Transesophageal demonstration of a coronary fistula with associated infective endocarditis

A 61 year old diabetic patient with bacterial endocarditis probably caused by a congenital coronary fistula is presented. The fistula was already dete cted by transthoracic echocardiography. Transesophageal color-Doppler echoc ardiography 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 consid ered as corresponding to bacterial vegetations. Coronary angiography disclo sed an ectopic aneurysmatic and elongated circumflex coronary artery. Thus, even in rare conditions such as coronary fistulas transesophageal echocard iography may be helpful to allow detection of morphological substrate of as sociated infective endocarditis.