Tanaka Yoshiro, Yoshida Jun, Kashiwagi Yusuke, Kunihara Takashi, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Eur Heart J Case Rep. 2025 May 22;9(6):ytaf260. doi: 10.1093/ehjcr/ytaf260. eCollection 2025 Jun.
Coronary artery fistula (CAF) is an uncommon congenital heart disease (CHD). Most patients are asymptomatic, and CAFs are typically discovered incidentally on echocardiography or computed tomography coronary angiography (CTCA). Although previous reports have suggested an association between CAF and infective endocarditis, there are few reports on the coexistence of CAF and tricuspid valve infective endocarditis (TVIE). We report a rare case where a CAF was identified as the underlying CHD in TVIE using multimodal imaging. Both the CAF and TVIE were successfully treated surgically.
A Japanese woman in her 40 s who presented with a fever of 38°C that persisted for 4 days. was isolated from two sets of blood cultures obtained on admission. Tricuspid valve vegetation was detected using transthoracic echocardiography, and a CAF, which originated from the right coronary artery (RCA) and terminated in the right atrium (RA), was detected by CTCA. Furthermore, the CAF and turbulent shunt flow directed towards the tricuspid valve were identified on transoesophageal echocardiography and subsequently confirmed as an RCA-RA fistula on coronary angiography. After antibiotic therapy, the patient underwent vegetation resection, tricuspid valve annuloplasty, and CAF excision.
Careful investigation of the underlying CHD is necessary when TVIE is found. In patients with TVIE, multimodal imaging is useful for investigating underlying CAF and the direct association between TVIE and CAF. When multimodal imaging suggests a direct association between CAF and TVIE, surgical resection of both the TVIE and CAF is essential to prevent the recurrence of TVIE.
冠状动脉瘘（CAF）是一种罕见的先天性心脏病（CHD）。大多数患者无症状，CAF通常在超声心动图或计算机断层扫描冠状动脉造影（CTCA）检查时偶然发现。尽管先前的报告表明CAF与感染性心内膜炎之间存在关联，但关于CAF与三尖瓣感染性心内膜炎（TVIE）并存的报道很少。我们报告了一例罕见病例，通过多模态成像在TVIE中发现潜在的CHD为CAF。CAF和TVIE均通过手术成功治疗。
一名40多岁的日本女性，发热38°C，持续4天。入院时采集的两组血培养物中分离出[具体病菌名称未给出]。经胸超声心动图检测到三尖瓣赘生物，CTCA检测到起源于右冠状动脉（RCA）并终止于右心房（RA）的CAF。此外，经食管超声心动图发现了CAF以及指向三尖瓣的湍流分流，随后冠状动脉造影证实为RCA-RA瘘。抗生素治疗后，患者接受了赘生物切除术、三尖瓣环成形术和CAF切除术。
发现TVIE时，有必要仔细调查潜在的CHD。对于TVIE患者，多模态成像有助于调查潜在的CAF以及TVIE与CAF之间的直接关联。当多模态成像提示CAF与TVIE之间存在直接关联时，手术切除TVIE和CAF对于预防TVIE复发至关重要。
