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

Abstract

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.

Echocardiographic features of indirect Gerbode defect in a cat

“…Gerbode defect is a rare type of ventricular septal defect that results in communication between the left ventricle (LV) and the right atrium (RA). Because the tricuspid valve (TV) attaches to the membranous septum more apically than that of the mitral valve, a congenital defect involving the atrioventricular portion of interventricular septum can cause an abnormal communication between the LV and RA [1,2]. The TV malformation, such as a perforation, cleft, widened commissural space, or abnormal chordae, when accompanied by a ventricular septal defect (VSD), also permits the LV to communicate with the RA [1].…”

“…In indirect-type Gerbode defect, blood flows from the LV through the VSD into the RV and then through a defect in the TV into the RA [1]. A Gerbode defect can occur congenitally or secondary to trauma, infective endocarditis, and other effects [1]. In humans, most indirect-type Gerbode defects are congenital defects [1].…”

“…A Gerbode defect can occur congenitally or secondary to trauma, infective endocarditis, and other effects [1]. In humans, most indirect-type Gerbode defects are congenital defects [1]. Depending on the anatomical location of the shunt, Gerbode defect is classified into one of three types.…”

“…Type 3, an intermediate defect, combines both supravalvular and infravalvular defects. In humans, the type 1 defect is more likely to be acquired while types 2 and 3 are usually congenital [1,3].…”

“…Moreover, the turbulent flows in both diseases develop in the systolic phase and induce RA and RV enlargements. Based on a typical finding for the origin of the turbulent flow from the perimembranous septum rather than between the TV leaflets, Gerbode defect presence can be suspected [1]. However, in some cases, it can be difficult to differentiate between Gerbode defect and TR based on the direction of flow [9].…”