Percutaneous closure of an acquired and iatrogenic left ventricular–right atrium communication (Gerbode defect) with an Amplatzer Vascular Plug II

Abstract

Gerbode defect is defined as an abnormal left ventricle–right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and <1% of the congenital heart diseases. The acquired defect can be classified as iatrogenic or non-iatrogenic, with previous cardiac surgery being the most common cause. Gerbode defect is classified depending on its position with respect to the tricuspid valve in supravalvular, infravalvular, or intermediate. Our purpose was to report a rare case of an iatrogenic and acquired Gerbode defect in a 10-year-old male patient following surgical correction of a partial anomalous pulmonary venous return of the right pulmonary veins to the right atrium. The defect was successfully closed percutaneously with an Amplatzer™ Vascular Plug II device. Percutaneous closure of acquired Gerbode defects could be considered as a good option using soft devices to reduce the possibility of severe complications such as complete heart block due to the location of the defect.<Learning objective: Transesophageal echocardiography has a high sensitivity for detection of left ventricle-right atrium shunts; however, it is often difficult to diagnose the anatomic location, relationships of the shunt, and also to distinguish left ventricle–right atrium shunt from sinus of Valsalva rupture, endocardial cushion defect, ventricular septal defect, and tricuspid regurgitation (high flow velocity shunts may also be misinterpreted as pulmonary hypertension). Percutaneous closure of Gerbode defects using soft devices could be considered a good alternative to surgical repair.>