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Masazumi Watanabe, Takahiro Taguchi, Keijiro Katayama, Katsuhiko Imai, Sueda Taijiro, The Gerbode defect diagnosed by 3D reconstructed cardiac computed tomography, European Heart Journal - Cardiovascular Imaging, Volume 18, Issue 7, July 2017, Page 762, https://doi.org/10.1093/ehjci/jex057
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A 76-year-old woman was treated with oral antibiotics for recurrent fever. After 2 months, the patient was referred to our hospital because of a newly developed cardiac murmur that was diagnosed as infectious endocarditis. A blood culture was positive for Streptococcus vestibularis. Transoesophageal echocardiography showed aortic valve regurgitation with vegetation on the right coronary cusp and left-to-right shunt (Panel A). It is difficult to distinguish left ventricular–right atrial communication from ventricular septal defect with tricuspid regurgitation by echocardiography. However, 3D-reconstructed cardiac computed tomography allowed direct visualization of the jet trajectory from the left ventricle to right atrium. (Panel B). After antibiotic treatment, she underwent aortic valve replacement and closure of the defect with an autologous pericardial patch. Intraoperatively, the defect was identified above the commissure of the anterior and septal leaflets of the tricuspid valve (Panel C). Left ventricular-to-right atrial communication is an uncommon congenital or acquired heart disorder known as Gerbode defect. The Gerbode defect is classified into three types based on the relationship between the defect and the tricuspid annulus: supravalvular type, infravalvular type, and mixed type. The identification of the type of the defect is often difficult. In this case, 3D-reconstructed cardiac computed tomography was helpful to identify the position of the defect.
