Unusual cause of dyspnoea: a case presentation of an echocardiographic pitfall

Abstract

Congenital or acquired communication between the left ventricle and the right atrium is known as the Gerbode defect, which is rarely diagnosed since the defect is very unusual and for this reason often misinterpreted as an eccentric tricuspid regurgitation jet.The entity and reason of the defect is unknown to many physicians, so that profound knowledge and a careful and meticulous echocardiogram are necessary in order to prevent misinterpretation of this defect as a pulmonary hypertension.We report the case of a 76-year-old Austrian woman who developed such a Gerbode defect after a recent bioprosthetic aortic valve replacement.

Expert review Left ventricular to right atrial shunt (Gerbode defect): congenital versus acquired

“…Aetiologies of the LV-RA shunts were congenital in 32 (26.4%) cases [ 6 , 7 , 9 – 28 , 30 – 32 ], acquired in 88 (72.7%) cases [ 2 , 3 , 7 , 8 , 18 , 31 , 33 – 68 , 70 – 90 , 92 , 94 – 104 , 106 – 108 , 110 , 111 ] and unknown in 1 (0.8%) patient [ 112 ], respectively. A significant difference was noted in the percentages between congenital and acquired LV-RA shunts (χ 2 = 52.3, p < 0.0001).…”

“…The retrieval resulted in a collection of 111 articles [ 2 – 113 ], which included 77 (59.3%) case reports [ 3 , 5 – 7 , 9 , 12 – 14 , 16 , 17 , 19 – 23 , 25 – 28 , 30 , 33 , 35 – 37 , 39 , 42 , 44 – 54 , 57 , 59 – 61 , 63 – 67 , 71 , 76 – 80 , 82 , 84 – 89 , 92 – 97 , 99 – 107 , 110 – 112 ] (including 8 (7.4%) case reports in the name of “letter to the editor” [ 5 , 25 , 26 , 30 , 79 , 84 , 92 , 111 ]), 17 (17.6%) medical images [ 2 , 10 , 11 , 15 , 22 , 32 , 40 , 41 , 43 , 58 , 69 , 70 , 72 , 74 , 98 , 108 , 109 ], 5 (4.6%) case series [ 8 , 18 , 34 , 38 ...…”

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

“…Surgical closure represents the conventional and well-established method of treatment for all types of Gerbode defects, presenting with positive outcomes as well as low morbidity and mortality, but requires open-heart surgery with cardiopulmonary bypass and cardioplegic diastolic arrest [ 31 , 40 , 69 , 70 ]. In the case of a smaller defect, a direct suture repair may be possible, whereas extended defects require the insertion of a pericardial or synthetic patch on the right atrial side in order to reduce the risk of recurrence and to prevent complications such as atrioventricular block [ 12 , 53 , 67 ].…”

“…Potential sequelae of surgical closure include infection, postoperative bleeding, valve injury, pulmonary hypertension with poor cardiac output, atrial tachycardia, arrhythmias, and complete heart block. Improved surgical techniques and intraoperative real-time monitoring by TTE have increased the rate of success and decreased the rate of complications [ 46 , 69 ].…”

Percutaneous closure of congenital Gerbode defect using Nit-Occlud® Lê VSD coil

“…The sonographer should meticulously look for Gerbode defect if physical examination suspects VSD but echocardiography can not detect any high velocity flow or aliasing in the right ventricle. The presence of normal diastolic pulmonary arterial pressure using pulmonic regurgitation jet is also very useful to distinguish the true pulmonary arterial hypertension from high velocity jet in the RA caused by Gerbode defect[ 4 , 5 ]. Actually, only about 2/3 of the LV-RA shunts of either congenital or acquired origin can be well diagnosed with TTE[ 6 ].…”