CA7 Aortic valvular endocarditis complicated with an unusual right coronary sinus of valsalva/right atrial fistula. (Cardiology).

CA7 AORTIC VALVULAR ENDOCARDITIS COMPLICATED WITH AN UNUSUAL RIGHT CORONARY SINUS OF VALSALVA/RIGHT ATRIAL FISTULA. Darren R. Swenson, MD, Randy Bottner, MD, and Ali R. Rahimiz, MD. Memorial Health University Medical Center, Savannah, Ga.

Fistulas between the right coronary sinus of valsalva and the right-sided chambers of the heart are a rare complication of valvular endocarditis and are usually diagnosed postmortem. A 77-year-old woman with end-stage renal failure had an upper extremity AV graft placement. Four weeks later, she presented with fever and chills. The diagnosis of tricuspid and aortic valve endocarditis with vegetation between 0.8 and 1 cm was confirmed with transthoracic echocardiography and persistent Staphlococcus epidermidis bacteremia. She was readmitted with chest pain and fatigue. Three weeks later, she successfully completed IV antibiotic treatment. Cardiac catheterization revealed a fistula formation between the right sinus of valsalva and the right atrium. Right coronary sinus of valsalva and right-sided heart fistulas are a rare complication of bacterial endocarditis. To our knowledge, a right sinus of valsalva and right atrium fistula due to bacterial endocarditis has not been reported.