Syndrome of left ventricular-right atrial shunt resulting from high interventricular septal defect associated with defective septal leaflet of the tricuspid valve

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.

Atrioventricular Shunt Post Acute Myocardial Infarction

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The mechanical complications of acute myocardial infarction (AMI) can be catastrophic.

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A Gerbode type defect after AMI is rare.

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Surgery is the mainstay of treatment, but percutaneous options are available.

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Gerbode defects can be congenital or acquired and can be closed percutaneously.

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Echocardiography reliably evaluates the mechanical complications of AMI.

A communication from the left ventricle to the right atrium: a defect in the central fibrous body

An isolated defect in the membranous atrioventricular septum was found in a five-year-old girl who presented with a cystic lesion in the right atrium. This type of left ventricular-right atrial communication could result from a structural abnormality of the central fibrous body in combination with arrested maturation of the membranous ventricular septum.

An echocardiographic study of perimembranous ventricular septal defect with left ventricular to right atrial shunting

Twenty nine patients with isolated perimembranous ventricular septal defects were investigated by M mode, cross sectional, and pulsed Doppler echocardiography. Tricuspid valve anomalies were present in all six patients with a left ventricular-right atrial shunt but in only six (26%) of 23 patients who had interventricular shunts only. Systolic flutter of the tricuspid valve was shown in five (83%) of the six patients with a ventriculoatrial shunt but not in the other patients. Systolic turbulence in both the right ventricle and right atrium was detected by Doppler echocardiography only in patients with ventriculoatrial shunting. A perimembranous ventricular septal defect with left ventricular to right atrial shunt can be diagnosed by its combined M mode, cross sectional, and pulsed Doppler echocardiographic features.

Cineangiography of the perimembranous ventricular septal defect with left ventricular-right atrial shunt

Nine cases are reported of perimembranous ventricular septal defect associated with left ventricular to right atrial shunting. Cineangiographic findings included an aneurysm of the membranous septum in all patients; two patients had obvious adherence of deformed tricuspid valve leaflets to the membranous septum. The location of the ventricular septal defect was confirmed at surgery or cardiac endoscopy in seven patients. In the presence of a perimembranous ventricular septal defect, left ventricular to right atrial shunting is usually the result of tricuspid valve abnormalities, including clefts or perforations of the septal leaflet, deformity or adherence of valve tissue to the margins of the septal defect and widening of the anteroseptal commissure. Biplane left ventriculography, using the long axial oblique and reciprocal right anterior oblique projections, may best demonstrate the pathologic anatomy, although the hepatoclavicular projection is a useful alternative, particularly when an atrioventricular canal defect is a diagnostic consideration.

Normal variations in tricuspid valve attachments to the membranous ventricular septum: a clue to the etiology of left ventricle-to-right atrial communication

In 39 out of 95 normal specimens, there was either no commissure between the anterior and medial leaflets of the tricuspid valve, which resulted in an interrupted valve margin at the center of the membranous ventricular septum, or an incompletely formed commissure. It is suggested that one end of this spectrum of normal anatomic variations could have a direct relationship to VSD associated with left ventricle-to-right atrial communication.

Communication between the left ventricle and right atrium

A further 15 patients with left ventricular/right atrial communication are reported, 14 of whom were treated surgically. The clinical triad of a ventricular septal defect murmur, cardiac enlargement, and an arteriovenous shunt at atrial level is characteristic of the malformation. Of the 14 patients accorded surgical treatment, one died soon after operation. The remainder are well, with both the electrocardiographic signs of left ventricular hypertrophy and the radiographic evidence of cardiomegaly having undergone regression.