Wiener klinische Wochenschrift

, Volume 127, Issue 21–22, pp 884–892 | Cite as

Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas

original article

Summary

Background

The acquired left ventricle-to-right atrium (LV-RA) shunt (Gerbode defect) is rare but it can sometimes be a critical condition. The diagnosis is quite challenging largely due to its exotic anatomic features and diagnostic difficulties. This study aims to present the clinical features and diagnostic solutions of this rare lesion.

Methods

Data source was based on a comprehensive literature retrieval of acquired LV-RA shunts of 1990–2014.

Results

Most of the acquired LV-RA shunts are of either a postoperative or an infective etiology. Transthoracic echocardiography showed a 62.2 % accurate diagnosis, 13.4 % inclusive diagnosis, 9.8 % missed diagnosis, and 14.5 % misdiagnosis rate. The accurate diagnostic rate of transthoracic echocardiography was significantly lower than that of the transesophageal echocardiography or cardiac catheterization. The LV-RA shunts are often misinterpreted as mitral regurgitation, pulmonary hypertension, tricuspid regurgitation, Valsalva aneurysm rupture, and subaortic/high perimembrane/residual ventricular septal defect. Surgical, interventional, and conservative treatments were applied in 57.8, 24.4, and 17.8 % patients, respectively. Prognosis showed an event-free survival of 85 %, a comorbidity of 9.1 %, and a mortality of 13.6 %.

Conclusions

A high jet detected in the right atrium with uncertain origin and course has to appeal to additional diagnostic techniques including transesophageal echocardiography, cardiac catheterization, or cardiac magnetic resonance imaging for differential diagnoses. Small restrictive shunts are preferred with conservative treatments, high-risk patients are candidates of interventional therapy, and the patients with unstable hemodynamics warrant an open heart surgery. Careful operative maneuver, good control of intracardiac infection, preservation of heart function, etc., are mandatory for the prevention of the development of an acquired LV-RA shunt.

