Use of Magnetic Resonance Imaging to Demonstrate a Fistula From the Aorta to the Right Atrium

A 74-year-old woman was admitted with a 1-month history of fever, malaise, cough, and anorexia. On examination, she had the signs of mixed aortic valve disease. Blood cultures were positive for Streptococcus viridans, and a diagnosis of infective endocarditis was made. The electrocardiogram showed sinus rhythm with first-degree heart block (PR interval, 300 ms). Transthoracic Doppler echocardiography showed severe aortic stenosis (gradient of 90 mm Hg) and mild aortic regurgitation. Vegetations were present …