Abstract
A Gerbode -type defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis. This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. However, identification of an actual communication is often extremely difficult, so a careful and meticulous echocardiogram should be done in order to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension. The large systolic pressure gradient between the left ventricle and the right atrium would expectedly result in a high velocity systolic Doppler flow signal in right atrium and it can be sometimes mistakably diagnosed as tricuspid regurgitant jet simulating pulmonary arterial hypertension.We present a rare case of young woman, with endocarditis who presented with severe pulmonary arterial hypertension. The preoperative diagnosis of left ventricle to right atrial communication (acquired Gerbode defect) was suspected initially by echocardiogram and confirmed at the time of the surgery.A point of interest, apart from the diagnostic problem, was the explanation for its mechanism and presentation. The probability of a bacterial etiology of the defect is high in this case.
Highlights
Gerbode’s defect is a rare form of VSD that allows for communication between the LV and RA
We present a case of our patient with this uncommon complication of endocarditis, simulating severe pulmonary hypertension
On closer inspection and careful review of her echocardiogram, we visualized a clear jet across a small defect between left ventricle and right atrium consistent with Gerbode type defect with a small VSD located at the same level (Additional file 3: video S3; Additional file 4: Video S4)
Summary
Gerbode’s defect is a rare form of VSD that allows for communication between the LV and RA. The patient came to us for further investigation and an echocardiogram was repeated at our institution and reviewed in detail It demonstrated normal valves and cardiac chambers, and demonstrated a large, irregularly shaped, oscillating and highly mobile vegetation in the RA located above to the tricuspid valve septal leaflet (figure 1B and 2). On closer inspection and careful review of her echocardiogram, we visualized a clear jet across a small defect between left ventricle and right atrium consistent with Gerbode type defect with a small VSD located at the same level (Additional file 3: video S3; Additional file 4: Video S4). The direction of the Doppler signal leads to the true diagnosis (figure 1C) This defect was the cause of high velocity jet in the right atrium simulating pulmonary arterial hypertension, probably due to the summation of tricuspid regurgitation(TR) and Gerbode defect (figure 1A). Echocardiogram demonstrated trivial tricuspid valve regurgitation and no residual shunt
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