Infective endocarditis of the aortic valve in a patient with a coronary artery fistula.

584 35%). Transesophageal echocardiography demonstrated marked dilation of the left main coronary artery (LMCA), up to 1 cm with turbulent flow. Invasive coronary angiography showed ectasia of both LMCA and the left circumflex artery (Cx), with a communication between the Cx and the right atrium (FIGURE 1A). Computed tomography (CT) revealed a fistula between the Cx and coronary sinus (FIGURE 1BC). A surgical evaluation confirmed inflammatory destruction of the left coronary cusp and a coronary artery fistula (CAF) between the Cx and right atrium (FIGURE 1D). The patient underwent uneventful mechanical aortic valve implantation (Sorin 27) and occlusion of the CAF. A 38-year-old man was admitted to our institution because of acute biventricular heart failure. He reported dry cough, reduced exercise tolerance, exertional dyspnea, and a single episode of fever 4 months earlier, with a sudden deterioration 2 weeks before admission. Laboratory tests showed an increased leukocyte count, elevated Creactive protein level, and evidence of renal and liver failure. Blood cultures were negative. Transthoracic echocardiography revealed tricuspid aortic valve, ruptured left coronary leaflet with a mobile vegetation protruding into the left ventricular outflow tract (15 × 3 mm), and significant aortic regurgitation. The left ventricle was dilated (71 mm) with reduced ejection fraction (EF, Correspondence to: Marta Kamińska, MD, PhD, Klinika Kardiologii, Uniwersytet Medyczny w Białymstoku, ul. Marii Skłodowskiej-Curie 24A, 15-276 Białystok, Poland, phone: +48 85 8318 656, fax: +48 85 8318 604, e-mail: aplle1@wp.pl Received: June 16, 2015. Accepted: June 30, 2015. Published online: July 3, 2015. Conflict of interest: none declared. Pol Arch Med Wewn. 2015; 125 (7-8): 584-585 Copyright by Medycyna Praktyczna, Kraków 2015 CLINICAL IMAGE