Gerbode Ventricular Septal Defect

A Gerbode defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. This is anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. The large systolic pressure gradient between the left ventricle and the right atrium would expectedly result in an unmistakeable high velocity three-to-four meter per second systolic Doppler flow signal in the right atrial cavity.

One diagnostic echocardiographic pitfall is the mistaken diagnosis of a Gerbode defect in a patient with the more common membranous ventricular septal defect. The flow from left ventricle to right ventricle can continue ("blow-through") into the right atrium as a regurgitant jet.

Conversely, since a true Gerbode Ventricular septal defect creates a high velocity systolic jet in the right atrium - this can suggest the mistaken echocardiographic diagnosis of severe pulmonary hypertension.

References

• 2017 comprehensive review.

• 2015 review of all the world literature.

• Gerbode ventricular septal defect following endocarditis.
  Battin M; Monro JL; Fong LV
  Eur J Cardiothorac Surg 1991;5(11):613-4
  A Gerbode defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. There has been some debate about the existence of such an entity. We present the case of a previously healthy 15-year-old boy who developed bacterial endocarditis following ear piercing and was subsequently found to have a defect between the left ventricle and right atrium, which was successfully repaired surgically.
  

• Ruptured aneurysm sinus of Valsalva and Gerbode defect with severe tricuspid and aortic regurgitation. A case report and its surgical correction.
  Coelho R; Cherian KM; Rao SG; Singh RS; Thakurta SG Pannu HS
  J Cardiovasc Surg (Torino) 1997 Oct;38(5):531-3
  An unusual early childhood presentation in a case with ruptured non-coronary sinus of Valsalva aneurysm with Gerbode defect and severe pulmonary hypertension is described. The reasons for early rupture are discussed and anatomically important relations of membranous septum, fibroskeleton of heart and conduction system are schematically elucidated. Associated severe tricuspid and aortic regurgitation are explained to be secondary effects following the rupture of aneurysm. A technique of surgical correction of this rare association of anomalies using single PTFE patch is illustrated, cautiously safeguarding the closely related conduction system. Regurgitant aortic and tricuspid valves were also successfully repaired. In retrospect, early repair before rupture of aneurysm and onset of severe pulmonary hypertension may be more beneficial, which would also prevent the leakage of semilunar and atrioventricular valves.
  

• Gerbode's defect associated with acute sinus node dysfunction as a complication of infective endocarditis.
  Michel C; Huynh T; Rabinovitch MA
  Heart 1996 Oct;76(4):379
  

• "Acquired" left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis.
  Velebit V; Schmuziger M; Simonet F; Christenson JT Maurice J; Bloch A; Ciaroni S; Schoneberger A
  Tex Heart Inst J 1995;22(1):100-2
  

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