Keywords

Congenital heart defects Endocarditis Septal occluder device 

References

  1. 1.
    Gerbode F, Hultgren H, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt: successful surgical repair of defect in five cases with observation of bradycardia on closure. Ann Surg. 1958;148(3):433–6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Vijayalakshmi IB. Device closure of small ventricular septal defects: when and why? BMH Med J. 2014;1(3):56–63. http://www.babymhospital.org/BMH_MJ/index.php/BMHMJ/article/view/33/27. Accessed on November 22, 2013.Google Scholar
  3. 3.
    Riemenschneider TA, Moss AJ. Left ventricular-right atrial communication. Am J Cardiol. 1967;19(5):710–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Demirkol S, Gurkan Yesil F, Bozlar U, Balta S, Sahin MA, Guler A. Multimodality imaging of a congenital Gerbode defect. Kardiol Pol. 2013;71(1):104.PubMedGoogle Scholar
  5. 5.
    Matt P, Winkler B, Gutmann M, Eckstein F. Acquired Gerbode defect after endocarditis. Eur J Cardiothorac Surg. 2009;36(2):402.CrossRefPubMedGoogle Scholar
  6. 6.
    Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(5):676–7.PubMedGoogle Scholar
  7. 7.
    Alphonso N, Dhital K, Chambers J, Shabbo F. Gerbode’s defect resulting from infective endocarditis. Eur J Cardiothorac Surg. 2003;23(5):844–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Álvarez JAG, Alonso JL, Leiva GA, Baglioni P, Fernández Recalde ML, Rivas C, Manuale OD, Migliaro G, Lezica AM, Sciegata A. Unconventional applications of endovascular devices in acquired structural cardiopathies. Rev Argent Cardiol. 2013;81(2):147–51.CrossRefGoogle Scholar
  9. 9.
    Amirghofran AA, Emaminia A. Left ventricular-right atrial communication (Gerbode-type defect) following mitral valve replacement. J Card Surg. 2009;24(4):474–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Aoyagi S, Arinaga K, Oda T, Hori H. Left ventricular-right atrial communication following tricuspid annuloplasty. Eur J Cardiothorac Surg. 2008;34(3):680–1.CrossRefPubMedGoogle Scholar
  11. 11.
    Battin M, Fong LV, Monro JL. Gerbode ventricular septal defect following endocarditis. Eur J Cardiothorac Surg. 1991;5(11):613–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Benisty J, Roller M, Sahar G, Paz R, Vidne B, Sagie A. Iatrogenic left ventricular-right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography. J Heart Valve Dis. 2000;9(5):732–5.PubMedGoogle Scholar
  13. 13.
    Bergman R, Natour E, Wang A, Sakamuri S, Jainandunsing J, Mahmood F. A Gerbode-like defect after infective endocarditis. Anesth Analg. 2013;116(SCA Suppl):1–182.Google Scholar
  14. 14.
    Bochard-Villanueva B, Fabregat-Andrés O, Estornell-Erill J, Payá-Serrano R, Ridocci-Soriano F. Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiography. J Cardiovasc Comput Tomogr. 2012;6(5):355–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Can I, Krueger K, Chandrashekar Y, Li JM, Dykoski R, Tholakanahalli VN. Images in cardiovascular medicine. Gerbode-type defect induced by catheter ablation of the atrioventricular node. Circulation. 2009;119(22):e553–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Carpenter RJ, Price GD, Boswell GE, Nayak KR, Ramirez AR. Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis. J Card Surg. 2012;27(3):316–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Chaturvedi A, Lau R, Kicska G, Reddy GP. MR findings in iatrogenic Gerbode defect. Int J Cardiovasc Imaging. 2013;29(1):3–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Cortez-Dias N, Varela MG, Marques J, Sargento L, Martins S, Ribeiro MA, Almeida AG, Diogo AN, Lopes MG. Acquired left ventricular-to-right atrial shunt (Gerbode defect) due to infective endocarditis. Rev Port Cardiol. 2009;28(6):735–9.PubMedGoogle Scholar
  19. 19.
    Dadkhah R, Friart A, Leclerc JL, Moreels M, Haberman D, Lienart F. Uncommon acquired Gerbode defect (left ventricular to right atrial communication) following a tricuspid annuloplasty without concomitant mitral surgery. Eur J Echocardiogr. 2009;10(4):579–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Dangol A, Bansal M, Al-Khatib Y. Transcatheter closure of acquired left ventricle-to-right atrium shunt: first case report in an infant and review of the literature. Pediatr Cardiol. 2013;34(5):1258–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Doig JC, Au J, Dark JH, Furniss SS. Post-infarction communication between a left ventricular aneurysm and the right atrium. Eur Heart J. 1992;13(7):1006–7.PubMedGoogle Scholar
