Gerbode defect: Another nail for the 3D transesophagel echo hammer?

  • Tuncay Taskesen
  • Andrew Fred Prouse
  • Steven Lewis Goldberg
  • Edward Allen Gill
Review Paper


Acquired type of LV to RA shunt (Gerbode defect) is rare form of intracardiac shunt which is due to complications of invasive cardiac procedures, endocarditis, trauma or myocardial infarction. Increasing invasive and recurrent cardiovascular procedures have led to more acquired cases of what used to be a predominant congenital heart defect. Advanced cardiac imaging techniques and awareness of this rare pathology may account for the increased number of case reports in the last two decades Advanced cardiac imaging tools such as cardiac CT, MRI and Real-time 3D echocardiography provide definitive diagnosis and anatomic characterization of the shunt. Real-time 3D echocardiography is an imaging technique with arguably the most advantages. It is not only a diagnostic tool; it has also become an integral part of percutaneous and surgical treatment. Although surgical repair is the usual treatment for this shunt, percutaneous catheter-based closure has seen significant success as a less invasive treatment in selected patients in the last decade. In summary, a beneficial side effect of the increasing frequency of acquired Gerbode defect has been the corresponding development of newer diagnostic tools and less invasive treatments. This article presents etiologic, diagnostic and treatment changes of acquired LVRA shunts over the last two decades.


LV–RA shunt 3D Echocardiography Gerbode defect Tricuspid valve Ventriculoatrial shunt 



