Infective Endocarditis of a Coronary Artery Fistula With Aortic Valve Involvement

Coronary artery fistula (CAF) is a rare congenital coronary artery anomaly, and infective endocarditis (IE) is an uncommon complication associated with a high mortality rate. We describe the case of a patient with a giant CAF complicated by IE of the fistula, extending to and involving the aortic valve (AV). The initial diagnosis was considered after transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE) with three-dimensional (3D) modality and cardiac computed tomography (CCT) were subsequently used to accurately identify the CAF, its origin, course, drainage site, and vegetation.