Acquired Gerbode Defect Diagnosed Seven Years After Surgical Mitral Valve Repair for Severe Primary Mitral Valve Regurgitation: A Case Report

Figures

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  Figure 1. Apical four-chamber view showing automatic left ventricular ejection fraction at 58%. 4CH = four chambers; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; VED = volume end diastole; VES = volume end systole; EF = ejection fraction

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  Figure 2. Apical four-chamber view showing grade II mitral regurgitation by color flow (red arrow). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle

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  Figure 3. Tricuspid regurgitation velocity recording using continuous wave Doppler at 27 mmHg (blue arrow). TR VELOCITY = tricuspid regurgitation velocity; p = pressure gradient; V = velocity

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  Figure 4. Apical four-chamber view showing mitral regurgitation jet (red arrow) with color aliasing in the right atrium (blue arrow). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle

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  Figure 5. Apical three-chamber view showing color flow aliasing in the posterior part of the LVOT (red arrow) with normal color flow in the anterior part of the LVOT. This color aliasing in the LVOT marks the onset of the Gerbode defect from the left ventricle to the right atrium. LA = left atrium; LV = left ventricle; POST LVOT = posterior left ventricular outflow tract

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  Figure 6. Pulsed Doppler wave recording from the posterior left ventricular outflow tract (red arrow) to the anterior LVOT ventricular outflow tract showing aliasing velocity in the posterior LVOT and normal velocity at the anterior LVOT (white arrow). The blue arrow indicates the final placement of the pulsed sample volume at the anterior LVOT.

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  Figure 7. Comparison of normal heart to hearts with Gerbode defect. (A) Normal heart. (B) Supravalvular defect involving the membranous portion of the septal wall, superior to the septal leaflet of the tricuspid valve. (C) Infravalvular defect involving the membranous portion of the septal wall, below the septal leaflet. (D) Both supravalvular and infravalvular defects with the septal leaflet of the tricuspid valve. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle Illustration by Jessica Holland © 2016. Reproduced from Saker et al. [9] under the CC-BY-NC-ND 4.0 license