Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas

Yuan, Shi‐Min

doi:10.1007/s00508-015-0710-1

Cited by 9 publications

(3 citation statements)

References 78 publications

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“…Transthoracic echocardiography showed a 62.2% accurate diagnosis, 13.4% inclusive diagnosis, 9.8% missed diagnosis, and 14.5% misdiagnosis rate as reported by Yuan SM [4]. The LV-RA shunts are often misinterpreted as mitral regurgitation, pulmonary hypertension, tricuspid regurgitation, Valsalva aneurysm rupture, and subaortic/high perimembrane/residual VSD.…”

Section: Discussionmentioning

confidence: 66%

Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

Likaj

Dumani

Kuçi

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: Communication between the left ventricle and right atrium, termed a Gerbode ventricular septal defect (VSD), was first described in 1838 and later explained with varying etiologies, including congenital and acquired forms. Most of the acquired LV-RA shunts are of either a postoperative or of infective etiology. Among these etiologies, infective endocarditis is a rare cause, and echocardiography is a mainstay of its diagnosis and clinical management. CASE REPORT: Here, we describe the case of a patient with bacterial endocarditis as a cause of a left ventricle to right atrium shunt, with subsequent intraoperative diagnosis and surgical repair. A 38-year-old man with a history of fever in the past 2 weeks was diagnosed with bacterial endocarditis involving the tricuspid, aortic, and mitral valve. Pre-operative transesophageal echocardiography revealed a severe aortic regurgitation with large vegetations on the right and non-coronary cusps sizing about 1 cm2. The mitral valve had mild regurgitation and some filiform vegetations on the ventricular side of the anterior leaflet. The examination showed advanced tricuspid regurgitation with vegetations on the anterior and septal leaflets. The cardiologists also measured severe pulmonary hypertension up to 90 mmHg. During surgery, after careful observation, a communication between the left ventricle and the right atrium was discovered in the area under the junction between the right and non-coronary cusps of the aortic valve. The patient underwent aortic valve replacement with a 25-mm Regent mechanical valve (St. Jude Medical, St. Paul, MN), primary closure of a 5 mm ×5 mm septal defect using polyester 2.0 pledgeted sutures, replacement of the tricuspid valve with 31-mm Epic bio-prosthesis, and curettage of the ventricular side of the anterior mitral valve leaflet. The patient’s postoperative course was uneventful and he was transferred at the infective hospital on the 10th post-operative day. After 4 weeks of parenteral antibiotic therapy, the patient was discharged in good conditions. CONCLUSION: To the best of our knowledge, this is a unique case reported with triple valve endocarditis and Gerbode defect treated with surgery. We encourage meticulous examination of patients with endocarditis to find abnormal communications.

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Section: Discussionmentioning

confidence: 66%

Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

Likaj

Dumani

Kuçi

et al. 2023

Open Access Maced J Med Sci

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“…In the diagnosis of the Gerbode defect, the high-velocity LV-RA jet may be misdiagnosed as TV regurgitation with pulmonary arterial hypertension, Valsalva aneurysm rupture, mitral regurgitation, paravalvular leak, VSDs, or other types of congenital intracardiac shunts [ 65 ].…”

Section: Resultsmentioning

confidence: 99%

Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt—State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies

Winter,

Strizek,

Recker

2024

JCDD

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The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients’ quality of life.

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“…Although less common, this shunt has also been described after thoracic trauma, aortic or mitral valve replacement, and in infective endocarditis as an extension of infection to the subanular region surrounding the interventricular membranous septum. Usually the organism most involved is Staphylococcus Aureus [1]. However other microorganisms may be involved, assuming in all cases a serious and potentially fatal complication.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2017

JCCR

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Left ventricular to right atrial (LV-RA) shunt (Gerbode defect) is rare. It is usually congenital, but rarely is acquired, as a complication of endocarditis. Usually the organism involved is Staphylococcus Aureus however other apparently less aggressive microorganism may be involved making diagnosis and early treatment of these patients a great challenge. We present a case of a 79 years old man with dyspnea and fever who was diagnosed of bacterial endocarditis due to Streptococcus anginosus complicated with a Gerbode defect secondary to an extension of infection to the subanular region surrounding the interventricular membranous septum. Despite of an early antibiotic and surgical treatment the patient died showing us the severity of this complication. Keywords: Gerbode defect; Bacterial endocarditis IntroductionThe congenital shunt defect between the left ventricle (LV) and the right atrium (RA) was initially described by Gerbode. Although less common, this shunt has also been described after thoracic trauma, aortic or mitral valve replacement, and in infective endocarditis as an extension of infection to the subanular region surrounding the interventricular membranous septum. Usually the organism most involved is Staphylococcus Aureus [1]. However other microorganisms may be involved, assuming in all cases a serious and potentially fatal complication. Case PresentationA 79 years old man was admitted to the hospital because of dyspnea and fever. Eleven days before admission, the patient had been diagnosed of a Klebsiella Oxytoca urinary tract infection initiating antibiotic treatment with ciprofloxacin. He had history of hypertension, dyslipidemia and multiple urological interventions with internal urethrotomy and dilatation due to urethral stenosis. Clinical examination at admission was normal without signs of heart failure. Electrocardiogram (ECG) showed complete heart block requiring implantation of a temporary pacemaker. Laboratory analysis showed leukocytosis with left deviation and elevated C-reactive protein suggesting an infectious process. In this context, a transthoracic (TTE) ( Figure 1) and a transesophageal echocardiography (TEE) was performed showing a large pediculated vegetation on a bicuspid native aortic valve that extends to the left ventricle (LV) and right atrium (RA) (Figure 2). A high velocity jet was observed across the right atrium simulating pulmonary hypertension. Aortic wall was complicated with an aneurysm. Rest of valves and biventricular function were normal [2].With the diagnosis of Gerbode defect (LV to RA shunt) due to bacterial endocarditis a coronary angiography was done to rule out the presence of coronary disease before cardiac surgery. The aortography showed contrast across the LV to the RA (Figure 3). Streptococcus anginosus was isolated in blood cultures starting antibiotic treatment with ceftriaxone and daptomycin. The patient underwent surgery with cryopreserved homograft implantation of the aortic root with reimplantation of the coronary arteries. After cardia...

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Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas

Cited by 9 publications

References 78 publications

Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt—State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies

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