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Acquired Gerbode defect following endocarditis of the tricuspid valve: a case report and literature review
© Prifti et al. 2015
- Received: 3 May 2015
- Accepted: 24 August 2015
- Published: 9 September 2015
The Gerbode’s defect is a communication between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis, myocardial infarction, trauma, or after previous cardiac surgery. The acquired Gerbode defect with involvement of the tricuspid valve acquired after bacterial endocarditis can be challenging to repair. We present a rare case of young woman, with endocarditis of the tricuspid valve and acquired Gerbode defect without previous cardiac surgery. She underwent successful surgical closure of the Gerbode defect and reconstruction of the septal leaflet of the tricuspid valve using a an autologous pericardial patch. A total of 20 other cases were reported with acquired Gerbode defect due to endocarditis in patients without previous cardiac surgery. Three other cases presented acquired Gerbode defect due to myocardial infarction and two due to chest trauma. Another series of 62 patients presented acquired Gerbode defect after previous cardiac surgery. Surgical treatment is always feasible with excellent outcome. However the percutanous transcatheter closure remains an excellent option especially in high risk patients.
The communication between the left ventricle and right atrium was firstly reported in 1838 by Thurman . In 1957, Gerbode et al.  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 , myocardial infarction, blunt chest trauma or after previous cardiac surgery . This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. Acquired Gerbode defects with large septal destructions and vegetations involving the tricuspid valve can be challenging and might require complex patch repair. We present a case of our patient with this uncommon complication of endocarditis, simulating severe pulmonary hypertension.
A 40 year old lady from Kosovo, was referred to our hospital for severe pulmonary arterial hypertension and a mass in right atrium suspected for vegetation. About one month before, she was admitted in another hospital and received iv medication. The patient was febrile and the C-reactive protein, white cell count and erythrocyte sedimentation rate were elevated. Blood cultures demonstrated a methacilin sensitive Staphylococcus aureus growth.
The acquired Gerbode defect a rare form of intracardiac shunt, but its incidence has been increasing during the last decades. Increased numbers of invasive and repeat cardiovascular procedures and infective endocarditis have led to this increase in acquired Gerbode defect. Surgical treatment is always feasible with excellent outcome. However the percutanous transcatheter closure remains an excellent option especially in high risk patients.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the Journal of Cardiothoracic Surgery.
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- Thurman J. Aneurysms of the heart. Med Clin Trans R. 1838;21:187.Google Scholar
- Gerbode F, Hultgren H, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt; successful surgical repair of defect in five cases, with observation of bradycardia on closure. Ann Surg. 1958;148:433–46.View ArticlePubMedPubMed CentralGoogle Scholar
- Cantor S, Sanderson R, Cohn K. Left ventricular-right atrial shunt due to bacterial endocarditis. Chest. 1971;60:552–4.View ArticlePubMedGoogle Scholar
- Taskesen T, Prouse AF, Goldberg SL, Gill EA. Gerbode defect: Another nail for the 3D transesophagel echo hammer? Int J Cardiovasc Imaging. 2015;31(4):753–64.View ArticlePubMedGoogle Scholar
- Battin M, Fong LV, Monro JL. Gerbode ventricular septal defect following endocarditis. Eur J Cardiothorac Surg. 1991;5(11):613–4.View ArticlePubMedGoogle Scholar
- Saiki Y, Kawase M, Ida T, Mannouji E, Kasegawa H, Takahashi Y, et al. The successful surgical repair of a left ventricular– right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: report of a case. Surg Today. 1994;24:655–8.View ArticlePubMedGoogle Scholar
- Katoh J, Okabe H, Ujiie T, Edamoto Y, Murakami H, Sakurai M, et al. A case report of left ventricular–right atrial com munication with tricuspid regurgitation due to infective endo- carditis. Jpn J Thorac Surg. 1994;47:228–23.Google Scholar
- Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z. Acquired left ventricular–right atrial communication caused by infective endocarditis detected by transesophageal echocar- diography: case report and review of the literature. J Am Soc Echocardiogr. 1995;8:108–10.View ArticlePubMedGoogle Scholar
