Abstract 12088: Left Ventricular Non-Compaction, Coronary Artery Fistula, and Infective Endocarditis: A Rare Combination

Abstract

Description of Case: A 48-year-old man underwent echocardiography for multifocal subacute infarctions found on brain MRI. No intracardiac shunts were found, but prominent LV trabeculae raised suspicion of LV non-compaction (LVNC). LV ejection fraction was 53%, and LV volume was within upper-normal range. Cardiac MRI confirmed these findings, although non-compacted:compacted myocardium ratio was 1.9. (Panel A-B) A right coronary artery to LV fistula was also diagnosed. (Panel C-D) The patient was followed-up uneventfully, but 10 months later was admitted after a generalized seizure episode. Brain MRI detected multiple new hemorrhagic infarcts, and echocardiography revealed a 10.8mmх10.1mm mobile mass and high-speed diastolic flow near the basolateral LV wall. (Panel E-F) Gemella morbillorum was identified on two blood cultures. The patient underwent surgery for fistula closure and vegetation resection. Vegetation pathology and culture however was negative for bacterial growth. Paroxysmal atrial fibrillation was also detected, before discharge with full recovery. Discussion: LVNC and coronary artery fistula (CAF) are both caused by arrest in embryonic myocardial compaction. Despite a hypothetical common origin, reports of co-occurrence are extremely rare. This is the first to report the association of a mild form of LVNC and a single large CAF. This is also the first to report infective endocarditis due to CAF by G. morbillorum . G. morbillorum infective endocarditis is rare, subacute in course, and causes significant destruction. The extensive, prolonged embolism found here has not been reported in other cases of CAF-associated infective endocarditis and may be due to G. morbillorum .