Acquired Gerbode defect


Acquired iatrogenic Gerbode defect


Acquired noniatrogenic Gerbode defect


Computer tomography






Left ventricle


Myocardial infarction


Magnetic resonance imaging


Transthoracic echocardiography


Transesophageal echocardiography


Right atrium


  1. 1.
    Laurichesse J, Ferrane J, Renais J, Scebat L, Lenegre J (1964) Communication between the left ventricle and the right auricle. Arch Mal Coeur Vaiss 57:703–724PubMedGoogle Scholar
  2. 2.
    Thurman J (1838) Aneurysms of the heart. Med Clin Trans R 21:187Google Scholar
  3. 3.
    Gerbode F, Hultgren H, Melrose D, Osborn J (1958) Syndrome of left ventricular–right atrial shunt: successful surgical repair of defect in five cases, with observation of bradycardia on closure. Ann Surg 148:433–446CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Riemenschneider TA, Moss AJ (1967) Left ventricular–right atrial communication. Am J Cardiol 19:710–718CrossRefPubMedGoogle Scholar
  5. 5.
    Perry EL, Burchell HB, Edwards JE (1949) Congenital communication between the left ventricle and the right atrium; co-existing ventricular septal defect and double tricuspid orifice. Proc Staff Meet Mayo Clin 24:198–206PubMedGoogle Scholar
  6. 6.
    Leung MP, Mok CK, Lo RN, Lau KC (1986) An echocardiographic study of perimembranous ventricular septal defect with left ventricular to right atrial shunting. Br Heart J 55:45–52CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Acar P, Seguela PE, Hascoet S (2011) The Gerbode defect or left ventricular to right atrial shunt assessed by transthoracic 3D echocardiography. Echocardiography 28:E140–E142CrossRefPubMedGoogle Scholar
  8. 8.
    Burrows PE, Fellows KE, Keane JF (1983) Cineangiography of the perimembranous ventricular septal defect with left ventricular–right atrial shunt. J Am Coll Cardiol 1:1129–1134CrossRefPubMedGoogle Scholar
  9. 9.
    Sinisalo JP, Sreeram N, Jokinen E, Qureshi SA (2011) Acquired left ventricular–right atrium shunts. Eur J Cardiothorac Surg 39:500–506CrossRefPubMedGoogle Scholar
  10. 10.
    Katta S, Akosah K, Stambler B, Salter D, Guerraty A, Mohanty PK (1994) Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient. J Am Soc Echocardiogr 7:405–409CrossRefPubMedGoogle Scholar
  11. 11.
    Dzwonczyk T, Davidson WR Jr (1995) The spectrum of left ventricular–right atrial communications in the adult: essentials of echocardiographic assessment. J Am Soc Echocardiogr 8:263–269CrossRefPubMedGoogle Scholar
  12. 12.
    Benisty J, Roller M, Sahar G, Paz R, Vidne B, Sagie A (2000) Iatrogenic left ventricular–right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography. J Heart Valve Dis 9:732–735PubMedGoogle Scholar
  13. 13.
    Weinrich M, Graeter TP, Langer F, Schafers HJ (2001) Left ventricular–right atrial fistula complicating redo mitral valve replacement. Ann Thorac Surg 71:343–345CrossRefPubMedGoogle Scholar
  14. 14.
    Fukui T, Shimizu Y, Takanashi S, Nishizawa K, Minamimura H, Hattori K et al (2000) A case of left ventricular rupture and left ventricular–right atrial communication after mitral valve re-replacement. Jpn J Thorac Surg 53:60–63Google Scholar
  15. 15.
    Saiki Y, Kawase M, Ida T, Mannouji E, Kasegawa H, Takahashi Y et al (1994) 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 24:655–658CrossRefPubMedGoogle Scholar
  16. 16.
    Katoh J, Okabe H, Ujiie T, Edamoto Y, Murakami H, Sakurai M et al (1994) A case report of left ventricular–right atrial communication with tricuspid regurgitation due to infective endocarditis. Jpn J Thorac Surg 47:228–231Google Scholar
  17. 17.
    Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z (1995) 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 8:108–110CrossRefPubMedGoogle Scholar
  18. 18.
    Velebit V, Schoneberger A, Ciaroni S, Bloch A, Maurice J, Christenson JT et al (1995) “Acquired” left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis. Tex Heart Inst J 22:100–102PubMedCentralPubMedGoogle Scholar
  19. 19.
    Winslow TM, Friar DA, Larson AW, Barry MJ (1995) A rare complication of aortic valve endocarditis: diagnosis with transesophageal echocardiography. J Am Soc Echocardiogr 8:546–550CrossRefPubMedGoogle Scholar
