Clinical Case of Correction of an Acquired Gerbode Defect After Mitral Valve Replacement in a Patient With New Coronavirus Infection

Clinical case. A patient after mitral valve replacement surgery for infective endocarditis was hospitalized with a new coronavirus infection. The examination revealed a left ventricular-right atrial communication. The complex treatment with a good clinical effect was performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Conclusions In the context of a pandemic of a new coronavirus infection, patients with a new coronavirus infection who have undergone a history of heart surgery are subject to greater clinical vigilance regarding the development of postoperative complications, including rare ones.

1. Gerbode F, Hultgren H, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt; successful surgical repair of defect in five cases, with observation of bradycardia on closure. Ann Surg. 1958;148(3):433–46. PMID: 13571920 https://doi.org/10.1097/00000658-195809000-00012

2. Laurichesse J, Ferrane J, Renais J, Scebat L, Lenegre J. Communication between the left ventricle and the right auricle. Arch Mal Coeur Vaiss. 1964;57:703–724. PMID: 14175554

3. Tidake A, Gangurde P, Mahajan A. Gerbode defect-a rare defect of atrioventricular septum and tricuspid valve. J Clin Diagn Res. 2015;9(9):OD06–OD068. PMID: 26500939 https://doi.org/10.7860/JCDR/2015/14259.6531

4. Kirby CK, Johnson J, Zinsser HF. Successful closure of a left ventricular– right atrial shunt. Ann Surg. 1957;145(3):392–394. PMID: 13403590 https://doi.org/10.1097/00000658-195703000-00014

5. Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z. Acquired left ventricular–right atrial communication caused by infective endocarditis detected by transesophageal echocardiography: case report and review of the literature. J Am Soc Echocardiogr. 1995;8(1):108–110. PMID: 7710745 https://doi.org/10.1016/s0894-7317(05)80368-2

6. Benisty J, Roller M, Sahar G, Paz R, Vidne B, Sagie A. Iatrogenic left ventricular–right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography. J Heart Valve Dis. 2000;9(5):732–735. PMID: 11041191

7. Yared K, Solis J, Passeri J, King ME, Levine RA. Three-dimensional echocardiographic assessment of acquired left ventricular to right atrial shunt (Gerbode defect). J Am Soc Echocardiogr. 2009;22(4):435.e1–3. PMID: 19201573 https://doi.org/10.1016/j.echo.2008.12.026

8. Silverman NA, Sethi GK, Scott SM. Acquired left ventricular–right atrial fistula following aortic valve replacement. Ann Thorac Surg. 1980;30(5):482–486. PMID: 7436619 https://doi.org/10.1016/s00034975(10)61301-x

9. Lee S, Hong B, Han W, Shim MS, Kim YH. Acquired Left Ventricular Gerbode’s Defect after Mitral Valve Replacement. J Cardiovasc Imaging. 2020;28(3):213–215. PMID: 32052605 https://doi.org/10.4250/jcvi.2019.0101

10. Seabra-Gomes R, Ross DN, Gonzalez-Lavin L. Iatrogenic left ventricular–right atrial fistula following mitral valve replacement. Thorax. 1973;28(2):235–241. PMID: 4731120 https://doi.org/10.1136/thx.28.2.235

11. Saker E, Bahri GN, Montalbano MJ, Johal J, Graham RA, Tardieu GG, et al. Gerbode defect: A comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment. J Saudi Heart Assoc. 2017;29(4):283–292. PMID: 28983172 https://doi.org/10.1016/j.jsha.2017.01.006

12. Aberg T, Johansson L, Michaelsson M, Rhedin B. Left ventricular–right atrial shunt of septic origin: presentation of a case with surgical closure. J Thorac Cardiovasc Surg. 1971;61:212-216.

13. Sinisalo JP, Sreeram N, Jokinen E, Qureshi SA. Qureshi Acquired left ventricular-right atrium shunts. Eur J Cardiothorac Surg. 2011;39(4):500– 506. PMID: 20627757 https://doi.org/10.1016/j.ejcts.2010.04.027

14. Hsu SY, Shen TC. A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging. 2014;15(4):471. PMID: 24168906 https://doi.org/10.1093/ehjci/jet192

15. Doig JC, Au J, Dark JH, Furniss SS. Post-infarction communication between a left ventricu-lar aneurysm and the right atrium. Eur Heart J. 1992;13(7):1006–1007. PMID: 1644071 https://doi.org/10.1093/oxfordjournals.eurheartj.a060279

16. Newman JN Jr, Rozanski L, Kreulen T. Acquired left ventricular to right atrial intracardiac shunt after myocardial infarction: A case report and review of the literature. J Am Soc Echocardiogr. 1996;9(5):716–720. PMID: 8887877 https://doi.org/10.1016/s0894-7317(96)90070-x

17. Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y, et al. Postinfarction atrioven-tricular septal rupture. J Am Soc Echocardiogr. 1997;10(6):680–684. PMID: 9282359 https://doi.org/10.1016/s08947317(97)70032-4