- Velebit V, Schoneberger A, Ciaroni S, Bloch A, Maurice J, Christenson JT, et al. “Acquired” left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis. Tex Heart Inst J. 1995;22:100–2.PubMedPubMed CentralGoogle Scholar
- Winslow TM, Friar DA, Larson AW, Barry MJ. A rare complication of aortic valve endocarditis: diagnosis with trans- esophageal echocardiography. J Am Soc Echocardiogr. 1995;8:546–50.View ArticlePubMedGoogle Scholar
- Michel C, Rabinovitch MA, Huynh T. Gerbode’s defect associated with acute sinus node dysfunction as a complication of infective endocarditis. Heart. 1996;76:379.View ArticlePubMedPubMed CentralGoogle Scholar
- Alphonso N, Dhital K, Chambers J, Shabbo F. Gerbode’s defect resulting from infective endocarditis. Eur J Cardiothorac Surg. 2003;23:844–6.View ArticlePubMedGoogle Scholar
- Raja Y, Jenkins N, Chauhan A, Millner RW. Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation. Int J Cardiol. 2006;113:E79–80.View ArticlePubMedGoogle Scholar
- Fukui K, Kanazawa J, Kawamura T, Yamauchi S, Watanabe K, Taniguchi S, et al. Left ventricular–right atrial communi- cation resulting from infective endocarditis. Jpn J Thorac Surg. 2007;60:213–6.Google Scholar
- Tatewaki H, Alesnik JP, Morales DSL. Acquired lef ventricle to right atrial shunt (Gerbode defect) and massive pul monary embolus. 2008; http://www.ctsnet.org/sections/clinicalresources/clinicalcases/article-14
- Inoue H, Iguro Y, Kinjo T, Matsumoto H, Yotsumoto G, Sakata R. Acquired left ventricular–right atrial communication and severe aortic valve regurgitation caused by infective endocarditis. Thorac Cardiovasc Surg. 2009;57:54–6.View ArticlePubMedGoogle Scholar
- Cortez-Dias N, Varela MG, Marques J, Sargento L, Martins S, Ribeiro MA, et al. Acquired left ventricular-to-right atrial shunt (Gerbode defect) due to infective endocarditis. Port J Cardiol. 2009;28:735–9.Google Scholar
- Mendoza DD, Wang Z, Gaglia MA, Taylor AJ. Gerbode defect. J Cardiovasc Comput Tomogr. 2009;3:279–81.View ArticlePubMedGoogle Scholar
- Hori D, Tanaka M, Yamaguchi A, Adachi H. Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Ger- bode defect. Gen Thorac Cardiovasc Surg. 2010;58:255–9.View ArticlePubMedGoogle Scholar
- Matt P, Winkler B, Carre T, Eckstein F. Plicated Patch Repair for Acquired Gerbode Defect Involving the Tricuspid Valve. Ann Thorac Surg. 2010;89:643–5.View ArticlePubMedGoogle Scholar
- Ota T, Yamaguchi R, Tanigawa T, Otuka K, Hayashi Y, Nishiyama H. Left ventricular–right atrial communication by perforation of the atrioventriculas portion of the membranous septum and severe aortic valve regugitation caused by infective endocarditis. J Echocardiogr. 2011;9:30–2.View ArticlePubMedGoogle Scholar
- Pillai V, Menon S, Kottayil B, Karunakaran J. Tricuspid endocarditis with indirect Gerbode: septal translocation of pos- terior leaflet. Heart Lung Circ. 2011;20:362–4.View ArticlePubMedGoogle Scholar
- Carpenter RJ, Price GD, Boswell GE, Nayak KR, Ramirez AR. Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis. J Card Surg. 2012;27:316–20.View ArticlePubMedGoogle Scholar
- Hsu SY, Shen TC. A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging. 2014;15:471.View ArticlePubMedGoogle Scholar
- Hole T, Wiseth R, Levang O. Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J. 1995;16:866–8.PubMedGoogle Scholar
- Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y, et al. Postinfarction atrioventricular septal rupture. J Am Soc Echocardiogr. 1997;10:680–4.View ArticlePubMedGoogle Scholar
- Newman Jr JN, Rozanski L, Kreulen T. Acquired left ventricular to right atrial intracardiac shunt after myocardial in- farction: a case report and review of the literature. J Am Soc Echocardiogr. 1996;9:716–20.View ArticlePubMedGoogle Scholar
- Venkatesh G, Lonn EM, Holder DA, Williams WG, Mulji A. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma. Can J Cardiol. 1996;12:349–52.PubMedGoogle Scholar
- Selinger L, Werner K, Silber R, Nellessen U, Inselmann G. Natural history of a ventriculoatrial fistula after a gunshot injury in 1945. Ann Thorac Surg. 1998;65:1137–8.View ArticlePubMedGoogle Scholar
- Taskesen T, Goldberg SL, Gill EA. Role of three-dimensional echocardiography in management of acquired intracardiacshunts. Echocardiography. 2014;31:E250–3.View ArticlePubMedGoogle Scholar
- Fanari Z, Barekatain A, Abraham N, Hopkins JT. Percutaneous closure of acquired Gerbode defect: management of a rare complication of cardiac surgery. Interact Cardiovasc Thorac Surg. 2015;4.Google Scholar