18Romanian Journal of Cardiology Vol. 26, No. 2, 2016 [601079]

18Romanian Journal of Cardiology | Vol. 26, No. 2, 2016
CASE PRESENTATION
Gerbode-type, left ventricular to right atrial
communication in a 63-year-old patient
Lelia Strîmbu1,2, Ioana Dregoesc1, Radu Hagiu1
Contact address:
Lelia Strîmbu, “Niculae St ăncioiu” Heart Institute, Calea Mo ților, 19-21,
Cluj-Napoca, 400001, Romania.
Mobile phone: (+40) 0730 014 514
E-mail: [anonimizat] REPORT
A 63-year-old Caucasian woman presented to our ho-
spital for a recent alteration in her exercise capacity. She had been diagnosed with a systolic heart murmur in young adulthood, but, at that time, she underwent no further investigations. Physical exam was normal except for an accentuated, splitted second heart sound and a grade 3/6 systolic murmur at the left sternal border. The electrocardiogram showed a minor right bundle branch block. Transthoracic echocardiography raised suspicion of a communication between the LV and the RA (Figures 1, 2). The velocity of the systolic fl ow reaching the RA was 4 m/sec. The enlargement of
the right chambers, a moderate pulmonic insuf fi ciency
and a mild tricuspid regurgitation with moderate pul-monary hypertension were also described. The ratio of pulmonary to systemic fl ow (Qp/Qs) was 2, consistent
with a moderate left to right shunt (Figure 2). The car-diac magnetic resonance imaging (MRI) examination confi rmed the presence of a 6 mm defect in the atri-oventricular septum, involving the septal lea fl et of the
tricuspid valve, with subsequent LV to RA communica-tion (Figures 3, 4). The right ventricular (RV) ejection fraction was 38%.
Since the intracardiac shunt was well tolerated for
a long period of time and the patient was only mildly symptomatic, we decided for a conservative approach with regular follow-ups.
The Gerbode defect is a very rare cardiac anomaly
that exists in congenital
1 and acquired forms (secon-
dary to trauma2, infective endocarditis3, myocardial in-
farction4 or valve surgery5).
The de fi nition of a Gerbode defect, according to the
Society of Thoracic Surgeons is a true, direct, left ven-
tricular to right atrial communication, located in the membranous septum
6. The most common, indirect
type of communication, is from the LV, through a ven-tricular septal defect into the RV and then, through a defect in the septal lea fl et of the tricuspid valve, into
the RA1.
1 “Niculae St ăncioiu” Heart Institute, Cluj-Napoca, Romania
2 “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca,
RomaniaAbstract: The left ventricular to right atrial communication, also known as the Gerbode defect, is a very uncommon car-
diac anomaly, rarely reported in literature. We present the case of a 63-year-old woman who was admitted to our hospital for altered exercise capacity and diagnosed with a type II Gerbode defect. The communication was initially identi fi ed by tran-
sthoracic echocardiography and further characterized by magnetic resonance imaging. The case is meant to demonstrate the value of contemporary imaging techniques in the noninvasive assessment of the anatomy and hemodynamics of intracardiac shunts. Keywords: Gerbode defect, echocardiography, cardiac magnetic resonance imaging
Rezumat: Defectul Gerbode sau comunicarea ventricul stâng – atriu drept este o anomalie cardiac ă rară, puține cazuri
fi ind raportate în literatura de specialitate. Prezent ăm cazul unei paciente în vârst ă de 63 de ani, care a fost evaluat ă în ser-
viciul nostru pentru alterarea toleran ței la efort și diagnosticat ă cu un defect Gerbode de tip II. Comunicarea a fost in țial
identi fi cată prin ecocardiogra fi e transtoracic ă și caracterizat ă suplimentar prin rezonan ță magnetic ă nucleară cardiacă. Acest
caz își propune s ă demonstreze valoarea tehnicilor imagistice contemporane în evaluarea neinvaziv ă a anatomiei și hemodi-
namicii șunturilor intracardiace.
Cuvinte cheie: defect Gerbode, ecocardiogra fi e, rezonan ță magnetic ă cardiacă

Romanian Journal of Cardiology
Vol. 26, No. 2, 2016
19Lelia Strimbu et al.
Gerbode-type, left ventricular to right atrial communication in a
This case demonstrates the value of contempo-
rary imaging techniques such as echocardiography and cardiac magnetic resonance imaging in noninvasively assessing the anatomy and hemodynamics of intracar-diac shunts. The data they provide in fl uence clinical
decision making and guide the therapeutic surgical or interventional procedures
10.
Acknowledgements: We would like to thank Dr.
Irinel Oancea, from “Phoenix” Diagnostic Clinic, Cluj-Napoca, for her interpretation of the cardiac MRI exa-mination.Confl ict of interests: none declared. References
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Surgery Nomenclature and Database Project: ventricular septal de-fect. Ann Thorac Surg 2000;69(Suppl):S25-35.Figure 1,2. Colour Doppler transthoracic echocardiographic images (1 – apical 5 chamber view; 2 – parasternal short axis view): systolic fl ow between
the LV and RA.
Figure 3,4. Cardiac MRI (3 – transversal and 4 – sagittal) views con fi rming the Gerbode defect (arrows).