18. Riemenschneider TA, Moss AJ. Left ventricular-right atrial communication. Am J Cardiol. 1967;19(5):710–718. PMID: 6023467 https://doi.org/10.1016/0002-9149(67)90476-6

19. Sakakibara S, Konno S. Left ventricular-right atrial communication. Ann Surg. 1963;158(1):93–99. PMID: 14042644 https://doi.org/10.1097/00000658-196307000-00018

20. Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M. The Gerbode defect: left ven-tricular to right atrial communication—anatomic, hemodynamic, and echocardiographic features. Echocardiography. 2009;26(8):993–998. PMID: 19968690 https://doi.org/10.1111/j.15408175.2009.01009.x

21. Cantor S, Sanderson R, Cohn K. Left ventricular–right atrial shunt due to bacterial endocarditis. Chest. 1971;60(6):552–554. PMID: 5126184 https://doi.org/10.1378/chest.60.6.552

22. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D. Cardiac Involvement in a Patient with Coronavirus Disease 2019 (COVID19). JAMA Cardiol. 2020;5(7):819–824. PMID: 32219357 https://doi.org/10.1001/jamacardio.2020.1096

23. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420–422. PMID: 32085846 https://doi.org/10.1016/S2213-2600(20)30076-X

24. Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020;8(6):e46–e47. PMID: 32353251 https://doi.org/10.1016/S2213-2600(20)30216-2

25. Haraf RH, Karnib M, El Amm C, Plummer S, Bocks M, Sabik EM. Gerbode defect following surgical mitral valve replacement and tricuspid valve repair: a case report. Eur Heart J Case Rep. 2020;5(2):ytaa534. PMID: 33738402 https://doi.org/10.1093/ehjcr/ytaa534

26. Taskesen T, Prouse AF, Goldberg SL, Gill EA. Gerbode defect: another nail for the 3D transesophagel echo hammer? Int J Cardiovasc Imaging. 2015;31(4):753–764. PMID: 25680357 https://doi.org/10.1007/s10554015-0620-3

27. Desai RV, Seghatol-Eslami F, Nabavizadeh F, Lloyd SG. Unusual mechanism of tricuspid regurgitation in ventricular septal defect. Echocardiography. 2011;28(2):E36–38. PMID: 21210838 https://doi.org/10.1111/j.1540-8175.2010.01332.x

28. Cheema OM, Patel AA, Chang SM, Shah DJ. Gerbode ventricular septal defect diagnosed at cardiac MR imaging: case report. Radiology. 2009;252(1):50–52. PMID: 19561249 https://doi.org/10.1148/radiol.2521082186

29. Mousavi N, Shook DC, Kilcullen N, Aranki S, Kwong RY, Landzberg MJ, et al. Multimodality imaging of a Gerbode defect. Circulation. 2012;126(1): e1–2. PMID: 22753537 https://doi.org/10.1161/CIRCULATIONAHA.111.088740

30. Kelle AM, Young L, Kaushal S, Duffy CE, Anderson RH, Backer CL. The Gerbode defect: the significance of a left ventricular to right atrial shunt. Cardiol Young. 2009;19Suppl2:96–99. PMID: 19857356 https:// doi.org/10.1017/S1047951109991685

31. Yuan SM.Leftventricular toright atrialshunt(Gerbode defect): congenital versus acquired. Postepy Kardiol Interwencyjnej. 2014;10(3):185–194. PMID: 25489305 https://doi.org/10.5114/pwki.2014.45146

32. Yuan SM. A systematic review of acquired left ventricle to right atrium shunts (Gerbode defects). Hellenic J Cardiol. 2015;56(5):357–372. PMID: 26429364

33. Tatewaki H, Alesnik JP, Morales DSL. Acquired left ventricle to right atrial shunt (Gerbode defect) and massive pulmonary embolus. GTSNET. 2008. Available at: http://www.ctsnet.org/sections/clinicalresources/clinicalcases/article-14 [Accessed October 12, 2022].

34. Prifti E, Ademaj F, Baboci A, Demiraj A. Acquired Gerbode defect following endocarditis of the tricuspid valve: a case report and literature review. J Cardiothorac Surg. 2015;10:115. PMID: 26353810 https://doi.org/10.1186/s13019-015-0320-z

35. Matt P, Winkler B, Carre T, Eckstein F. Plicated Patch Repair for Acquired Gerbode Defect Involving the Tricuspid Valve. Ann Thorac Surg. 2010;89(2):643–645. PMID: 20103373 https://doi.org/10.1016/j.athoracsur.2009.04.095

36. Vijayalakshmi IB, Natraj Setty HS, Chitra N, Manjunath CN. Amplatzer duct occluder II for closure of congenital Gerbode defects. Catheter Cardiovasc Interv. 2015;86(6):1057–1062. PMID: 26152234 https://doi.org/10.1002/ccd.26020