The Gerbode Defect: The Significance of a Left Ventricular to Right Atrial Shunt

Abstract

The membranous ventriculo-atrial defect can be recognized echocardiographically on the basis of dilation of the right atrium in the setting of an unusually high Doppler echocardiogram gradient compared to the ventricular septal defect with shunting only at ventricular level. Since all patients in our series were symptomatic, we recommend surgical closure of all these defects.

A Rare Type of Gerbode Defect

“…3 In the more common type II defects the basic anatomical defect is a VSD associated with a tricuspid valve defect. Kelle et al 4 in their series noted dilated RA in all patients and the Doppler gradient ranged from 65 mmHg to 150 mm Hg, with a mean gradient of 95 mm Hg. This high Doppler gradient is one of the hallmarks of the Gerbode defect due to the difference between the LV systolic pressure and the low RA pressure.…”

“…3 This gra- dient may be misinterpreted as pulmonary arterial (PA) hypertension. 4 This case illustrates an unusual type of Gerbode defect. 6 Kelle et al also noted that LV-RA shunt causes significant symptoms, and majority have either heart failure, failure to thrive, or exercise intolerance and spontaneous closure of these defects is very rare.…”

Percutaneous Closure of the Acquired Gerbode Shunt Using the Amplatzer Duct Occluder in a 3-Month Old Patient

“…According to the previous reports, there are two routes for blood to travel from the left ventricle to the right atrium 4). The more common, indirect, type of communication occurs via a perimembranous VSD when there is an additional defect in the leaflets of the tricuspid valve.…”

Real-time three-dimensional transesophageal echocardiography of the Gerbode defect

“…In the supravalvular type, communication is located in the atrioventricular portion of the membranous septum, producing a direct shunt of LV-RA [2].…”