Blood culture grew methicillin-resistant Staphylococcus aureus. All these findings supported a diagnosis of infective endocarditis, resulting in aortic valve perforation and regurgitation, accompanied by heart failure.
Discussion
A sinus of Valsalva fistula with left to right shunting from the aorta to right atrium or right ventricle is an unusual complication of infective endocarditis [1].

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