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- Received October 31, 2013
- Accepted November 12, 2013
- Published online April 22, 2014.
A 67-year-old man presented with worsening dyspnea 1 month after double mitral and tricuspid valve repair. Physical examination revealed high-pitched holosystolic murmur across the precordium. Two-dimensional transthoracic echocardiography revealed an abnormal, high velocity left-to-right shunt across the basal interventricular septum (jet velocity of 4.3 m/s), along with significant mitral regurgitation. Real-time 3-dimensional transesophageal echocardiography showed a ventriculoatrial shunt above the septal leaflet of the tricuspid valve, consistent with a Gerbode defect (A to D; Online Videos 1 and 2). The mitral ring (triangle) was dehisced and avulsed anteriorly with resultant severe mitral regurgitation (F, G; Online Videos 3 and 4). The intraoperative findings confirmed the 3-dimensional transesophageal echocardiography description of the lesions (E, H). The patient then underwent mitral valve replacement and repair of the defect with good outcomes. This case illustrates Gerbode defect complicating double valve repair. The use of 3-dimensional transesophageal echocardiography further characterized the extent and the location of the defect, which has guided the surgical repair. AS = atrial septum; AV = aortic valve; GD = Gerbode defect; LA = left atrium; LAA = left atrial appendage; LV = left ventricle; LVO = left ventricular outflow tract; MR = mitral regurgitation; RA = right atrium; ROA = regurgitant orifice area; ∗ = tricuspid annular ring; Δ = mitral annular ring.
- Received October 31, 2013.
- Accepted November 12, 2013.
- American College of Cardiology Foundation