A Case of Acquired Gerbode Defect (Left Ventricular-Right Atrial Communication) Complicated with Aortic Regurgitation Caused by Infective Endocarditis / 日本心臓血管外科学会雑誌

ABSTRACT

Gerbode defect is a communication between the left ventricle and right atrium. It is usually congenital rather than acquired, but can occur as a complication of endocarditis, myocardial infarction, trauma, or cardiac surgery. We report a case of surgical repair of acquired Gerbode defect resulting from infective endocarditis. A 69-year-old woman with aortic regurgitation due to infective endocarditis was referred to our hospital with a diagnosis of congestive heart failure. She was hospitalized and underwent medical treatment (intensive antibiotic therapy). Preoperative transthoracic and transesophageal echocardiography were performed and revealed a mobile mass (vegetation) on the aortic valve. The patient also had severe aortic regurgitation and a communication between the left ventricle and right atrium. The communication was visualized in the atrioventricular membranous septum. Due to the mobility of the mass (vegetation) and uncontrollable congestive heart failure caused by severe aortic regurgitation, surgical treatment was advised. Surgery was performed through a median sternotomy with the patient on cardiopulmonary bypass. After aortic cross-clamping, the vegetation was approached through a horizontal incision in the ascending aorta and a right atriotomy. The communication site from the left view was below the commissure between the right coronary and non-coronary cusps ; from the right view, it was just above the tricuspid annulus of the septal leaflet. The defect was closed with two 0.4-mm thick Gore-Tex cardiovascular patches one was placed on the LV side and the other on the RA side. The aortic valve was replaced with a bioprosthetic valve (SJM Epic 21 mm). The operation was finished and her clinical course was almost uneventful.