Communication between the left ventricle and right atrium

Abstract

A further 15 (Gerbode, Hultgren, Melrose, and Osborn, 1958;Braunwald and Morrow, 1960;Levy and Lillehei, 1962;and Mellins, Cheng, Ellis, Jameson, Malm, and Blumenthal, 1964).We wish to record a further 15 patients who had a communication between the left ventricle and right atrium; they were collected over a period of six years, which would indicate that the anomaly is not so rare as was previously thought. All but one had surgical treatment, and our report is concerned with these. The fifteenth was an infant who had multiple congenital abnormalities, who developed congestive cardiac failure when 3 weeks old, and who was successfully digitalized but died of gastro-enteritis at 4 months. Cardiomegaly was accompanied by radiographic and electrocardiographic evidence of left ventricular hypertrophy and by evidence at cardiac catheterization of an arteriovenous shunt at atrial level: necropsy demonstrated a direct communication between the left ventricle and right atrium.

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

“…The most noticeable physical examination finding of an LV-RA shunt is a characteristic murmur similar to that of a VSD: loud, harsh pansystolic, Grade III–VI, unvarying with respiration and often associated with a thrill along the left sternal border [9], [10], [20], [75], [76]. Among all Gerbode patients with a heart murmur, nearly 72% displayed a systolic murmur [20], which is often audible over the entire precordium and radiates posteriorly [15].…”

“…The congenital LV-RA connection was first mentioned in an autopsy report on a patient in 1838 [6], [7]. Subsequently, Thurman [6] (1938), Buhl [7] (1857), and Hillier [8] (1859) extrapolated this discovery by reporting malformations between the LV and RA [9], [10]. Thereafter there was a hiatus until Perry et al [11] (1949), after reviewing five cases from the literature, added a sixth, and described variations in the anatomy of this anomaly [10], [11].…”

“…Subsequently, Thurman [6] (1938), Buhl [7] (1857), and Hillier [8] (1859) extrapolated this discovery by reporting malformations between the LV and RA [9], [10]. Thereafter there was a hiatus until Perry et al [11] (1949), after reviewing five cases from the literature, added a sixth, and described variations in the anatomy of this anomaly [10], [11]. In 1955, Stahlman et al [12] reported two more cases, which like all their predecessors were at necropsy [10].…”

“…Thereafter there was a hiatus until Perry et al [11] (1949), after reviewing five cases from the literature, added a sixth, and described variations in the anatomy of this anomaly [10], [11]. In 1955, Stahlman et al [12] reported two more cases, which like all their predecessors were at necropsy [10]. It was not until 1957, when Kirby et al [13] successfully closed a left ventricular/right atrial shunt, that the diagnosis was established in a living patient, albeit during an operation [10].…”

“…Until recently, communication between the LV and the RA was regarded as extremely rare and of little clinical significance [10]. However, as documented by Yuan [20], [21], acquired LV-RA communication is increasingly being reported.…”