  20. 20.
    Michel C, Rabinovitch MA, Huynh T (1996) Gerbode’s defect associated with acute sinus node dysfunction as a complication of infective endocarditis. Heart 76:379CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Alphonso N, Dhital K, Chambers J, Shabbo F (2003) Gerbode’s defect resulting from infective endocarditis. Eur J Cardiothorac Surg 23:844–846CrossRefPubMedGoogle Scholar
  22. 22.
    Newman JN Jr, Rozanski L, Kreulen T (1996) Acquired left ventricular to right atrial intracardiac shunt after myocardial infarction: a case report and review of the literature. J Am Soc Echocardiogr 9:716–720CrossRefPubMedGoogle Scholar
  23. 23.
    Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y et al (1997) Postinfarction atrioventricular septal rupture. J Am Soc Echocardiogr 10:680–684CrossRefPubMedGoogle Scholar
  24. 24.
    Hole T, Wiseth R, Levang O (1995) Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J 16:866–868PubMedGoogle Scholar
  25. 25.
    Venkatesh G, Lonn EM, Holder DA, Williams WG, Mulji A (1996) Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma. Can J Cardiol 12:349–352PubMedGoogle Scholar
  26. 26.
    Selinger L, Werner K, Silber R, Nellessen U, Inselmann G (1998) Natural history of a ventriculoatrial fistula after a gunshot injury in 1945. Ann Thorac Surg 65:1137–1138CrossRefPubMedGoogle Scholar
  27. 27.
    Wasserman SM, Fann JI, Atwood JE, Burdon TA, Fadel BM (2002) Acquired left ventricular–right atrial communication: Gerbode-type defect. Echocardiography 19:67–72CrossRefPubMedGoogle Scholar
  28. 28.
    Cabalka AK, Hagler DJ, Mookadam F, Chandrasekaran K, Wright RS (2005) Percutaneous closure of left ventricular-to-right atrial fistula after prosthetic mitral valve replacement using the Amplatzer duct occluder. Catheter Cardiovasc Interv 64:522–527CrossRefPubMedGoogle Scholar
  29. 29.
    Lorber A, Nair P, Gruberg L (2006) Transcatheter closure of acquired Gerbode defect following mitral valve replacement using the Amplatzer duct occluder. J Invasive Cardiol 18:E264–E266PubMedGoogle Scholar
  30. 30.
    Ramasubbu K, Coselli J, Zoghbi WA (2006) Unusual complication of aortic root reconstruction with sparing of the aortic valve: left ventricular outflow tract to right atrial fistula. J Am Soc Echocardiogr 19(469):e5–e9PubMedGoogle Scholar
  31. 31.
    Trehan V, Ramakrishnan S, Goyal NK (2006) Successful device closure of an acquired Gerbode defect. Catheter Cardiovasc Interv 68:942–945CrossRefPubMedGoogle Scholar
  32. 32.
    Martinez MW, Mookadam F, Sun Y, Hagler DJ (2007) Transcatheter closure of ischemic and post-traumatic ventricular septal ruptures. Catheter Cardiovasc Interv 69:403–407CrossRefPubMedGoogle Scholar
  33. 33.
    Frigg C, Cassina T, Siclari F, Mauri R (2008) Unusual complication after aortic valve replacement. Interact Cardiovasc Thorac Surg 7:149–150CrossRefPubMedGoogle Scholar
  34. 34.
    Moaref AR, Aslani A, Zamirian M, Sharifkazemi MB (2008) Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement. J Am Soc Echocardiogr 21(408):e1–e2Google Scholar
  35. 35.
    Rothman A, Galindo A, Channick R, Blanchard D (2008) Amplatzer device closure of a tortuous Gerbode (left ventricle-to-right atrium) defect complicated by transient hemolysis in an octogenarian. J Invasive Cardiol 20:E273–E276PubMedGoogle Scholar
  36. 36.
    Hansalia S, Manda J, Pothineni KR, Nanda NC (2009) 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 26:224–227CrossRefPubMedGoogle Scholar
  37. 37.
    Subramaniam K, Wei L (2009) Left ventricular outflow tract to right atrial fistula after aortic valve replacement. J Cardiothorac Vasc Anesth 23:360–363CrossRefPubMedGoogle Scholar
  38. 38.
    Amirghofran AA, Emaminia A (2009) Left ventricular–right atrial communication (Gerbode-type defect) following mitral valve replacement. J Card Surg 24:474–476CrossRefPubMedGoogle Scholar
  39. 39.
    Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M (2009) The Gerbode defect: left ventricular to right atrial communication—anatomic, hemodynamic, and echocardiographic features. Echocardiography 26:993–998CrossRefPubMedGoogle Scholar
