PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Am Soc Echocardiogr. Author manuscript; available in PMC 2010 April 1.
Published in final edited form as:
PMCID: PMC2821679
NIHMSID: NIHMS170106

Three-Dimensional Echocardiographic Assessment of Acquired Left Ventricular to Right Atrial Shunt (Gerbode Defect)

Kibar Yared, MD, FRCPC, Jorge Solis, MD, Jonathan Passeri, MD, Mary Etta E. King, MD, FACC, and Robert A. Levine, MD, FACC

Abstract

A 60-year-old man was readmitted 1 year after bioprosthetic aortic valve replacement for recurrent endocarditis. Transthoracic 2-dimensional color Doppler revealed a novel finding of a left-to-right shunt from the left ventricular outflow tract to the right atrium immediately superior to the septal leaflet of the tricuspid valve consistent with an acquired Gerbode defect. Real-time 3-dimensional echocardiography was used to accurately delineate the course of the shunt. To avoid overestimating right ventricular systolic pressure by mistaking such a shunt for an eccentric jet of tricuspid regurgitation, it is important to accurately differentiate the two. Real-time 3-dimensional echocardiography now provides rapid, detailed 3-dimensional appreciation of the origin and course of such shunts with easy facility of orienting views to the flows of interest by cropping. Such information can help design optimal surgical or catheter-based therapy.

Keywords: Aortic valve replacement, Gerbode defect, Three-dimensional echocardiography

A 60-year-old man underwent bioprosthetic aortic valve replacement for infective endocarditis and was readmitted 1 year later for recurrent endocarditis. Transthoracic 2-dimensional color Doppler revealed a novel finding of a left-to-right shunt from the left ventricular outflow tract to the right atrium immediately superior to the septal leaflet of the tricuspid valve (Figure 1), consistent with an acquired Gerbode defect. No evidence of paravalvular abscess was found.

Figure 1
Two-dimensional echocardiography with color Doppler interrogation in apical 4-chamber view demonstrating left ventricular outflow tract to right atrial shunting (arrow). RV, Right ventricle; RA, right atrium; LA, left atrium; TV, tricuspid valve.

To further define shunt anatomy, real-time 3-dimensional echocardiography (Philips iE33, Andover, MA) was performed. Color full-volume images were cropped (Figure 2, Video 1) to demonstrate flow acceleration within the left ventricular outflow tract and extension of flow across the atrioventricular septum into the right atrium at the base of the septal tricuspid valve leaflet (Figure 3, Video 2).

Figure 2
Three-dimensional echocardiography with color Doppler interrogation in apical 4-chamber view demonstrating left to right shunting (arrow) and flow acceleration at the beginning of the jet (arrowhead). RV, Right ventricle; RA, right atrium.
Figure 3
Three-dimensional echocardiography with (right) and without (left) color Doppler interrogation. Manual cropping of a full-volume acquisition enables proper visualization of the extent of the defect (long arrow). Accurate delineation of the defect is then ...

To avoid overestimating right ventricular systolic pressure by mistaking such a shunt for an eccentric jet of tricuspid regurgitation, it is important to accurately differentiate the two. Real-time 3-dimensional echocardiography now provides rapid, detailed 3-dimensional appreciation of the origin and course of such shunts with easy facility of orienting views to the flows of interest by cropping.1,2 Such information can help design optimal surgical or catheter-based therapy.

References

1. Agoston I, Esquivel-Avila J, Ahmad M. Live three dimensional echocardiography in evaluation of left ventricular to right atrial shunt (Gerbode defect) Heart. 2006;92:1562. [PMC free article] [PubMed]
2. Rivera JM, Siu SC, Handschumacher MD, Lethor JP, Guerrero JL, Vlahakes GJ, et al. Three-dimensional reconstruction of ventricular septal defects: validation studies and in vivo feasibility. J Am Coll Cardiol. 1994;23:201–8. [PubMed]