The Gerbode defect: a case series

Abstract

Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes. Case summaries Patient 1 A 64-year-old male presented with features of decompensated cardiac failure and a low-grade temperature. Dehiscence of a recently implanted bioprosthetic aortic valve and high-velocity LV to RA jet (Gerbode defect) was found on echocardiography. Blood cultures grew Staphylococcus warneri and the diagnosis of infective endocarditis was established. The patient was treated with intravenous antibiotics and the aortic valve and Gerbode defect were successfully surgically repaired. Patient 2 An 81-year-old male presented after being found on the floor at home. On admission, he was clinically septic with evidence of decompensated heart failure. No clear infective focus was initially found. Transthoracic echocardiography revealed severe left ventricular impairment, with a normal bioprosthetic aortic valve. He was treated with intravenous antibiotics, but later deteriorated with evidence of embolic phenomena. Repeat echocardiography revealed a complex infective aortic root lesion with bioprosthetic valve dehiscence and flow demonstrated from the LV to RA. Unfortunately, the patient succumbed to the infection and cardiac complications. Discussion The Gerbode defect is a rare but important complication of infective endocarditis and valve surgery. Care needs to be taken to assess for Gerbode defect shunts on echocardiogram, especially in the context of previous cardiac surgery.

Gerbode defect resulting from Group B Streptococcus infective endocarditis: a case report

“…Compared with the more stable congenital Gerbode defects, acute fistulation between the LV and the RA associated with IE is a life-threatening complication that often requires urgent definitive intervention [ 5 ]. However, the identification of actual communication is often extremely difficult.…”

Defecto tipo gerbode secundario a corrección de anomalía de Ebstein. Reporte de caso

“…En una revisión del Children' s Memorial Hospital de Chicago de 2010, se reportaron únicamente seis casos de esta patología en el período de 1990 a 2008. En la actualidad existen publicados un total de solo 120 casos en el mundo (1) .…”

Underrecognized pathogen; Staphylococcus warneri‐associated native mitral valve endocarditis in an immunocompetent host: A case report and literature review

“…Only one patient had diabetes, 13 while almost one‐third had prosthetic valves. 14 , 15 , 16 , 17 Half of the patients had a recent surgery or device implantation but only one patient described some form of immunosuppressed status. Of the 14 cases reviewed, five reported symptoms more than 2 weeks, although the data were not obtainable in 4 cases.…”

“…Cases ranged between 28 and 79 years of age and were predominantly male. Only one patient had diabetes, 13 while almost one‐third had prosthetic valves 14‐17 . Half of the patients had a recent surgery or device implantation but only one patient described some form of immunosuppressed status.…”