An Unusual Mechanism for a Fistulous Communication Between the Aorta and Right Side of the Heart

A case of infective endocarditis is reported in which a fistulous communication developed from the septal tricuspid valve leaflet, through the membranous ventricular septum, into the non-coronary aortic cusp. From a nidus of infection in the uterus, the tricuspid valve was seeded, leading eventually to the fistula. The particular course of the perforation avoided conduction system damage until late in the clinical course, when idioventricular rhythm and eventual cardiac arrest supervened.