Three-dimensional printing: to guide management of a right coronary artery to left ventricular fistula

A 26-year-old female presented with 4 weeks of intermittent fever. Physical examination was notable for a diastolic murmur over the left sternal edge. Blood cultures were positive for Streptococcus anginosus. Transthoracic echocardiography demonstrated a mildly dilated left ventricle (LV) with normal function and a markedly dilated right coronary artery (RCA) fistula that enters the basal inferior LV (Panel A) with turbulent Doppler flow across the mitral valve (MV) leaflets. Transoesophageal echocardiography highlighted the severely dilated RCA (Panel C) and revealed a strand-like echodensity associated with the posterior MV leaflet tip, consistent with infective endocarditis (IE). Persistent turbulent flow may have cause scarring and eventual nidus for IE. The patient was treated with intravenous penicillin.

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