  22. 22.
    Dores H, Abecasis J, Ribeiras R, Neves JP, Mendes M. Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis. Cardiovasc Ultrasound. 2012;10:7. doi:10.1186/1476-7120-10-7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Dragicevic N, Schmidlin E, Hazelton TR, Nallamshetty L. Gerbode ventricular septal defect diagnosed using cardiac CTA imaging. Radiol Case Rep. 2011;6(3):1–3.CrossRefGoogle Scholar
  24. 24.
    Dzwonczyk T, Davidson WR Jr. The spectrum of left ventricular-right atrial communications in the adult: essentials of echocardiographic assessment. J Am Soc Echocardiogr. 1995;8(3):263–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z. Acquired left ventricular-right atrial communication caused by infective endocarditis detected by transesophageal echocardiography: case report and review of the literature. J Am Soc Echocardiogr. 1995;8(1):108–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Elmistekawy E, Dickie S, Nicholson D, Mesana T. Left ventricular outflow tract-right atrial fistula following aortic valve replacement. J Card Surg. 2012;27(5):570–2.CrossRefPubMedGoogle Scholar
  27. 27.
    Frigg C, Cassina T, Siclari F, Mauri R. Unusual complication after aortic valve replacement. Interact Cardiovasc Thorac Surg. 2008;7(1):149–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Garg R, Garcia R, Cubeddu RJ. Gerbode defect misinterpreted as pulmonary hypertension. J Cardiol Cases. 2013;7(2):e34–6.CrossRefGoogle Scholar
  29. 29.
    Gorki H, Loulmet DF, Lessnau KD. A postoperative Gerbode defect in aortic prosthesis endocarditis with non-typhoid Salmonella. J Heart Valve Dis. 2009;18(3):325–6.PubMedGoogle Scholar
  30. 30.
    Hansalia S, Manda J, Pothineni KR, Nanda NC. Usefulness of live/real time three-dimensional transthoracic echocardiography in diagnosing acquired left ventricular-right atrial communication misdiagnosed as severe pulmonary hypertension by two-dimensional transthoracic echocardiography. Echocardiography. 2009;26(2):224–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Hilberath JN, Shook D, Shernan SK, Rosenberger P. Left ventricular outflow tract to right atrial fistula diagnosed by intraoperative transesophageal echocardiography. Anesth Analg. 2007;104(2):261–2.CrossRefPubMedGoogle Scholar
  32. 32.
    Hole T, Wiseth R, Levang O. Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J. 1995;16(6):866–8.PubMedGoogle Scholar
  33. 33.
    Holy EW, Hufschmid U, Friedli BC. Acquired Gerbode defect following valve-sparing surgical repair of acute aortic type A dissection. Rare cardiac emergencies and other rarities: clinical cases part II, Freitag, 14. Juni 2013, 11:00–11:15. http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=172973&XNSPRACHE_ID=1&XNKONGRESS_ID=188&XNMASKEN_ID=900. Accessed on November 22, 2013.
  34. 34.
    Hori D, Tanaka M, Yamaguchi A, Adachi H. Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Gerbode defect. Gen Thorac Cardiovasc Surg. 2010;58(5):255–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Hsu SY, Shen TC. A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging. 2014;15(4):471.CrossRefPubMedGoogle Scholar
  36. 36.
    Hussain ST, Mawulawde K, Kapadia SR, Blackstone EH, Pettersson GB. Lessons learned from failed attempt at transcatheter closure of postoperative Gerbode defect. J Thorac Cardiovasc Surg. 2014;148(5):e228–30.Google Scholar
  37. 37.
    Inoue H, Iguro Y, Kinjo T, Matsumoto H, Yotsumoto G, Sakata R. Acquired left ventricular-right atrial communication and severe aortic valve regurgitation caused by infective endocarditis. Thorac Cardiovasc Surg. 2009;57(1):54–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Jainandunsing JS, Bergman R, Wilkens J, Wang A, Michielon G, Natour E. Ventriculo-atrial defect after bioprosthetic aortic valve replacement. J Cardiothorac Surg. 2014;9(1):137.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y, Dewilde J, Barra JA, Blanc JJ, Boschat J. Postinfarction atrioventricular septal rupture. J Am Soc Echocardiogr. 1997;10(6):680–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Joyce ES, McCarthy PM, Stewart WJ, Tomford JW, Rehm SJ, Heupler F A, Trohman RG. Left ventricular to right atrial fistula after aortic homograft replacement for endocarditis. Eur J Cardiothorac Surg. 1994;8(2):100–2.CrossRefPubMedGoogle Scholar
