Uncommon acquired Gerbode defect (left ventricular to right atrial communication) following a tricuspid annuloplasty without concomitant mitral surgery.

Left ventricular (LV) to right atrial (RA) communication, also known as Gerbode defect, is very rare, usually congenital but sometimes also acquired. Cases of Gerbode defect have been reported after left valve surgery, usually valve replacement. We describe the first case of LV-RA communication following a tricuspid annuloplasty not combined to a left valve surgery. The case we report concerns a 73-year-old woman who underwent a double-valve surgery (pulmonary valve replacement and tricuspid annuloplasty) for symptomatic severe right heart failure due to post-endocarditis pulmonary valve regurgitation. A LV-RA shunt was discovered 1 year after surgery. This case report confirms the responsibility of a tricuspid annuloplasty in an acquired LV-RA shunt.

Thrombosis of aortic valve homograft associated with lupus anticoagulant antibodies.

One of the main advantages of an aortic valve homograft in comparison with a mechanical prosthesis is the low incidence of thromboembolism without anticoagulation. Development of an obstructive thrombosis is virtually unknown. We report the case of a patient who twice was seen with hemodynamically significant thrombosis of an aortic valve homograft. The diagnosis was suspected on the basis of a subacute increase in the transvalvular gradient and was confirmed by transesophageal echocardiography. Lupus anticoagulant antibodies were detected. Oral anticoagulation proved to be effective in relieving the obstruction, but recurrence after discontinuation of acenocoumeral suggests that treatment should be long term, if not lifelong. To our knowledge, this complication of primary antiphospholipid syndrome is the first reported case of thrombotic obstruction of an aortic valve homograft.