Key result
Acquired Gerbode defect 15 days post-TAVR caused a Qp/Qs of 2.9 (O2 step-up 51% to 79%) and acute liver/kidney injury, leading to hemolysis after transcatheter closure and death after surgery.
Why the study?
Acquired Gerbode defects after TAVR are rare and may present atypically, which can delay diagnosis.
Case Report (n=1)
Occult intracardiac shunting such as an acquired Gerbode defect should be considered after TAVR when severe acute liver and kidney injury occur despite reassuring transthoracic echocardiographic findings, requiring transesophageal echocardiography and invasive hemodynamic assessment for diagnosis.
Answers are grounded in this paper and cite their sources.
Post-TAVR multiorgan injury with normal echocardiography may signal rare acquired shunts; leaves open optimal screening and incidence.
BACKGROUND: Acquired Gerbode defects after transcatheter aortic valve replacement (TAVR) are rare and may present atypically, delaying diagnosis. CASE SUMMARY: A 71-year-old man presented 15 days after TAVR with severe acute liver and kidney injury despite preserved ventricular systolic function and normal prosthetic valve function on transthoracic echocardiography. Right heart catheterization revealed elevated filling pressures, an oxygen saturation step-up from the superior vena cava (51%) to the pulmonary artery (79%), and a pulmonary/systemic flow ratio of 2.9. Transesophageal echocardiography identified a high-pressure left ventricular-to-right atrial shunt through the membranous septum. Residual shunting after transcatheter closure caused severe intravascular hemolysis and necessitated surgical salvage. The postoperative course was complicated by multiorgan failure and death. DISCUSSION: This case highlights an atypical presentation of an acquired Gerbode defect. Complementary transesophageal echocardiography and invasive hemodynamic assessment were essential for diagnosis. TAKE-HOME MESSAGE: Occult intracardiac shunting should be considered after TAVR when severe end-organ dysfunction is discordant with reassuring transthoracic echocardiographic findings.
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Jadav et al. (2026) conducted a case report in Acquired Gerbode defect after transcatheter aortic valve replacement (TAVR) (n=1). Transcatheter closure followed by surgical salvage was evaluated. Acquired Gerbode defect 15 days post-TAVR caused a Qp/Qs of 2.9 (O2 step-up 51% to 79%) and acute liver/kidney injury, leading to hemolysis after transcatheter closure and death after surgery.
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