  40. 40.
    Cheema OM, Patel AA, Chang SM, Shah DJ (2009) Gerbode ventricular septal defect diagnosed at cardiac MR imaging: case report. Radiology 252:50–52CrossRefPubMedGoogle Scholar
  41. 41.
    Can I, Krueger K, Chandrashekar Y, Li JM, Dykoski R, Tholakanahalli VN (2009) Images in cardiovascular medicine. Gerbode-type defect induced by catheter ablation of the atrioventricular node. Circulation 119:e553–e556CrossRefPubMedGoogle Scholar
  42. 42.
    Hussain ST, Mawulawde K, Kapadia SR, Blackstone EH, Pettersson GB (2014) Lessons learned from failed attempt at transcatheter closure of postoperative Gerbode defect. J Thorac Cardiovasc Surg 148(5):e228–e230. doi:10.1016/j.jtcvs.2014.06.077
  43. 43.
    Dadkhah R, Friart A, Leclerc JL, Moreels M, Haberman D, Lienart F (2009) Uncommon acquired Gerbode defect (left ventricular to right atrial communication) following a tricuspid annuloplasty without concomitant mitral surgery. Eur J Echocardiogr 10:579–581CrossRefPubMedGoogle Scholar
  44. 44.
    Sun X, Yang C, Zhou G, Wang C (2010) Acquired left ventricular–right atrial communication following mitral valve replacement. J Heart Valve Dis 19:676–677PubMedGoogle Scholar
  45. 45.
    Sun X, Yang C, Zhou G, Wang C (2010) Acquired left ventricular–right atrial communication following mitral valve replacement. J Heart Valve Dis 19:801–802PubMedGoogle Scholar
  46. 46.
    Pursnani AK, Tabaksblat M, Saric M, Perk G, Loulmet D, Kronzon I (2010) Acquired Gerbode defect after aortic valve replacement. J Am Coll Cardiol 55:e145CrossRefPubMedGoogle Scholar
  47. 47.
    Zhu D, Liu B, Tang H (2012) Intraoperative device closure of acquired left ventricular–right atrium shunt in a pediatric patient with pulmonary hypertension. J Card Surg 27:235–237CrossRefPubMedGoogle Scholar
  48. 48.
    Sharma AK, Chander R, Singh JP (2011) AV nodal ablation-induced Gerbode defect (LV–RA Shunt). J Cardiovasc Electrophysiol 22:1288–1289CrossRefPubMedGoogle Scholar
  49. 49.
    Chaturvedi A, Lau R, Kicska G, Reddy GP (2013) MR findings in iatrogenic Gerbode defect. Int J Cardiovasc Imaging 29:3–4CrossRefPubMedGoogle Scholar
  50. 50.
    Vallakati A, Nerella N, Lodha A, Sadiq A, Shani J (2012) Unusual presentation of Gerbode defect. Tex Heart Inst J 39:446–447PubMedCentralPubMedGoogle Scholar
  51. 51.
    Elmistekawy E, Dickie S, Nicholson D, Mesana T (2012) Left ventricular outflow tract-right atrial fistula following aortic valve replacement. J Card Surg 27:570–572CrossRefPubMedGoogle Scholar
  52. 52.
    Dores H, Abecasis J, Ribeiras R, Neves JP, Mendes M (2012) Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis. Cardiovasc Ultrasound 10:7CrossRefPubMedCentralPubMedGoogle Scholar
  53. 53.
    Mousavi N, Shook DC, Kilcullen N, Aranki S, Kwong RY, Landzberg MJ et al (2012) Multimodality imaging of a Gerbode defect. Circulation 126:e1–e2CrossRefPubMedGoogle Scholar
  54. 54.
    Anderson CA, Rodriguez E, Kypson AP (2012) Delayed left ventricle-to-right atrial fistula following aortic valve replacement. J Heart Valve Dis 21:364–365PubMedGoogle Scholar
  55. 55.
    Toprak C, Kahveci G, Akpinar S, Tabakci MM, Guler Y (2013) Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis. Echocardiography 30:E231–E235CrossRefPubMedGoogle Scholar
  56. 56.
    Notarangelo MF, Bontardelli F, Taliani U, Agostinelli A, Vignali L, Ardissino D (2013) A rare ventricular septal defect: a case report. G Ital Cardiol 14:283–285Google Scholar
  57. 57.
    Sinisalo J, Sreeram N, Qureshi SA (2013) Transcatheter closure of acquired left ventricle to right atrium shunts. Catheter Cardiovasc Interv 82:E809–E814CrossRefPubMedGoogle Scholar
  58. 58.
    Dangol A, Bansal M, Al-Khatib Y (2013) Transcatheter closure of acquired left ventricle-to-right atrium shunt: first case report in an infant and review of the literature. Pediatr Cardiol 34:1258–1260CrossRefPubMedGoogle Scholar
  59. 59.
    Lee SY, Song JY, Baek JS (2013) Percutaneous closure of the acquired Gerbode shunt using the Amplatzer duct occluder in a 3-month old patient. Korean Circ J 43:429–431CrossRefPubMedCentralPubMedGoogle Scholar
