An aorto-right-atrial fistula caused by infective endocarditis in a patient with an anomalous coronary artery from the opposite sinus

A 35-year-old man presented with an anomalous right coronary artery from the opposite Valsalva sinus. He developed an aorto-right-atrial fistula due to destructive infective endocarditis undetected during preoperative computed tomography. Intraoperative retrograde cardioplegia and direct insertion of the coronary probe demonstrated that the right coronary ostium was in the left Valsalva sinus near the left coronary ostium. The right-sided aortic root and right atrium were severely damaged. This coronary anomaly allowed us to perform a unique aortic root reconstruction without touching or injuring the right coronary artery. Two years later, the patient remains well without complications. This novel reconstruction treatment is feasible for destructive infective endocarditis in such patients.