Diagnosis of right coronary artery to right atrial fistula in a dog using two-dimensional echocardiography.

A five-year-old boxer dog developed cardiac murmurs, complete heart block and cardiomegaly associated with vegetative bacterial endocarditis. Using two-dimensional echocardiography, vegetative lesions of the aortic valves and extension of the vegetations into the proximal right coronary artery and adjacent atrial septum were identified. The vegetation within the atrial septum appeared as a cavitated mass which protruded into the right atrium. Fistulae within the atrial septal vegetation permitting communication between the coronary artery and right atrium were observed with colour Doppler echocardiography. The dog died despite medical treatment. Post mortem examination confirmed the echocardiographic findings. Vegetative endocarditis with invasion into the right coronary artery and atrial septum producing fistulae and communication with the right atrium has not been reported previously in dogs. Doppler echocardiography proved useful in demonstrating the abnormal anatomy, intraluminal fistular blood flow and its communication with the right atrium.