title: An unusual case of infective endocarditis involving a right coronary artery to superior vena cava fistula.
abstract: Coronary artery fistulas (CAFs) are rare and mostly congenital anomalous connections between a coronary artery and a cardiac chamber or great vessel. Most CAFs are small, asymptomatic, and found incidentally during cardiac imaging. However, they can lead to serious complications including myocardial infarction, congestive heart failure, arrhythmias, or fistula rupture. CAFs have been associated with infective endocarditis, but to our knowledge, this complication has never been reported involving an isolated CAF to an otherwise anatomically normal great vessel. We report the first case of this complication in a 49-year-old man with a presumed streptococcus vegetation found within an isolated large, tortuous CAF connecting the right coronary artery to the superior vena cava. After completing antibiotic treatment, transcatheter closure of the CAF was performed. Since then, the patient has remained symptom-free. This case demonstrates that CAF closure is feasible following CAF-associated endocarditis, and that closure may represent a viable strategy for reducing risk of recurrent infection.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland; Greater Baltimore Medical Center, Towson, Maryland.
authors.forename: Ujjval
authors.initials: U
authors.lastname: Jariwala
authors.forename: Rani K
authors.initials: RK
authors.lastname: Hasan
authors.forename: Eric M
authors.initials: EM
authors.lastname: Thorn
authors.forename: Sammy
authors.initials: S
authors.lastname: Zakaria
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006328:Cardiac Catheterization; D002932:Cineangiography; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging
chemical_list: D000900:Anti-Bacterial Agents
keywords: angiography; anomalous coronaries; closure; coronary; fistula/shunts; vascular access