1Department of Cardiology and Vascular Medicine Subspecialty Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
2Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
3Universitas Airlannga Hospital, Surabaya, Indonesia
4Department of Anaesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
5Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
*Corresponding Author E-mail: d.paramita.kartikasari@fk.unair.ac.id
Online Published on 28 May, 2026.
Coronary artery fistulas (CAFs) are uncommon coronary anomalies that create left-to-right shunts and turbulent flow, predisposing to endothelial injury and, rarely, infective endocarditis (IE).
A 25-year- old woman presented with acute parietal cortical-subcortical infarction. Transthoracic echocardiography revealed mobile vegetations on the right coronary and non-coronary aortic cusps. Blood cultures yielded Gemella morbillorum. During surgery for aortic valve replacement, intraoperative transesophageal echocardiography (TEE) incidentally identified a 7-mm fistulous connection from the right coronary artery to the right atrium, which was closed surgically.
Post-operative recovery was uneventful with hemodynamic stability.
This case underscores the importance of comprehensive imaging to detect concealed CAFs in young IE patients without classic risk factors. Turbulent shunting through a CAF may facilitate bacterial colonization and embolic complications; early surgical management of both valve pathology and fistulous tract can be curative.
Coronary artery fistula, Right atrium, Infective endocarditis, Gemella morbillorum, Embolic stroke, Transthoracic echocardiography, Transesophageal echocardiography
