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Linda A. Zacharkiw, Helen L. Stimpson, Mirror-image Gerbode defect?, European Journal of Echocardiography, Volume 12, Issue 8, August 2011, Page 627, https://doi.org/10.1093/ejechocard/jer079
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Extract
A 43-year-old man with a repaired partial atrioventricular septal defect presented post-stroke. Transthoracic and bubble contrast echocardiography was positive, suggesting a right-to-left shunt. Transoesophageal echocardiography (TOE) was arranged to define the anatomy.
TOE demonstrated an atrial septal and left atrioventricular valve repair with mild central regurgitation and a second small jet of presumed residual regurgitation through the valve.
Bubble contrast injection showed bubbles in the left heart immediately after the right heart opacification. Using real-time three-dimensional echo, bubble contrast opacified the right atrium and the right ventricle (RV), crossing the AV bridging leaflet, entering the left atrium before the left ventricle (LV), and suggesting a possible pathway for paradoxical emboli.
ECG confirmed that bubbles crossed in systole (Figure A–C), clearly demonstrated by frame advancing the image.
A full-volume acquisition was able to demonstrate a lack of apposition in the superior bridging leaflet, which was a direct communication for flow from the RV to the left atrium (Figure D).