  60. 60.
    Poulin F, Horlick EM, David T, Woo A, Thavendiranathan P (2013) 3-Dimensional transesophageal echocardiography-guided closure of a Gerbode shunt due to CorMatrix patch dehiscence. J Am Coll Cardiol 62(3):e5. doi:10.1016/j.jacc.2013.02.090
  61. 61.
    Aoyagi S, Arinaga K, Oda T, Hori H (2008) Left ventricular–right atrial communication following tricuspid annuloplasty. Eur J Cardiothorac Surg 34:680–681CrossRefPubMedGoogle Scholar
  62. 62.
    Yurdakul S, Tayyareci Y, Sezgic M, Aytekin S (2012) Case images: acquired Gerbode type ventricular septal defect after aortic valve replacement. Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 40:471CrossRefGoogle Scholar
  63. 63.
    Uslu N, Kayacioglu I, Ates M, Eren M (2007) ‘Acquired’ left ventricular to right atrial shunt after mitral valve replacement: detection by transthoracic colour Doppler echocardiography. Can J Cardiol 23:735–736CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Tayama E, Tomita Y, Imasaka K, Kono T (2014) Iatrogenic left ventricular–right atrial communication after tricuspid annuloplasty; a case report. J Cardiothorac Surg 9:104CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Kumar PA, Sale S, Arora H, Petterson G (2011) Acquired “Gerbode-like” defect in aortic valve endocarditis: An imposter for tricuspid regurgitation? J Cardiothorac Vasc Anesth 25:751–752CrossRefPubMedGoogle Scholar
  66. 66.
    Chamsi-Pasha MA, Sayyed SH, Moulton MJ (2014) Real-time 3-dimensional transesophageal echocardiography in the assessment of ventriculoatrial shunt (Gerbode defect) complicating simultaneous mitral and tricuspid valve repair. J Am Coll Cardiol 63:e37CrossRefPubMedGoogle Scholar
  67. 67.
    Taskesen T, Goldberg SL, Gill EA (2014) Role of three-dimensional echocardiography in management of acquired intracardiac shunts. Echocardiography 31:E250–E253CrossRefPubMedGoogle Scholar
  68. 68.
    Raja Y, Jenkins N, Chauhan A, Millner RW (2006) Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation. Int J Cardiol 113:E79–E80CrossRefPubMedGoogle Scholar
  69. 69.
    Tatewaki H, Alesnik, JP, Morales, DSL (2008) Acquired left ventricle to right atrial shunt (Gerbode defect) and massive pulmonary embolus.
  70. 70.
    Inoue H, Iguro Y, Kinjo T, Matsumoto H, Yotsumoto G, Sakata R (2009) Acquired left ventricular–right atrial communication and severe aortic valve regurgitation caused by infective endocarditis. Thorac Cardiovasc Surg 57:54–56CrossRefPubMedGoogle Scholar
  71. 71.
    Cortez-Dias N, Varela MG, Marques J, Sargento L, Martins S, Ribeiro MA et al (2009) Acquired left ventricular-to-right atrial shunt (Gerbode defect) due to infective endocarditis. Port J Cardiol 28:735–739Google Scholar
  72. 72.
    Mendoza DD, Wang Z, Gaglia MA, Taylor AJ (2009) Gerbode defect. J Cardiovasc Comput Tomogr 3:279–281CrossRefPubMedGoogle Scholar
  73. 73.
    Matt P, Winkler B, Gutmann M, Eckstein F (2009) Acquired Gerbode defect after endocarditis. Eur J Cardiothorac Surg 36:402. doi:10.1016/j.ejcts.2009.04.005
  74. 74.
    Hori D, Tanaka M, Yamaguchi A, Adachi H (2010) Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Gerbode defect. Gen Thorac Cardiovasc Surg 58:255–259CrossRefPubMedGoogle Scholar
  75. 75.
    Xhabija N, Prifti E, Allajbeu I, Sula F (2010) Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension. Cardiovasc Ultrasound 8:44CrossRefPubMedCentralPubMedGoogle Scholar
  76. 76.
    Ota T, Yamaguchi R, Tanigawa T, Otuka K, Hayashi Y, Nishiyama H (2011) Left ventricular–right atrial communication by perforation of the atrioventriculas portion of the membranous septum and severe aortic valve regugitation caused by infective endocarditis. J Echocardiogr 9:30–32CrossRefGoogle Scholar
  77. 77.
    Pillai V, Menon S, Kottayil B, Karunakaran J (2011) Tricuspid endocarditis with indirect Gerbode: septal translocation of posterior leaflet. Heart Lung Circ 20:362–364CrossRefPubMedGoogle Scholar
  78. 78.
    Fukui K, Kanazawa J, Kawamura T, Yamauchi S, Watanabe K, Taniguchi S et al (2007) Left ventricular–right atrial communication resulting from infective endocarditis. Jpn J Thorac Surg 60:213–216Google Scholar