  41. 41.
    Karaci AR, Aydemir NA, Harmandar B, Sasmazel A, Saritas T, Tuncel Z, Yekeler I. Surgical treatment of infective valve endocarditis in children with congenital heart disease. J Card Surg. 2012;27(1):93–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Katta S, Akosah K, Stambler B, Salter D, Guerraty A, Mohanty PK. Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient. J Am Soc Echocardiogr. 1994;7(4):405–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Katz ES, Tunick PA, Kronzon I. To-and-fro left ventricular-to-right atrial shunting after valve replacement shown by transesophageal echocardiography. Am Heart J. 1991;121(1 Pt 1):211–4.CrossRefPubMedGoogle Scholar
  44. 44.
    Kautzner J, Munclinger MJ, Kozáková M. Acquired left ventricular-right atrial and right ventricular communication due to infective endocarditis after aortic valve replacement. Am Heart J. 1990;120(5):1233–4.CrossRefPubMedGoogle Scholar
  45. 45.
    Kumar PA, Sale S, Arora H, Petterson G. Acquired “Gerbode-like” defect in aortic valve endocarditis: an imposter for tricuspid regurgitation? J Cardiothorac Vasc Anesth. 2011;25(4):751–2.CrossRefPubMedGoogle Scholar
  46. 46.
    Lax D, Bhatt RD, Klewer SE, Sorrell VL. Are all ventricular septal defects created equal? J Am Soc Echocardiogr. 2010;23(7):791.e5–7.CrossRefGoogle Scholar
  47. 47.
    Lee SY, Song JY, Baek JS. Percutaneous closure of the acquired Gerbode shunt using the Amplatzer duct occluder in a 3-month old patient. Korean Circ J. 2013;43(6):429–31.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Lorber A, Nair P, Gruberg L. Transcatheter closure of acquired Gerbode defect following mitral valve replacement using the Amplatzer duct occluder. J Invasive Cardiol. 2006;18(10):E264–6.PubMedGoogle Scholar
  49. 49.
    Matt P, Winkler B, Carrel T, Eckstein F. Plicated patch repair for acquired Gerbode defect involving the tricuspid valve. Ann Thorac Surg. 2010;89(2):643–5.CrossRefPubMedGoogle Scholar
  50. 50.
    Mendoza DD, Wang Z, Gaglia MA, Taylor AJ. Gerbode defect. J Cardiovasc Comput Tomogr. 2009;3(4):279–81.CrossRefPubMedGoogle Scholar
  51. 51.
    Michel C, Rabinovitch MA, Huynh T. Sinus node dysfunction as a complication of Gerbode’s defect associated with acute infective endocarditis. Heart. 1996;76(4):379.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Moaref AR, Aslani A, Zamirian M, Sharifkazemi MB. Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement. J Am Soc Echocardiogr. 2008;21(4):408.e1–2.CrossRefGoogle Scholar
  53. 53.
    Mohapatra S, Minhas HS, Virmani S, Mishra BB, Mukherjee K, Banerjee A. Acquired left atrial-to-right ventricular shunt with mitral valve incompetence: a rare sequela after repair of atrioventricular septal defect. Tex Heart Inst J. 2009;36(1):69–71.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Mousavi N, Shook DC, Kilcullen N, Aranki S, Kwong RY, Landzberg MJ, Blankstein R. Multimodality imaging of a Gerbode defect. Circulation. 2012;126(1):e1–2.CrossRefPubMedGoogle Scholar
  55. 55.
    Neuss M, Meyhofer J, Butter C. Interventional closure of a postoperative left ventricular, right atrial fistula. EuroPCR Case Corner: Interactive Case Corner 25. http://www.pcronline.com/Lectures/2012/EuroPCR-Case-Corner/Interventional-closure-of-a-postoperative-left-ventricular-right-atrial-fistula. Accessed on November 22, 2013.
  56. 56.
    Newman JN Jr., Rozanski L, Kreulen T. Acquired left ventricular to right atrial intracardiac shunt after myocardial infarction: a case report and review of the literature. J Am Soc Echocardiogr. 1996;9(5):716–20.CrossRefPubMedGoogle Scholar
  57. 57.
    Ota T, Yamaguchi R, Tanigawa T, Otuka K, Hayashi Y, Nishiyama H, Tsumori T, Kamimori K, Yanagi S, Ishikawa I. Left ventricular–right atrial communication by perforation of the atrioventricular portion of the membranous septum and severe aortic valve regurgitation caused by infective endocarditis. J Echocardiogr. 2011;9(1):30–2.CrossRefGoogle Scholar
