Left ventricular—Right atrial communication

doi:10.1016/0002-9149(67)90476-6

The American Journal of Cardiology

Volume 19, Issue 5, May 1967, Pages 710-718

https://doi.org/10.1016/0002-9149(67)90476-6 Get rights and content

Abstract

Ten cases of left ventricular-right atrial communication are reported, making a total of 122 cases documented in the literature. A new anatomic classification is proposed, based on the location of the defect in the cardiac septum.

The clinical course of left ventricular-right atrial communication is similar to that of ventricular septal defect in many respects but may be differentiated from it by the earlier onset of congestive failure and the development of arrhythmias of atrial origin.

Physical examination reveals a harsh holosystolic murmur and thrill at the left sternal border. The murmur usually radiates well to the right of the sternum and is frequently associated with close expiratory splitting of the second sound in the pulmonic area. The murmur is often heard during the newborn period.

Typical electrocardiographic findings consist of peaked P waves, a prolonged P-R interval, rSR pattern in the right precordial leads and biventricular hypertrophy.

Chest roentgenograms characteristically disclose cardiomegaly and increased pulmonary vascularity. The most striking finding is disproportionate right atrial enlargement. This, together with a prominent pulmonary artery and ventricular enlargement, produces a “ball-like” configuration.

Cardiac catheterization reveals a moderate left to right shunt at the level of the right atrium, despite the presence of an intact atrial septum. The diagnosis is confirmed by left ventricular angiocardiography, which demonstrates immediate opacification of a dilated right atrium.

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Cited by (79)

