Intraoperative Transesophageal Echocardiographic Detection of a Gerbode Defect in a Patient Referred for Aortic Valve Endocarditis: A Case Report

Abstract

This clinical challenge discusses a case in which a patient was referred for aortic valve repair or replacement due to severe aortic regurgitation from infective endocarditis. In addition to discovering a previously unknown tricuspid valve vegetation, the intraoperative echocardiographic evaluation was instrumental in revealing an undiagnosed Gerbode defect. The flow through this Gerbode defect was previously mistaken for tricuspid regurgitation, and the patient was misdiagnosed as exhibiting severe pulmonary hypertension. This case highlights the importance of reviewing preoperative echocardiographic imaging, as well as diligence in completing a thorough intraoperative transesophageal echocardiographic exam prior to cardiopulmonary bypass. In addition, while flow typically occurs in Gerbode defects during systole, this case demonstrates that flow can also occur during diastole, which was most likely due to the severe aortic regurgitation. Fortunately, the patient was able to undergo successful treatment for the unexpected sequalae of the infective endocarditis, including repair of the Gerbode defect, tricuspid valve repair, and aortic valve and root replacement. Importantly, the incorrect diagnosis of severe pulmonary hypertension was removed.

Gerbode Defect—Multimodality Imaging

“…1,2 A Gerbode defect can be classified according to its location-supravalvular (superior to the septal leaflet of the tricuspid valve) or infravalvular (inferior but through the septal leaflet of the tricuspid valve). [3][4][5] In our case, the flow through the Gerbode defect was previously mistaken for tricuspid regurgitation. This case highlights the importance of multimodality imaging to reveal such misdiagnosed findings.…”

Cardiothoracic Anesthesiology: Novel Milestone and Renewed Opportunities

“…23 Fernando et al present a case of infectious endocarditis presenting with an incidental finding of perforation and shunting between the LV and right atrium (Gerbode defect). 24 These unique cases provide the reader with some insight into the clinical management of uncommon clinical situations.…”