Percutaneous closure of left ventricular-to-right atrial fistula after prosthetic mitral valve rereplacement using the Amplatzer duct occluder

Percutaneous closure of congenital Gerbode defect using Nit-Occlud® Lê VSD coil

We present a case report about percutaneous closure of a congenital Gerbode defect using Nit-Occlud^® Lê VSD coil. The patient was referred to our hospital with a diagnosis of ventricular septal defect (VSD) and severe pulmonary arterial hypertension. But transthoracic echocardiography revealed a communication between the left ventricle (LV) and the right atrial (RA), called Gerbode defect. Catheterization confirmed the shunt from the LV to the RA. We successfully closed the defect with a VSD coil. After uneventful 6 mo follow-up, the patient was out of dyspnea, the symptom urged him to have medical attention. This case report is to discuss the diagnosis and percutaneous treatment approach for this rare congenital heart disease.

Gerbode defect: A comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment

The purpose of this paper is to survey the literature on Gerbode defect and provide an overview of its history, anatomy, development, pathophysiology, diagnosis, and treatment options. The available literature on this topic, including case reports, was thoroughly reviewed. Gerbode defect is defined as abnormal shunting between the left ventricle and right atrium resulting from either a congenital defect or prior cardiac insults. The pathophysiology underlying the development of Gerbode defect is a disease process that injures the atrioventricular septum and leads to the abnormal shunting of blood. Although the most prevalent cause of Gerbode defect has historically been congenital, an increasing trend towards acquired cases has recently been reported owing to improved diagnostic capabilities and a greater number of invasive cardiac procedures. In conclusion, Gerbode defect is an increasingly recognized condition that warrants further study.

Gerbode Defect of Congenital Variety in an Infant: A Case Report

Gerbode defect is a rare communication from left ventricle to right atrium. It is of two types: congenital versus acquired OR Direct (type I) versus Indirect (type II). Acquired forms are more common and increasingly reported than congenital. We report a second Indian case of such a rare defect and highlight the salient points of all such previously reported cases to make aware the clinicians and paediatricians of need of early diagnosis and timely surgery/ referral for successful outcome.

Transcatheter closure of iatrogenic Gerbode defect with an Amplatzer duct occluder in a 23-year-old patient

A 23-year-old man was referred to our center with hematuria and hemolysis. The patient had undergone mitral and tricuspid valve replacement 3 months previously. Echocardiography and catheterization revealed a Gerbode-type ventricular septal defect. A decision was made to occlude the defect interventionally. The patient's hematuria ceased immediately after the occlusion of the defect. <Learning objective: Iatrogenic ventricular septal defects (especially Gerbode-type) are relatively rare complications after valvular surgery. Correction of such defects can be done both surgically and interventionally, but since the risk of another operation for correction is high, percutaneous ventricular septal defect closure is usually the preferred treatment option. Using an appropriate approach will increase the success rate.>.

Transcatheter occlusion of a left ventricular to right atrial communication by an Occlutech duct occluder

Left ventricular to right atrial communication is a rare congenital or acquired heart defect. There are many reports of successful transcatheter closure of this defect. We describe the device closure of one such communication in a 5-year-old girl using the Occlutech duct occluder. We believe that this device may have some advantages over the devices previously used for this purpose.

Transcatheter closure of acquired left ventricle to right atrium shunts

We describe transcatheter closure of an acquired Gerbode defect (left ventricle to right atrium shunt) in four patients, ranging in age from 8 to 75 years. All of them had undergone previous surgery (VSD closure in 3, aortic valve replacement in 1), and either had persistent symptoms of heart failure, or developed new symptoms several months or years later. The diagnosis was made by one of several imaging modalities (transthoracic or transesophageal echocardiography, or MRI), and confirmed at cardiac catheterization. Device closure using a variety of devices was successful in all, with resolution of symptoms. One patient developed complete heart block, requiring permanent pacemaker implantation. Transcatheter closure is effective, and may replace surgery in the management of these defects.

Transcatheter closure of acquired left ventricle-to-right atrium shunt: first case report in an infant and review of the literature

Gerbode defect, a left ventricle to right atrium (LV-RA) communication, is usually congenital. Acquired LV-RA communications are rare and only few case reports of successful trans-catheter closure have been published though none of them were on infants. We hereby report a rare case of LV to RA shunt acquired following surgical repair of Tetralogy of Fallot (TOF). The defect was successfully closed percutaneously with an Amplatzer duct occluder. This is the first reported case of device closure of an acquired Gerbode defect in an infant.

Intraoperative device closure of acquired left ventricular-right atrium shunt in a pediatric patient with pulmonary hypertension

A postoperative acquired left ventricular (LV) to right atrium (RA) shunt in a pediatric patient is a rare complication, which requires immediate intervention. We report a case of successful management of an acquired LV-RA shunt using an intraoperative closure device.

Percutaneous Repair of Paravalvular Prosthetic Regurgitation

Background—

Percutaneous repair has emerged as a potential therapy for patients with prosthetic paravalvular regurgitation. However, there is a relative paucity of data on the feasibility and outcome of this procedure.

Methods and Results—

All patients in whom percutaneous paravalvular regurgitation closure was attempted at our hospital were identified and included. Under echocardiographic and fluoroscopic guidance, patients underwent implantation of ≥1 an Amplatzer Septal Occluder, Duct Occluder, Muscular Ventricular Septal Defect Occluder, or Vascular Plug II. Percutaneous repair of 141 paravalvular defects was attempted in 115 patients (age, 67±12 years; men, 53%) with heart failure, hemolytic anemia, or both and who were at high risk of open surgery (mean estimated Society of Thoracic Surgeons mortality, 6.9%). Devices were implanted in 125 defects (89% of total defects), including in 19 patients with multiple defects. Because of the complexity of the procedures, wire exteriorization was required in 29 patients. Overall, successful percutaneous closure (defined as ≤1+ residual regurgitation) was achieved in 88 (77%) patients. Procedural time decreased with increasing case experience for percutaneous repair of both perimitral and periaortic defects. Overall, the 30-day complication rate was 8.7% (sudden and unexplained death, 1.7%; stroke, 2.6%; emergency surgery, 0.9%; bleeding, 5.2%). Two devices embolized during the procedure and were retrieved without sequelae. No procedural deaths occurred, but 2 (1.7%) patients died by 30 days.

Conclusions—

Percutaneous repair of paravalvular prosthetic regurgitation can be performed with a reasonable rate of procedural success and may be an initial therapeutic option, particularly in patients at significant risk for open surgery. Increased case experience is associated with shorter procedural time.

Transcatheter occlusion of a residual muscular ventricular septal defect using an Amplatzer duct occluder in a child with congenitally corrected transposition of the great arteries

Transcatheter occlusion has become an acceptable alternative to surgery in patients with congenital muscular and residual post-surgical ventricular septal defects (VSD). We present a case of an 11 year old male with congenitally corrected transposition of the great arteries, dextrocardia, pulmonary atresia, VSD, and advanced second degree atrioventricular block who underwent successful transcatheter occlusion of a residual post-surgical VSD with an Amplatzer duct occluder, in preparation for transvenous pacemaker implantation.