Gerbode defect: Another nail for the 3D transesophagel echo hammer?

Abstract

Acquired type of LV to RA shunt (Gerbode defect) is rare form of intracardiac shunt which is due to complications of invasive cardiac procedures, endocarditis, trauma or myocardial infarction. Increasing invasive and recurrent cardiovascular procedures have led to more acquired cases of what used to be a predominant congenital heart defect. Advanced cardiac imaging techniques and awareness of this rare pathology may account for the increased number of case reports in the last two decades Advanced cardiac imaging tools such as cardiac CT, MRI and Real-time 3D echocardiography provide definitive diagnosis and anatomic characterization of the shunt. Real-time 3D echocardiography is an imaging technique with arguably the most advantages. It is not only a diagnostic tool; it has also become an integral part of percutaneous and surgical treatment. Although surgical repair is the usual treatment for this shunt, percutaneous catheter-based closure has seen significant success as a less invasive treatment in selected patients in the last decade. In summary, a beneficial side effect of the increasing frequency of acquired Gerbode defect has been the corresponding development of newer diagnostic tools and less invasive treatments. This article presents etiologic, diagnostic and treatment changes of acquired LV-RA shunts over the last two decades.

Acquired Gerbode defect following endocarditis of the tricuspid valve: a case report and literature review

“…However cardiac catheterization, cardiac tomography or magnetic resonance such as in our case offers valuable information. Interestingely our case after been diagnosed with Gerbode defect underwent cardiac magnetic resonance which revealed a class C acquired Gerbode defect as previously described [ 4 ].…”

“…In 1957, Gerbode et al [ 2 ] reported the first 5 cases with such a heart defect undergoing successful surgical repair. Such a defect is usually congenital, but rarely is acquired, as a complication of endocarditis [ 3 ], myocardial infarction, blunt chest trauma or after previous cardiac surgery [ 4 ]. This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve.…”

A Congenital Gerbode Defect associated with a Rare Structural Abnormality of the Mitral Valve Diagnosed in an Adult Patient

“… 6) 7) A high velocity jet with an unclear origin detected in the RA requires additional imaging, including TEE, cardiac catheterization, or cardiac magnetic resonance for differential diagnosis. 8) TEE can avoid diagnostic errors allowing to identify the trajectory and location of the communication, as well as its dimensions. In this setting, 3D echocardiography may also have an important role.…”

An acquired Gerbode defect from the left ventricle to the coronary sinus following mitral valve replacement

“…1 This defect is now primarily seen in patients after valve surgery. 2,3,4 We present an unusual case of an acquired Gerbode defect from the LV to the coronary sinus producing cardiac failure following mitral valve replacement (MVR) for the management of left ventricular outflow tract obstruction (LVOTO) in hypertrophic obstructive cardiomyopathy (HOCM).…”

“…Certain closure devices however can interfere with prosthetic valve leaflet function as seen in this case. 4 Surgical correction is more commonly used in non-iatrogenic acquired cases such as infective endocarditis, post MI and trauma. 2 In this case, the recent chemotherapy for adenocarcinoma may have contributed to the friability of tissues encountered at surgery and predisposed to the development of the defect.…”