We present the case of a 37-year-old Japanese woman referred for right-sided infective endocarditis (IE) and complete atrioventricular block with accelerated junctional rhythm (AJR). On admission, electrocardiography (ECG) showed first-degree atrioventricular block with a PR interval of 580 ms. Transthoracic echocardiography revealed a 25 × 6-mm area of mobile windsock-like vegetation near the coronary sinus (CS) ostium (yellow arrow, Panel A) and a 17 × 8-mm area of echo-dense vegetation on the right ventricular myocardium beneath the tricuspid valve septal leaflet (blue arrow, Panel B). Transoesophageal echocardiography revealed that the CS vegetation originated from the edge of the ostium (red arrow, Panel C). Vegetation resection was performed after 4 weeks of antibiotic therapy. The attachment site of the CS vegetation was identified at the septal portion of the CS ostium (Panels D and E). The right atrial endocardium around the CS ostium, including the Koch’s triangle area (blue dashed-line triangle, Panel E), was extensively edematous, thickened, and reddened. She was discharged without any complication on the 30th post-operative day. The ECG exam at 1 month after discharge revealed sinus rhythm with normalization of the PR interval (197 ms).

中文翻译：

---

右侧感染性心内膜炎伴冠状窦植物引起完全房室传导阻滞。

我们介绍了一名因右侧感染性心内膜炎（IE）和完全房室传导阻滞伴加速交界性节律（AJR）而被转诊的37岁日本女性的病例。入院时，心电图（ECG）显示一级房室传导阻滞，PR间隔为580 ms。经胸超声心动图检查发现，冠状窦口（CS）口附近有25×6 mm的活动性类似风向袋的植物（黄色箭头，图A），下方右室心肌的回声致密植物的面积为17×8 mm。三尖瓣隔小叶（蓝色箭头，B板）。经食道超声心动图检查发现，CS植被起源于口的边缘（红色箭头，图C）。抗生素治疗4周后进行植被切除。CS植被的附着部位在CS开口的中部被确定（图D和E）。CS口周围的右心内膜，包括Koch三角区（蓝色虚线三角形，E板），已广泛水肿，增厚并变红。术后第30天出院，无任何并发症。出院后1个月的心电图检查显示窦性心律，PR间隔（197 ms）恢复正常。