve and surgical closure of the CAF using pledgeted sutures. Her postoperative course was uneventful, with significant improvement in symptoms and cardiac function.

Discussion
Diagnosis and management of CAF remain challenging, especially when coexisting with infective endocarditis. While small fistulas are often silent, larger ones can present with hemodynamic disturbances that are difficult to detect. The combination of CAF and endocarditis is rare but typically presents in a complicated clinical context. In this case, early diagnosis allowed for timely surgical intervention, which contributed to a favorable prognosis. The infective endocarditis was managed with valve replacement, while the coronary-cameral fistula was directly closed via the right atrium.

Conclusion
This case highlights the importance of thorough preoperative imaging and multidisciplinary planning in managing complex cardiac pathologies. Incidental CAF can significantly affect the surgical approach to infective endocarditis. Prompt recognition and definitive surgical management are essential for optimizing outcomes in such high-risk scenarios.