  79. 79.
    Carpenter RJ, Price GD, Boswell GE, Nayak KR, Ramirez AR (2012) Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis. J Card Surg 27:316–320CrossRefPubMedGoogle Scholar
  80. 80.
    Hsu SY, Shen TC (2014) A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging 15:471CrossRefPubMedGoogle Scholar
  81. 81.
    Hilberath JN, Shook D, Shernan SK, Rosenberger P (2007) Left ventricular outflow tract to right atrial fistula diagnosed by intraoperative transesophageal echocardiography. Anesth Analg 104:261–262CrossRefPubMedGoogle Scholar
  82. 82.
    Yared K, Solis J, Passeri J, King ME, Levine RA (2009) Three-dimensional echocardiographic assessment of acquired left ventricular to right atrial shunt (Gerbode defect). J Am Soc Echocardiogr 22(435):e1–e3PubMedGoogle Scholar
  83. 83.
    Gorki H, Loulmet DF, Lessnau KD (2009) A postoperative Gerbode defect in aortic prosthesis endocarditis with non-typhoid Salmonella. J Heart Valve Dis 18:325–326PubMedGoogle Scholar
  84. 84.
    Bochard-Villanueva B, Fabregat-Andres O, Estornell-Erill J, Paya-Serrano R, Ridocci-Soriano F (2012) 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 6:355–356CrossRefPubMedGoogle Scholar
  85. 85.
    Ozdogan O, Cinar CS (2012) Left ventricle-right atrium communication along with a membranous septum aneurysm. J Cardiovasc Med 13:597–599CrossRefGoogle Scholar
  86. 86.
    Marsten JL, Hildner FJ (1969) Left ventricular–right atrial communication following valve replacement. J Thorac Cardiovasc Surg 58:588–591PubMedGoogle Scholar
  87. 87.
    Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS et al (2000) Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (global utilization of streptokinase and TPA for occluded coronary arteries) trial investigators. Circulation 101:27–32CrossRefPubMedGoogle Scholar
  88. 88.
    Primus C, Grabscheit G, Ng CK, Auer J (2013) Unusual cause of dyspnoea: a case presentation of an echocardiographic pitfall. J Cardiothorac Surg 8:230CrossRefPubMedCentralPubMedGoogle Scholar
  89. 89.
    Tehrani F, Movahed MR (2007) How to prevent echocardiographic misinterpretation of Gerbode type defect as pulmonary arterial hypertension. Eur J Echocardiogr 8:494–497CrossRefPubMedGoogle Scholar
  90. 90.
    Desai RV, Seghatol-Eslami F, Nabavizadeh F, Lloyd SG (2011) Unusual mechanism of tricuspid regurgitation in ventricular septal defect. Echocardiography 28:E36–E38CrossRefPubMedGoogle Scholar
  91. 91.
    Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Higgins CB (2003) Cardiovascular shunts: MR imaging evaluation. Radiographics 23:S181–S194CrossRefPubMedGoogle Scholar
  92. 92.
    Burgstahler C, Brodoefel H, Schroeder S (2009) Cardiac CT in 2009. Minerva Cardioangiol 57:495–509PubMedGoogle Scholar
  93. 93.
    Nordenstrom B, Ovenfors CO (1960) Septal defect between the left ventricle and the right atrium diagnosed by cardioangiography. Acta Radiol 54:393–396CrossRefPubMedGoogle Scholar
  94. 94.
    Wu MH, Wang JK, Lin MT, Wu ET, Lu FL, Chiu SN et al (2006) 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 117:e262–e267CrossRefPubMedGoogle Scholar
  95. 95.
    Bentham JR, Gujral A, Adwani S, Archer N, Wilson N (2011) Does the technique of interventional closure of perimembranous ventricular septal defect reduce the incidence of heart block? Cardiol Young 21:271–280CrossRefPubMedGoogle Scholar
  96. 96.
    Kelle AM, Young L, Kaushal S, Duffy CE, Anderson RH, Backer CL (2009) The Gerbode defect: the significance of a left ventricular to right atrial shunt. Cardiol Young 19(Suppl 2):96–99CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Tuncay Taskesen
    • 1
  • Andrew Fred Prouse
    • 2
  • Steven Lewis Goldberg
    • 3
  • Edward Allen Gill
    • 1
    • 3
  1. 1.Division of CardiologyHarborview Medical CenterSeattleUSA
  2. 2.Division of Pulmonary Critical CareUniversity of Washington Medical CenterSeattleUSA
  3. 3.Cardiology DivisionUniversity of Washington Medical CenterSeattleUSA

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