Gerbode septal defect after surgery for aortic valve endocarditis
2023, Cirugia Cardiovascular
El Gerbode es un defecto septal infrecuente que origina un cortocircuito entre el ventrículo izquierdo y la aurícula derecha. Presentamos el caso de un paciente de 68 años con insuficiencia aórtica moderada en seguimiento y antecedentes de neurocirugía reciente para resección de malformación arteriovenosa cerebral, con epilepsia de difícil control posterior. Ingresó en nuestro centro por fiebre secundaria a tromboflebitis y hemocultivos positivos a Staphylococcus aureus resistente a meticilina. En el ecocardiograma transesofágico no se observaron signos de endocarditis y se instauró tratamiento antibiótico dirigido. Seis días después presentó parada cardiorrespiratoria en el contexto de bloqueo auriculoventricular completo y bajo gasto cardiaco. Ingresó en la UCI, donde se implantó un marcapasos transitorio, sufriendo una crisis tónico-clónica que obligó a intubación. Un nuevo ecocardiograma demostró insuficiencia aórtica masiva y engrosamiento de la continuidad mitroaórtica, decidiéndose reemplazo valvular aórtico emergente. El paciente tuvo una buena evolución posquirúrgica inicial hasta que a la semana se detectó en eco de control una masa en la aurícula derecha asociada a comunicación tipo Gerbode. Se decidió manejo conservador pero a los 15 días del diagnóstico, coincidiendo con un claro empeoramiento clínico, se objetivó importante aumento del shunt, indicándose corrección quirúrgica urgente mediante cierre del orificio de salida en la aurícula derecha. El eco de control poscirugía mostró una prótesis aórtica normofuncionante, ausencia de shunt residual y válvula tricúspide competente. La evolución posterior discurrió sin incidencias y el paciente fue dado de alta al finalizar el tratamiento antibiótico.
Gerbode is a rare septal defect that causes a shunt between the left ventricle and the right atrium. We present the case of a 68-year-old patient with moderate aortic regurgitation under follow-up and a history of recent neurosurgery for resection of a cerebral arteriovenous malformation, with residual epilepsy difficult to control. He was admitted to our center due to fever secondary to thrombophlebitis and positive blood cultures for methicillin-resistant Staphylococcus aureus. Transesophageal echocardiogram showed no signs of endocarditis and targeted antibiotic treatment was started. 6 days later, he presented cardiorespiratory arrest in the context of complete atrioventricular block and low cardiac output. He was admitted to the ICU, where a temporary pacemaker was implanted, suffering a tonic-clonic seizure that required intubation. A new echocardiogram showed massive aortic insufficiency and thickening of the mitro-aortic continuity, so emergent aortic valve replacement was indicated. The patient had a good initial post-surgical evolution but, a week later, a mass in the right atrium associated with a Gerbode-type communication was detected in a control echo. Conservative management was decided, but 15 days after the diagnosis of the shunt, coinciding with a clear clinical worsening, a significant increase in the shunt was observed, and he underwent urgent surgical correction by closing the outlet orifice in the right atrium. Post-surgery control echo showed normally functioning aortic prosthesis, absence of residual shunt and competent tricuspid valve. Postoperative recovery was uneventful and patient was discharge after finishing antibiotic treatment.
Percutaneous closure of an acquired and iatrogenic left ventricular–right atrium communication (Gerbode defect) with an Amplatzer Vascular Plug II
2020, Journal of Cardiology Cases
Gerbode defect is defined as an abnormal left ventricle–right atrium shunting which may have congenital or acquired origin, first described by Thurman in 1838, representing 0.08% of intracardiac shunts and <1% of the congenital heart diseases. The acquired defect can be classified as iatrogenic or non-iatrogenic, with previous cardiac surgery being the most common cause. Gerbode defect is classified depending on its position with respect to the tricuspid valve in supravalvular, infravalvular, or intermediate. Our purpose was to report a rare case of an iatrogenic and acquired Gerbode defect in a 10-year-old male patient following surgical correction of a partial anomalous pulmonary venous return of the right pulmonary veins to the right atrium. The defect was successfully closed percutaneously with an Amplatzer™ Vascular Plug II device. Percutaneous closure of acquired Gerbode defects could be considered as a good option using soft devices to reduce the possibility of severe complications such as complete heart block due to the location of the defect.
<Learning objective: Transesophageal echocardiography has a high sensitivity for detection of left ventricle-right atrium shunts; however, it is often difficult to diagnose the anatomic location, relationships of the shunt, and also to distinguish left ventricle–right atrium shunt from sinus of Valsalva rupture, endocardial cushion defect, ventricular septal defect, and tricuspid regurgitation (high flow velocity shunts may also be misinterpreted as pulmonary hypertension). Percutaneous closure of Gerbode defects using soft devices could be considered a good alternative to surgical repair.>
A child with acquired Gerbode defect due to infective endocarditis: Successful percutaneous closure with Nit-occlud device®
2018, Progress in Pediatric Cardiology
Left ventricle to right atrial communication, also known as Gerbode defect, is usually a congenital defect and frequently is closed by cardiac surgery. The percutaneous closure has been reported using Amplatzer muscular occluder® I or Amplatzer ductal occluder® II. We report a rare case of a child with an acquired Gerbode defect following Infective Endocarditis of the tricuspid valve which was successfully closed with a Nit-Occlud device®. There are only a few reports of Gerbode defect percutaneously closed using this device, especially in the young pediatric population.
Gerbode defect: A comprehensive review of its history, anatomy, embryology, pathophysiology, diagnosis, and treatment Gerbode defect
2017, Journal of the Saudi Heart Association
Citation Excerpt :
Communis type defects are usually large and associated with a cleft tricuspid leaflet or a widened commissural space. They differ from the more common forms of endocardial cushion and abnormalities in that both the atrial septum and the mitral valve are generally intact [19]. Physiologically, shunting occurs from the LV to RA due to the large pressure gradient that exists between these cardiac chambers [20,24].
The purpose of this paper is to survey the literature on Gerbode defect and provide an overview of its history, anatomy, development, pathophysiology, diagnosis, and treatment options. The available literature on this topic, including case reports, was thoroughly reviewed. Gerbode defect is defined as abnormal shunting between the left ventricle and right atrium resulting from either a congenital defect or prior cardiac insults. The pathophysiology underlying the development of Gerbode defect is a disease process that injures the atrioventricular septum and leads to the abnormal shunting of blood. Although the most prevalent cause of Gerbode defect has historically been congenital, an increasing trend towards acquired cases has recently been reported owing to improved diagnostic capabilities and a greater number of invasive cardiac procedures. In conclusion, Gerbode defect is an increasingly recognized condition that warrants further study.
Group B streptococcus endocarditis with left ventricle-right atrium (Gerbode's) defect
2014, Annals of Thoracic Surgery
Citation Excerpt :
Because this patient has a history of childhood murmur, it may be possible that she could have had a congenital perimembranous ventricular septal defect that has spontaneously closed, but this has still predisposed her to infective endocarditis [2]. Another possibility is the presence of a small LV-RA defect that produced only a small shunt that was not clinically detectable, but this would be rare and unlikely given that such defects would usually have shown some degree of cardiovascular compromise [7, 8]. Spontaneous closures of supraventricular defects do not usually occur and are also more likely to be acquired than congenital [2].
Gerbode defect associated with blunt trauma in a dog
2011, Journal of Veterinary Cardiology
Citation Excerpt :
In humans, a shunt from the LV to the RA is termed a Gerbode defect, first characterised by Gerbode et al.1 This is a rare cardiac defect, which may be congenital or secondary to septic endocarditis, valve replacement, or thoracic trauma.2–4
A 6 year-old Labrador retriever was presented after being struck by a car. A ventricular arrhythmia, attributed to myocardial trauma, developed 12 h post-trauma. Echocardiography revealed lesions consistent with a subaortic paramembranous ventricular septal defect (VSD) with shunting of blood from the left ventricle to the right atrium (Gerbode defect). A right-to-left shunting atrial septal defect (ASD) was visualised. Pleural and peritoneal effusions developed within 48 h. Fifteen days post-trauma flow across the ASD was left-to-right while left-to-right shunting across the VSD persisted. No cavitary effusions were detected at 15 days post-trauma or subsequently.

