Abstract
BACKGROUND: Aorta-right atrial tunnel (ARAT) is a rare congenital anomaly whose aetiology and incidence are unknown. It might represent a diagnostic and therapeutic challenge requiring a combination of imaging modalities and an integrated teamwork. CASE SUMMARY: We report a case of a 23-year-old man with an asymptomatic ARAT complicated by infective endocarditis, diagnosed with non-invasive multimodality imaging, and successfully treated with a catheter-based approach. DISCUSSION: Aorta-right atrial tunnel closure in asymptomatic patients is still a matter of debate. Considering the risk of serious complications surgical treatment might be recommended soon after diagnosis. In selected cases, catheter-based closure might represent a safe, effective, and less invasive alternative to traditional surgical approach.