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*Corresponding Author E-mail: d.paramita.kartikasari@fk.unair.ac.id
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
