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

Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt-State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies

The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients' quality of life.

The Gore Cardioform Atrial Septal Defect Occluder: A novel solution to the management of severe hemolysis following transcatheter septal defect closure

Significant hemolysis is a recognized complication of transcatheter high-velocity shunt occlusion using some Amplatzer devices. We describe a case of severe hemolysis following occlusion of an iatrogenic Gerbode defect with an Amplatzer muscular ventricular septal defect occluder successfully managed by transcatheter device removal and reocclusion with a Gore Cardioform Atrial Septal Defect Occluder.

Transcatheter device closure of perimembranous ventricular septal defect associated with indirect Gerbode defect: A retrospective study

Perimembranous ventricular septal defect (pmVSD) is a common congenital heart disease that is sometimes associated with indirect left ventricle (LV) to right atrium (RA) shunt (indirect Gerbode defect). This defect has a rare chance of spontaneous closure and therefore was usually closed surgically in the past, but more recently transcatheter closure has been reported by a few authors. In our study, we have described a series of 14 children (age ranging from 1.2 to 12 years and weight ranging from 7.2 to 25.5 kg) with the above-mentioned defect which were closed by various interventional devices. The procedures were successful in complete elimination of pmVSD and immediate reduction of indirect LV-RA shunts with negligible residual tricuspid regurgitation on follow-up. In our midterm experience, the judicious use of double-disc devices is efficacious for occluding pmVSD associated with indirect Gerbode defect.

Transcatheter closure of a rare congenital left ventricle to right atrium shunt using the amplatzer duct occluder II: A case report

RATIONALE

Left ventricle-right atrium (LV-RA) shunt is a rare case and surgical repair has been the routine procedure to correct this defect. With the rapid development of transcatheter technology, some of the cases can be closed with transcatheter technique. Here, we would like to report a congenital LV-RA case who received transcatheter closure using the Amplazter duct occluder II (ADO II) and the short-term outcomes of this procedure.

PATIENT CONCERNS

A 2-year-old female presented a systolic murmur between the 2 to 3 sternal rib during the routine examination before kindergarten administration.

DIAGNOSIS

The patient denied any cardiac surgery, endocarditis, trauma or cardiomyopathy. The echocardiography confirmed an abnormal shunt between left ventricle and right atrium located in the superior part of ventricular septum which is closed to septal tricuspid valve and anterior mitral valve, and the diameter of this shunt is 2 mm. Besides, the dilation of right atrium (40 mm) has been identified which was not a common clinical manifestation of typical ventricular septal defect. Angiography demonstrated the shunt driven from left ventricle to right atrium.

INTERVENTION

An AGA ADO II device had been delivered to close the defect.

OUTCOME

Follow-up kept for 3 months. Echocardiography revealed completed closure of the shunt with normal movement and function valves. And no complication of arrhythmia has been recorded.

LESSONS

This case report highlighted the administration of ADO II in some ventricular septal defect with superior location, and provided an essential experience of using ADO II to close long tunnel type LV-RA shunt.

Mid-term results of transcatheter closure of ventricular septal defect using Nit-Occlud Lê ventricular septal defect coil, single-center experience

Objectives

To assess safety, efficacy and follow-up results of transcatheter closure of ventricular septal defect (VSD) using Nit-Occlud_ Lê VSD Coil (pfm medical, KÖln, Germany).

Background

Transcatheter VSD closure has achieved encouraging results but more follow-up studies are needed.

Patients and methods

Between January 2012 and December 2013 in the cardiology department, Tanta University Hospital, Tanta, Egypt, 80 patients underwent percutaneous VSD closure using Nit-Occlud_ Lê VSD Coil. Early and mid- term follow-up was done for 3 years, follow-up was concluded in 2016.

Results

The mean age of patients was 5.34 ± 3 years, and their mean weight was 17.24 ± 8.17 kg. Overall, 77 of 80 patients had perimembranous VSD with aneurysmal tissue; eight had multiple right ventricular exits, 14 had deficient aortic rim, two had high outlet muscular, and one had Gerbode defect. The procedure was successful in 98.75% of patients, and was aborted in one patient because of the development of complete heart block and the coil had to be removed. The mean procedure time was 104.98 ± 9.50 minutes. The mean fluoroscopy time was 30.58 ± 2.79 minutes. The immediate complete occlusion rate was 62%, which increased to 82.3% on the second day, and 94.9% by the 3rd month, and 97.5% by 1 year. There was a significant decrease in mitral incompetence after 6 months of follow-up (p = 0.002), and only one patient had trivial aortic incompetence prior to the procedure that remained the same during follow-up period.

Conclusion

Using Nit-Occlud_ Lê VSD-Coil to close VSD is safe and feasible in VSDs with various morphology.

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.

Simultaneous "traumatic Gerbode" and aortic rupture due to blunt chest trauma

The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non-penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography.