  58. 58.
    Ozdogan O, Cinar CS. Left ventricle-right atrium communication along with a membranous septum aneurysm. J Cardiovasc Med (Hagerstown). 2012;13(9):597–9.CrossRefGoogle Scholar
  59. 59.
    Ozeke O, Celik E, Grbovic E, Colak A, Dogan P, Tufekcioglu O, Golbasi Z, Kisacik HL. Delayed left ventricular-to-right atrial communication (acquired Gerbode defect) after aortic valve replacement. Herz. 2015;40(1):157–8.Google Scholar
  60. 60.
    Pillai V, Menon S, Kottayil B, Karunakaran J. Tricuspid endocarditis with indirect Gerbode: septal translocation of posterior leaflet. Heart Lung Circ. 2011;20(6):362–4.CrossRefPubMedGoogle Scholar
  61. 61.
    Portet N, Riu B, Bounes V, Minville V, Fourcade O. Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma. J Emerg Med. 2012;43(6):e385–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Primus C, Grabscheit G, Ng CK, Auer J. Unusual cause of dyspnoea: a case presentation of an echocardiographic pitfall. J Cardiothorac Surg. 2013;8:230. doi:10.1186/1749-8090-8-230.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Pursnani AK, Tabaksblat M, Saric M, Perk G, Loulmet D, Kronzon I. Acquired Gerbode defect after aortic valve replacement. J Am Coll Cardiol. 2010;55(25):e145.CrossRefPubMedGoogle Scholar
  64. 64.
    Raja Y, Jenkins N, Chauhan A, Millner RW. Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation. Int J Cardiol. 2006;113(3):E79–80.CrossRefPubMedGoogle Scholar
  65. 65.
    Rothman A, Galindo A, Channick R, Blanchard D. Amplatzer device closure of a tortuous Gerbode (left ventricle-to-right atrium) defect complicated by transient hemolysis in an octogenarian. J Invasive Cardiol. 2008;20(9):E273–6.PubMedGoogle Scholar
  66. 66.
    Saiki Y, Kawase M, Ida T, Mannouji E, Kasegawa H, Takahashi Y, Kikuchi T, Tatsuno K. The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: report of a case. Surg Today. 1994;24(7):655–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Scully RE, Mark EJ, McNeely WF, Ebeling SH. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1998. New Engl J Med. 1998;393(20):1457–65.Google Scholar
  68. 68.
    Sharma AK, Chander R, Singh JP. AV nodal ablation-induced Gerbode defect (LV-RA Shunt). J Cardiovasc Electrophysiol. 2011;22(11):1288–9.CrossRefPubMedGoogle Scholar
  69. 69.
    Shen WK, Khandheria BK. Transesophageal echocardiography: detection of an acquired left ventricular-right atrial shunt. J Am Soc Echocardiogr. 1991;4(2):199–202.CrossRefPubMedGoogle Scholar
  70. 70.
    Shih R, Shook D, Mousavi N, Aranki S. [-59] Diagnosis and management of acquired Gerbode defect after reoperative aortic valve. http://www.scahq.org/sca3/events/2012/annual/syllabus/submissions/postersandabstracts/SCA-59.pdf. Accessed. on January 23, 2014.
  71. 71.
    Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M. The Gerbode defect: left ventricular to right atrial communication-anatomic, hemodynamic, and echocardiographic features. Echocardiography. 2009;26(8):993–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Sinisalo J, Sreeram N, Qureshi SA. Transcatheter closure of acquired left ventricle to right atrium shunts. Catheter Cardiovasc Interv. 2013;82(6):E809–14.CrossRefPubMedGoogle Scholar
  73. 73.
    Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(6):801–2.PubMedGoogle Scholar
  74. 74.
    Taskesen T, Goldberg SL, Gill EA. Role of three-dimensional echocardiography in management of acquired intracardiac shunts. Echocardiography. 2014;31(8):E250–3.CrossRefPubMedGoogle Scholar
  75. 75.
    Tatewaki H, Alesnik J, Morales D. Acquired left ventricle to right atrial shunt (Gerbode defect) and massive pulmonary embolus. http://www.ctsnet.org/sections/clinicalresources/clinicalcases/article-14. Accessed on November 22, 2013.
  76. 76.
    Toprak C, Kahveci G, Akpinar S, Tabakçi MM, Güler Y. Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis. Echocardiography. 2013;30(8):E231–5.CrossRefPubMedGoogle Scholar
  77. 77.
    Trehan V, Ramakrishnan S, Goyal NK. Successful device closure of an acquired Gerbode defect. Catheter Cardiovasc Interv. 2006;68(6):942–5.CrossRefPubMedGoogle Scholar
