European Journal of Echocardiography 2008 9(2):314-315; doi:10.1016/j.euje.2006.11.010
Published on behalf of the European Society of Cardiography. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
Echocardiographic diagnosis of left ventricular–right atrial communication (Gerbode-type defect) in an adult with chronic renal failure: A case report
Serpil Eroglu*,
Elif Sade,
Huseyin Bozbas,
Bahar Pirat,
Aylin Yildirir and
Haldun Muderrisoglu
University of Baskent, Faculty of Medicine, Department of Cardiology, Maresal Fevzi Cakmak, Cad. 10. sok No:45, 06490 Bahcelievler, Ankara, Turkey
Received 1 November 2006; accepted after revision 26 November 2006.
* Corresponding author. Tel: +90 312 212 68 68; fax: +90 312 223 86 97. E-mail address: serpileroglu{at}gmail.com (S. Eroglu).
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Abstract
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Left ventricular–right atrial communication, known as
a
Gerbode-type defect, is a rare form of ventricular septal
defect. It is usually congenital, but rarely acquired. Clinical
presentation is associated with the volume of the shunt. Transthoracic
echocardiography is the most useful diagnostic method. We present
a 63-year-old man with chronic renal failure and left ventricular–right
atrial shunt.
Keywords: Ventricular septal defect; Gerbode; Echocardiography
A 63-year-old man with end-stage renal disease was admitted to the cardiology department with dyspnea. On physical examination, his blood pressure was 140/90 mmHg and II–III/VI pansystolic murmur was heard at the apex and the left sternal border. Transthoracic echocardiographic examination revealed a dilated left ventricle and diminished left ventricular systolic function (ejection fraction, 26%). On colour Doppler examination, a turbulent colour flow jet from the LV to the RA was detected from the apical 4-chamber (Figures 1 and 2). The jet velocity was 4.1 m/s with a gradient of 67.1 mmHg on continuous wave Doppler (Figure 3). This flow was different from the tricuspid regurgitant jet (velocity 3.1 m/s) with colour and continuous wave (CW) Doppler from the apical 4-chamber view (Figure 4). The right atrium was dilated, and the estimated pulmonary artery systolic pressure was 45–50 mmHg. The tricuspid valve was placed more apically than the mitral valve from the apical 4-chamber view. We clearly identified that the shunt flow was due to a communication error between the LV and the RA, and we observed neither a ruptured sinus of Valsalva nor an endocardial cushion defect in parasternal short axis and subcostal views as previously suggested to examine in this type of defect.1 The shunt flow jet was more prominent prior to hemodialysis (the jet velocity was 4.4 m/s and the gradient was 77 mmHg) and diminished after the dialysis. Cardiac catheterization showed elevated left ventricular end diastolic and pulmonary artery pressures. On oxymetric study, the shunt was found to be nonsignificant (Qp/Qs < 1.5). Although rare, LV–RA communications can be acquired. The history of our patient revealed no valvular surgery, endocarditis, trauma, or myocardial infarction. Therefore, in our case, this was likely a congenital defect. We also thought that this defect was small, and the catheterization findings also proved that the shunt was mild, therefore no surgical intervention was planned. In our patient clinical and echocardiographic findings supported a Gerbode-type defect; an LV–RA shunt. Transthoracic echocardiography with colour and spectral Doppler is widely available, rapid and highly sensitive noninvasive tool for the detection of this type of shunt even in mild cases.
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Figure 2 Transthoracic echocardiography, apical 4-chamber view, shunt flow from LV to RA (arrow) and unlike this, jet flow of tricuspid regurgitation are seen. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle, and TR = tricuspid regurgitation.
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Reference
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- Dzwonczyk T, Davidson WR Jr. The spectrum of left ventricular–right atrial communications in the adult: essentials of echocardiographic assessment. J Am Soc Echocardiogr (1995) 8:263–9.[CrossRef][Medline]
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