Amplatzer duct occluder II for closure of congenital Gerbode defects

BACKGROUND

Congenital left ventricle to right atrial communications (Gerbode defects) are extremely rare (0.08%) type of ventricular septal defects. They were traditionally closed by surgery in the past. There are few case reports and small series of acquired and congenital Gerbode defects, closed with various types of devices. Aim of our study is to assess the feasibility, efficacy, and complications of transcatheter closure of congenital Gerbode defects with Amplatzer duct occluder II (ADO II).

MATERIAL

Twelve consecutive cases of Gerbode defects, age ranging from 10 months to 16 years (mean 6.7 years), weight ranging from 6.5 kg to 34 kg (mean 19.3 kg), were diagnosed on transthoracic echocardiography.

RESULTS

Transcatheter closure of Gerbode defects was done successfully through retrograde approach with ADO II. No aortic or tricuspid regurgitation or residual shunt occurred in any of the patients. One patient developed transient complete heart block needing temporary pacing.

DISCUSSION

The soft low profile, easily trackable ADO II appears to be ideal for closure of Gerbode defects, as the central cylinder fits in the defect and the soft retention discs on either side, without polyester material, do not impinge on either aortic, mitral, or tricuspid valve. We report the successful transcatheter closure of twelve cases of congenital Gerbode defects with ADO II.

CONCLUSIONS

Transcatheter closure of congenital Gerbode defects with ADO II is safe, effective, and an attractive alternative to surgical closure. ADO II appears to be tailor made for Gerbode defects, as the success rate is very high and complication rate is very low.

Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas

BACKGROUND

The acquired left ventricle-to-right atrium (LV-RA) shunt (Gerbode defect) is rare but it can sometimes be a critical condition. The diagnosis is quite challenging largely due to its exotic anatomic features and diagnostic difficulties. This study aims to present the clinical features and diagnostic solutions of this rare lesion.

METHODS

Data source was based on a comprehensive literature retrieval of acquired LV-RA shunts of 1990-2014.

RESULTS

Most of the acquired LV-RA shunts are of either a postoperative or an infective etiology. Transthoracic echocardiography showed a 62.2% accurate diagnosis, 13.4% inclusive diagnosis, 9.8% missed diagnosis, and 14.5% misdiagnosis rate. The accurate diagnostic rate of transthoracic echocardiography was significantly lower than that of the transesophageal echocardiography or cardiac catheterization. The LV-RA shunts are often misinterpreted as mitral regurgitation, pulmonary hypertension, tricuspid regurgitation, Valsalva aneurysm rupture, and subaortic/high perimembrane/residual ventricular septal defect. Surgical, interventional, and conservative treatments were applied in 57.8, 24.4, and 17.8% patients, respectively. Prognosis showed an event-free survival of 85%, a comorbidity of 9.1%, and a mortality of 13.6%.

CONCLUSIONS

A high jet detected in the right atrium with uncertain origin and course has to appeal to additional diagnostic techniques including transesophageal echocardiography, cardiac catheterization, or cardiac magnetic resonance imaging for differential diagnoses. Small restrictive shunts are preferred with conservative treatments, high-risk patients are candidates of interventional therapy, and the patients with unstable hemodynamics warrant an open heart surgery. Careful operative maneuver, good control of intracardiac infection, preservation of heart function, etc., are mandatory for the prevention of the development of an acquired LV-RA shunt.

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.

Left ventricular to right atrial shunt (Gerbode defect): congenital versus acquired

Introduction

Congenital left ventricular to right atrial (LV-RA) shunt (Gerbode defect) is rare, while acquired LV-RA shunt has been increasingly reported. As yet, systematically incorporated data of the LV-RA shunt have not been presented.

Aim

To present the clinical features, diagnostic challenge and management strategies of congenital and acquired LV-RA shunts.

Material and methods

The data source was based on a comprehensive literature retrieval of the LV-RA shunt in the period 1990–2013.

Results

In comparison with the acquired Gerbode defect, the congenital Gerbode defect group of patients were younger and were associated more often with additional congenital disorders. Previous cardiac surgery and infective endocarditis were the two major aetiologies of the occurrence of the acquired shunts. Paravalvular abscess was associated in 10.2% and atrioventricular block in 13.6% of the acquired group patients. Transoesophageal echocardiography showed a higher diagnostic accuracy, lower missed diagnosis and lower inclusive diagnosis rates, in comparison to transthoracic echocardiography, but the misdiagnosis rates of the two modalities did not differ from each other. Four (4.5%) of the acquired group patients were complicated by atrioventricular block following surgical or interventional closure of the shunt. Eight (9.1%) patients died in the acquired group, but no patient died in the congenital group.

Conclusions

The diagnosis of an LV-RA shunt is quite challenging, especially in the context of coexisting abnormalities including an additional intracardiac shunt, tricuspid regurgitation, pulmonary artery hypertension and infective endocarditis, which have to be carefully differentiated from the shunt by further investigations. A better control of infective complications and careful manoeuvres during surgery may help to keep the LV-RA-sensitive septum intact.