  78. 78.
    Uslu N, Kayacioglu I, Ates M, Eren M. ‘Acquired’ left ventricular to right atrial shunt after mitral valve replacement: detection by transthoracic colour Doppler echocardiography. Can J Cardiol. 2007;23(9):735–6.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Vallakati A, Nerella N, Lodha A, Sadiq A, Shani J. Unusual presentation of Gerbode defect. Tex Heart Inst J. 2012;39(3):446–7.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Velebit V, Schöneberger A, Ciaroni S, Bloch A, Maurice J, Christenson JT, Simonet F, Schmuziger M. “Acquired” left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis. Tex Heart Inst J. 1995;22(1):100–2.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Venkatesh G, Lonn EM, Holder DA, Williams WG, Mulji A. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma. Can J Cardiol. 1996;12(4):349–52.PubMedGoogle Scholar
  82. 82.
    Wasserman SM, Fann JI, Atwood JE, Burdon TA, Fadel BM. Acquired left ventricular-right atrial communication: Gerbode-type defect. Echocardiography. 2002;19(1):67–72.CrossRefPubMedGoogle Scholar
  83. 83.
    Watanabe A, Kazui T, Tsukamoto M, Komatsu S. Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis. Ann Thorac Surg. 1993;55(5):1236–9.CrossRefPubMedGoogle Scholar
  84. 84.
    Weinrich M, Graeter TP, Langer F, Schäfers HJ. Left ventricular-right atrial fistula complicating redo mitral valve replacement. Ann Thorac Surg. 2001;71(1):343–5.CrossRefPubMedGoogle Scholar
  85. 85.
    Winslow TM, Friar DA, Larson AW, Barry MJ. A rare complication of aortic valve endocarditis: diagnosis with transesophageal echocardiography. J Am Soc Echocardiogr. 1995;8(4):546–50.CrossRefPubMedGoogle Scholar
  86. 86.
    Xhabija N, Prifti E, Allajbeu I, Sula F. Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension. Cardiovasc Ultrasound. 2010;8:44.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Xin W, Hong T. GW24-e3091: The perioperative role of the echocardiography in left ventricular-right atrium shunt (Gerbode defect). Heart. 2013;99:A265. doi:10.1136/heartjnl-2013-304613.748.CrossRefGoogle Scholar
  88. 88.
    Yared K, Solis J, Passeri J, King ME, Levine RA. Three-dimensional echocardiographic assessment of acquired left ventricular to right atrial shunt (Gerbode defect). J Am Soc Echocardiogr. 2009;22(4):435.e1–3.CrossRefPubMedCentralGoogle Scholar
  89. 89.
    Yoo YP, Kang KW, Yoon HS, Yoo S, Lee MS. Infective endocarditis caused by Neisseria elongata on a native tricuspid valve and confirmed by DNA sequencing. Tex Heart Inst J. 2014;41(2):227–30.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Yurdakul S, Tayyareci Y, Sezgiç M, Aytekin S. Case images: acquired Gerbode type ventricular septal defect after aortic valve replacement. Turk Kardiyol Dern Ars. 2012;40(5):471.CrossRefPubMedGoogle Scholar
  91. 91.
    Zhu D, Liu B, Tang H. Intraoperative device closure of acquired left ventricular-right atrium shunt in a pediatric patient with pulmonary hypertension. J Card Surg. 2012;27(2):235–7.CrossRefPubMedGoogle Scholar
  92. 92.
    Rajiah P, Kanne JP. Cardiac MRI: Part 1, cardiovascular shunts. AJR Am J Roentgenol. 2011;197(4):W603–20.CrossRefPubMedGoogle Scholar
  93. 93.
    Panduranga P, Mukhaini M. A rare type of Gerbode defect. Echocardiography. 2011;28(6):E118–20.CrossRefPubMedGoogle Scholar
  94. 94.
    Millan R, Pericas P, Forteza JF, Rodriguez A, Pascual M, Vidal L, Bonnin O, Bethencourt A. Real-time three-dimensional transesophageal echocardiography of the Gerbode defect. Int J Cardiol. 2012;157(3):e52–3.CrossRefPubMedGoogle Scholar
  95. 95.
    Wu MH, Wang JK, Lin MT, Wu ET, Lu FL, Chiu SN, Lue HC. Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure. Pediatrics. 2006;117(2):e262–7.CrossRefPubMedGoogle Scholar
  96. 96.
    Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr., Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833.CrossRefPubMedGoogle Scholar

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© Springer-Verlag Wien 2015

Authors and Affiliations

  1. 1.Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching HospitalFujian Medical UniversityPutianPeople’s Republic of China

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