Gerbode ventricular septal defect following endocarditis

Abstract

A Gerbode defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. There has been some debate about the existence of such an entity. We present the case of a previously healthy 15-year-old boy who developed bacterial endocarditis following ear piercing and was subsequently found to have a defect between the left ventricle and right atrium, which was successfully repaired surgically.

Infective Endocarditis After Body Art: A Review of the Literature and Concerns

“…Since 1991, at least 22 cases of IE have been associated with piercing of the tongue (seven cases) [10,12,18 -23], ear lobes (six cases) [13,16,17,[24][25][26], navel (five cases) [15,[27][28][29][30], lip (one case) [17], nose (one case) [31], and nipple (one case) [32], and reported in one heavily tattooed male [33] (Table 1). Several other recent cases were presented but further details could not be obtained as patient and physician responses were anonymous [17].…”

“…In addition most IE reports only cited the most recent cases, and rarely included an in-depth, historical perspective. Although only three IE cases were reported from 1991 to 2000 [24,26,31], since 2001 there have been at least two cases of IE published yearly, in 2006 and 2007 there were four [12,13,15,17,25,27,28].…”

“…In seven cases, this was sufficient IE treatment [15,17,22,25,28,31]. Of the known nine individuals with CHD, five had surgical interventions following their IE [16,24,27,30,32,33], whereas one patient declined the recommended treatment [18]. Twelve patients had surgical procedures for mitral (four patients) [10,12,19,20,29], aortic (four patients) [26,27,30,31], triscupsid (one patient) [13] valves, other valvular defects (one patient) [27], ventricular septal defect (one patient) [24], and the Ross procedure (one patient) [21].…”

Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation

“…Acquired defects may also occur, however, following chest trauma, ventricular septal perforation secondary to endocarditis, and after aortic and mitral valve replacement, often above the insertion of the septal leaflet [3,4]. Endocarditis may result in reopening of a congenital defect [5], but unusually in the case described, appeared to have resulted from a post myocardial infarction Gerbode defect.…”

Tricuspid Endocarditis with Indirect Gerbode: Septal Translocation of Posterior Leaflet

“…Gerbode's defect is a rare type of left ventricular to right atrial shunt. The defect is usually congenital but can be acquired after bacterial endocarditis [2,3]. The acquired defect differs from the congenital, as the communication is between the left ventricle and the right atrium above the septal leaflet of the tricuspid valve.…”