[Transesophageal imaging of a coronary fistula in simultaneous endocarditis lenta]

A 61 year old diabetic patient with bacterial endocarditis probably caused by a congenital coronary fistula is presented. The fistula was already detected by transthoracic echocardiography. Transesophageal color-Doppler echocardiography identified the precise localization and course of the fistula. Additionally, in some parts of the fistula echogenic material could be seen that decreased in size after antibiotic treatment. Therefore, it was considered as corresponding to bacterial vegetations. Coronary angiography disclosed an ectopic aneurysmatic and elongated circumflex coronary artery. Thus, even in rare conditions such as coronary fistulas transesophageal echocardiography may be helpful to allow detection of morphological substrate of associated infective endocarditis.