Acquired Gerbode Defect and Severe Aortic Regurgitation Following Surgical Aortic Valve Replacement Treated with Percutaneous Approach
Journal of the American College of Cardiology
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).
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.
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.
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.
Vira A, Mustafa S, Silverman A. Acquired Gerbode defect and severe aortic regurgitation following surgical aortic valvse replacement treated with percutaneous approach. J Am Coll Cardiol 2021;77(18 Suppl 1):2375.