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Background <p>Gerbode defect is a rare cardiac anomaly characterized by an abnormal communication between the left ventricle and the right atrium, first described in 1958. This LV-RA shunt, although uncommon, has significant clinical implications, including its effects on hemodynamics, diagnosis, and treatment.</p> Case Presentation <p>A 49-year-old patient was admitted to the hospital with progressive dyspnea for 20 days. Transthoracic echocardiography (TTE) revealed a bicuspid aortic valve associated with a discontinuity defect at the transition between the perimembranous septum and the non-coronary sinus of Valsalva, approximately 5 mm in size, communicating the left ventricular outflow tract with the right atrium, with a predominantly systolic flow and a left ventricle-to-right atrium gradient of 140 mmHg, along with moderate tricuspid regurgitation. After a comprehensive evaluation, the patient was diagnosed with endocarditis, and treatment was initiated with ceftriaxone, guided by blood cultures identifying <i>Streptococcus gordonii</i>. Surgical intervention included aortic valve replacement, correction of the Gerbode defect, and tricuspid valve repair. Aortotomy confirmed the echocardiographic findings. After resecting the aortic valve cusps, the Gerbode defect was identified in the perimembranous region below the commissure between the non-coronary and right cusps. The defect was repaired transaortically using a bovine pericardial patch with separate 4–0 polypropylene sutures with pledgets. Subsequently, a 21-mm Epic (Abbott) biological prosthesis was implanted. Right atriotomy revealed a perforation in the anterior leaflet of the tricuspid valve. Repair was performed using a bovine pericardial patch followed by annuloplasty.</p> Conclusions <p>Gerbode defect, especially when associated with other conditions such as a bicuspid aortic valve and tricuspid valve endocarditis, presents significant clinical challenges. Surgical treatment remains a definitive and preferred option. This case highlights the importance of a multidisciplinary approach to ensure comprehensive management of complex cardiac pathologies.</p>

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Gerbode Defect with Bicuspid Aortic Valve and Tricuspid Regurgitation Associated with Streptococcus gordonii Endocarditis – Case Report

  • 期刊论文

  • 发表日期：

    2025年12月2日

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  • Adnaldo da Silveira Maia,
  • Melina Moroz Barg,
  • Antônio Agostinho Moura Filho,
  • Priscila Fernanda Vieira,
  • Almiro Carlos Ferro Junior,
  • Renato Arnoni

摘要

Background

Gerbode defect is a rare cardiac anomaly characterized by an abnormal communication between the left ventricle and the right atrium, first described in 1958. This LV-RA shunt, although uncommon, has significant clinical implications, including its effects on hemodynamics, diagnosis, and treatment.

Case Presentation

A 49-year-old patient was admitted to the hospital with progressive dyspnea for 20 days. Transthoracic echocardiography (TTE) revealed a bicuspid aortic valve associated with a discontinuity defect at the transition between the perimembranous septum and the non-coronary sinus of Valsalva, approximately 5 mm in size, communicating the left ventricular outflow tract with the right atrium, with a predominantly systolic flow and a left ventricle-to-right atrium gradient of 140 mmHg, along with moderate tricuspid regurgitation. After a comprehensive evaluation, the patient was diagnosed with endocarditis, and treatment was initiated with ceftriaxone, guided by blood cultures identifying Streptococcus gordonii. Surgical intervention included aortic valve replacement, correction of the Gerbode defect, and tricuspid valve repair. Aortotomy confirmed the echocardiographic findings. After resecting the aortic valve cusps, the Gerbode defect was identified in the perimembranous region below the commissure between the non-coronary and right cusps. The defect was repaired transaortically using a bovine pericardial patch with separate 4–0 polypropylene sutures with pledgets. Subsequently, a 21-mm Epic (Abbott) biological prosthesis was implanted. Right atriotomy revealed a perforation in the anterior leaflet of the tricuspid valve. Repair was performed using a bovine pericardial patch followed by annuloplasty.

Conclusions

Gerbode defect, especially when associated with other conditions such as a bicuspid aortic valve and tricuspid valve endocarditis, presents significant clinical challenges. Surgical treatment remains a definitive and preferred option. This case highlights the importance of a multidisciplinary approach to ensure comprehensive management of complex cardiac pathologies.