Acquired Gerbode Defect and Severe Aortic Regurgitation Following Surgical Aortic Valve Replacement Treated with Percutaneous Approach

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-15-2021

Publication Title

Journal of the American College of Cardiology

Abstract

Background

Gerbode defect is defined as abnormal shunting between the left ventricle (LV) and right atrium (RA). The prevalent cause has historically been congenital, however an increasing trend towards acquired cases owing to increased invasive procedures. We present a case of an acquired Gerbode defect with associated severe aortic regurgitation (AR) that was treated with percutaneous closure and a transcatheter aortic valve replacement (TAVR).

Case

A 72-year-old male with bicuspid aortic valve with two prior SAVRs, last in 2019, presents with acute decompensated heart failure. Transthoracic echocardiography revealed severe bioprosthetic AR with a left-to-right shunt. Transesophageal echocardiogram confirmed an atrioventricular septal defect between the LV and RA.

Decision-making

The defect was considered iatrogenic secondary to the prior SAVR. After thorough discussion, he was deemed a high risk for redo surgery given prior sternotomies and was recommended for a transcathether approach. He ultimately received with a 6 mm Amplatzer occluder device followed a 23 mm Edwards Sapien III TAVR one month later with great results.

Conclusion

Although rare, gerbode defect is being recognized as a complication of invasive cardiac procedures causing significant left-to-right shunting leading to symptoms of heart failure. Management is often challenging and percutaneous closure is a reasonable alternative to surgery in high surgical risk patients who also have associated severe AR.

Volume

77

Issue

18

First Page

2375

Comments

70th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Virtual, May 15-17, 2021.

DOI

10.1016/S0735-1097(21)03730-X

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