View all citing articles on Scopus

^☆: This study was supported in part by U. S. Public Health Service Grant HD-35-05 and H-40495J-23640.

View full text

ReviewLeft ventricular—Right atrial communication☆

Abstract

Aneurysms of the heart

Med. Chir. Tr. Roy. Med. & Chir. Soc. London

Uber angeborene Enge oder Verschluss der Lungenarterienbahn

Virchow's Arch. f. path. Anat.

Zur Casuistik der fötalen Herzenkrankungen

Arch. path. Anat.

Beitrage zur Lehre von der angeborenen Herzanomalien

Beitr. path. Anat.

Congenital communication between the left ventricle and the right atrium: Co-existing ventricular septal defect and double tricuspid orifice

Successful closure of a left ventricular-right atrial shunt

Ann. Surg.

Septal defect between left ventricle and right atrium, diagnosed by cardioangiography

Acta. radiol.

Left ventriculo—right atrial communication: Diagnosis by clinical, hemodynamic and angiographic methods

Am. J. Med.

Congenital malformation of the heart: Perforation of the septum ventricularum, establishing a communication between the left ventricle and the right auricle

Tr. Path. Soc. London

Üeber die Defekte im oberen Teile der Kammerscheidewand des Herzens mit Brucksichtigung der Perforation des hautigen Septums

Arch. path. Anat.

Ein Beitrag zur Frage der Herzmissbildungen an Hand Falles von kongentaler Defektbildung in häutigen Ventrikelseptum und von gleichzeitigem Defekt in dem diesem Septumdefekt anliegendem Klappenzipfel der Valvula tricuspidalis

Arch. path. Anat.

A congenital perforate interventricular septum of the heart accompanied by a shortened medial tricuspid leaflet and a dilated pulmonary artery with two cusps

Tr. Path. Soc. Chicago

Congenital cardiac anomalies in infants. Report of 5 cases

Am. J. Dis. Child.

Localized congenital defects of cardiac interventricular septum: A study of 3 cases

Am. J. Path.

Congenital ventriculo-atrial communication with anomalous tricuspid valve

Am. J. Cardiol.

Defect of endocardial cushion development as a source of cardiac anomaly

Am. J. Path.

An oxygenator pump for use in total bypass of heart and lungs

J. Thoracic Surg.

Syndrome of left ventricular-right atrial shunt resulting from high interventricular septal defect associated with defective septal leaflet of the tricuspid valve

Circulation

Atrioventricular defect of the membranous septum. Left ventricular-right atrial communication with malformed mitral valve simulating aortic stenosis

Bull. Johns Hopkins Hosp.

Syndrome of left ventricular-right atrial shunt: Successful surgical repair of defect in 5 cases with observation of bradycardia on closure

Ann. Surg.

Diagnosis of Congenital Heart Disease

The syndrome of left ventricular to right atrial shunt

Brit. Heart J.

Communication ventricule gauche-oreillete droite: Diagnostic par le catheterisme et la phonocardiographic intracardiaque

Arch. mal. coeur

Left ventricular-right atrial canal and subaortic stenosis: Report of case diagnosed preoperatively

Am. Heart J.

Left ventricular-right atrial canal: Ten cases treated surgically

Am. J. Cardiol.

Communicazione dirette tra ventricolo sinistro e atrio destro

Cuore e circoloz.

Review
Left ventricular—Right atrial communication☆