This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Allum, C. Articles by Poole-Wilson, P. Search for Related Content PubMed PubMed Citation Articles by Allum, C. Articles by Poole-Wilson, P.

(Circulation. 1998;97:1024.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

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

Caroline Allum, MBBS, MRCP; Charles Knight, MB, MRCP; Raad Mohiaddin, MBBS, FRCR; ; Philip Poole-Wilson, MD, FRCP

From the Royal Brompton National Heart and Lung Hospital, London, UK.

Correspondence to Dr Caroline Allum, Radiology Department, Chelsea and Westminster Hospital, Fulham Rd, London SW10 9NH, UK.

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 on the calcified, disorganized aortic valve. Although there was no obvious aortic root abscess, the possibility of the existence of a fistula from the aorta to the right atrium was raised, with an indication of continuous localized flow from the area of the aorta toward the tricuspid valve. Transesophageal echocardiography was therefore undertaken, but this did not demonstrate a fistula. To clarify the anatomic situation before aortic valve replacement, MRI was performed. This showed a fistula between the aortic root and the right atrium (Figure). This finding was confirmed at surgery. MRI allows detailed delineation of cardiac anatomy and blood flow and may be helpful in resolving discrepancies raised by other investigations.\.

View larger version (46K): [in this window] [in a new window]   Figure 1. A, Spin-echo image in a coronal plane showing a fistula (arrow) between the aortic root and the right atrium. B, Diastolic image selected from cine gradient echo images acquired in a plane similar to A. A turbulent jet extends from the aortic root into the body of the right atrium (arrow). C, Corresponding systolic (left) and diastolic (right) velocity maps. Cranial flow . . . [Full Text of this Article]