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

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.

Transcatheter Closure of a Iatrogenic Gerbode Type Ventricular Septal Defect Post Surgical Septal Myectomy With Mitral and Aortic Valve Replacement

Jatrogenic communication between left ventricle and right atrium, known as Gerbode type ventricular septal defect (GVSD) may be observed after different surgical interventions. We present a case of iatrogenic GVSD following complex cardiac surgery including septal myectomy combined with mitral and aortic valve replacement, which was successfully closed percutanously by Occlutech septal occluder.

Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

BACKGROUND: Communication between the left ventricle and right atrium, termed a Gerbode ventricular septal defect (VSD), was first described in 1838 and later explained with varying etiologies, including congenital and acquired forms. Most of the acquired LV-RA shunts are of either a postoperative or of infective etiology. Among these etiologies, infective endocarditis is a rare cause, and echocardiography is a mainstay of its diagnosis and clinical management. CASE REPORT: Here, we describe the case of a patient with bacterial endocarditis as a cause of a left ventricle to right atrium shunt, with subsequent intraoperative diagnosis and surgical repair. A 38-year-old man with a history of fever in the past 2 weeks was diagnosed with bacterial endocarditis involving the tricuspid, aortic, and mitral valve. Pre-operative transesophageal echocardiography revealed a severe aortic regurgitation with large vegetations on the right and non-coronary cusps sizing about 1 cm2. The mitral valve had mild regurgitation and some filiform vegetations on the ventricular side of the anterior leaflet. The examination showed advanced tricuspid regurgitation with vegetations on the anterior and septal leaflets. The cardiologists also measured severe pulmonary hypertension up to 90 mmHg. During surgery, after careful observation, a communication between the left ventricle and the right atrium was discovered in the area under the junction between the right and non-coronary cusps of the aortic valve. The patient underwent aortic valve replacement with a 25-mm Regent mechanical valve (St. Jude Medical, St. Paul, MN), primary closure of a 5 mm ×5 mm septal defect using polyester 2.0 pledgeted sutures, replacement of the tricuspid valve with 31-mm Epic bio-prosthesis, and curettage of the ventricular side of the anterior mitral valve leaflet. The patient’s postoperative course was uneventful and he was transferred at the infective hospital on the 10th post-operative day. After 4 weeks of parenteral antibiotic therapy, the patient was discharged in good conditions. CONCLUSION: To the best of our knowledge, this is a unique case reported with triple valve endocarditis and Gerbode defect treated with surgery. We encourage meticulous examination of patients with endocarditis to find abnormal communications.

Gerbode Ventricular Septal Defect -A Rare Cardiac Anomaly Associated with Genetic Variants in Indian Population- A Case Series

Gerbode defects are rare Ventricular Septal Defects (VSD) constituting approximately one percent cases of congenital heart diseases. The genetic predispositions towards the Gerbode Defect (GD) have remained an unexplored area of study till date. We investigated the genotype-phenotype correlation in patients with Gerbode VSD. Molecular genetic study on Sanger sequencing and subsequent data analysis showed that the contributing sequence variations in the NKX2-5, GATA4 and TBX5 gene lies in one of the highly conserved regions and this region is responsible for encoding a functional protein. The resulting genotype variation may be responsible for causing the diseased phenotype known as GD.