Left ventricular to right atrial shunt (Gerbode defect): congenital versus acquired. Postepy Kardiol Interwencyjnej. 2014;10:185-194. [PMID: 25489305 PMCID: PMC4252310 DOI: 10.5114/pwki.2014.45146]

Percutaneous Closure of an Iatrogenic Intracardiac Shunt in Treating Torrential Tricuspid Regurgitation

A patient presented with severe right heart failure due to a large LV-to-RA shunt with left-to-right shunting and torrential tricuspid regurgitation 6-weeks following surgical sub-aortic stenosis resection. Retrograde delivery of an Occlutech ventricular septal defect device produced instantaneous resolution of shunt, reduction in tricuspid regurgitation, and impressive diuresis of 28 kg.

Utility of Three-Dimensional and Four-Dimensional Transesophageal Echocardiography in Decision-Making in a Patient with Iatrogenic Left Ventricle-to-Right Atrium Shunt (Gerbode Defect)

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Two-dimensional echocardiography is the workhorse of cardiovascular imaging.

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Three-dimensional echocardiography can improve diagnostic capability.

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In structural and congenital heart disease, 3D echo can be extremely useful.

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Three-dimensional echo should be used more often in cardiac interventional procedures.

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.

Native tricuspid valve infective endocarditis with Staphylococcus lugdunesis: An unusual complication post spinal epidural injection - Case report and literature review

Infective Endocarditis (IE) is a very rare complication following spinal epidural injection and requires high index of suspicion for early diagnosis and effective management.

Staphylococcus Lugdunesis is a coagulase negative staphylococcus (CoNS) that, unlike other CoNS, may result in aggressive form of native valve infective endocarditis (IE) mimicking IE caused by S aureus. Surgical intervention is usually needed to control infection in most cases of S. Lugdunesis IE.

Herein, we report a case of young lady with congenital Gerbode defect who developed tricuspid native valve IE with S. Lugdunesis secondary to spondylodiscitis post lumbar epidural injection that was performed for disk prolapse. She required urgent surgical intervention and had an excellent outcome.

The Many Lives of a Complex Marfan Syndrome Patient: Staged Therapeutic Decisions

We present a complex Marfan case, with previous type A aortic dissection, subsequent progressing aortic arch aneurysm, type B chronic aortic dissection, and Barlow disease with severe mitral regurgitation, all expressions of the same phenotype, all needing staged complex surgical therapies. (Level of Difficulty: Intermediate.)

Ruptured Sinus of Valsalva Aneurysm and Gerbode Defects: Patient and Procedural Selection: the Key to Optimising Outcomes

PURPOSE OF REVIEW

In this review, we reflect on the historical background, clinical features and imaging techniques used to assess Gerbode defects and sinus of Valsalva aneurysms. We aim to review the evolution of treatment strategies and the progression towards less invasive management for these conditions.

RECENT FINDINGS

While transthoracic echocardiography is often diagnostic, transesophageal echocardiography (2D and 3D) has improved our understanding of these defects and allowed us to more accurately define their anatomy. Cardiac MRI provides improved assessment of the physiological impact of defects by quantifying shunt volume. Transcatheter techniques are currently vying with surgery as the mainstay of treatment. New insights are being discovered regarding diagnostic modalities and treatment pathways. Defining criteria for patient selection for catheter or surgical therapy is essential when deciding on the optimum intervention for the individual patient.

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 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.

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.

Transcatheter closure of left ventricle to right atrial communication using cera duct occluder

Left ventricle—right atrial communication could be congenital (Gerbode defect) or acquired as a complication of surgery or infective endocarditis and leads to volume overloading of pulmonary circulation. Two types, direct and indirect types are known depending on the involvement of septal tricuspid leaflet. Transcatheter closure of this defect is feasible and appears an attractive alternative to surgical management. Various devices like Amplatzer duct occluder I, II, Muscular ventricular septal defect device etc. have been used to close this defect. We report two patients, a preteen boy with direct left ventricle-right atrial communication as post operative complication and an adult female with indirect communication who underwent transcatheter closure with Cera duct occluder (Lifetech Scientific (Shenzhen), China).

Gerbode Defect-A Rare Defect of Atrioventricular Septum and Tricuspid Valve

Left ventricular to right atrial communications (the Gerbode defect) are rare types of ventricular septal defect and present as direct or an indirect type. We hereby, report two cases, one direct and another indirect type. Cardiopulmonary bypass surgery was done and a successful suture closure of ventricularseptal defect using pericardial patch was performed.