Mechanical hemolysis secondary to percutaneous repair of an iatrogenic Gerbode defect with the Amplatzer™ Septal Occluder

The Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium, and is etiologically classified as congenital or acquired (iatrogenic or not). The typical treatment consists of surgical repair of the shunt, but transcatheter occlusion of this condition has proven to be a safe and effective therapeutic alternative for such patients, especially for those with prior surgeries. The aim of this study was to report a case of transcatheter closure of an acquired Gerbode defect, using the Amplatzer™ Septal Occluder device, in a 58-year-old patient, with two prior mitral valve replacements, and the consequent post-procedure mechanical hemolysis.

Spinal abscess in a patient with undiagnosed gerbode defect: a case report

Background Gerbode defect is a rare cardiac defect in which an abnormal communication occurs between the left ventricle and right atrium. The aetiology is usually congenital but acquired defects can occur. Case summary We report on a 47-year-old male with atrioventricular block prior to decompression of an epidural abscess extending from the skull base to the seventh thoracic vertebrae. Following positive blood cultures for Staphylococcus Aureus, a transoesophageal echocardiogram performed revealed a small Gerbode defect with associated endocarditis. In our case, the defect was small and there was no evidence of heart failure, there was little guidance or literature available on how to best manage our patient. A multidisciplinary decision was taken to treat the endocarditis medically and to not close the defect in the acute setting. He recovered well and did not suffer any further cardiac complications. A repeat transthoracic echocardiogram did not reveal any evidence of endocarditis. Conclusion Gerbode defects are rare but have been known to increase the risk of developing endocarditis. It is important to have a high clinical suspicion of endocarditis in patients with evidence of conduction disorders and systemic infection.

Congenital Gerbode Defects Complicated by Infective Endocarditis: 2 Case Reports

Gerbode defect is a rare shunt between the left ventricule and right atrium. The etiology is typically congenital. The infravalvular type is the most common. The congenital defects are believed to close by forming an aneurysmal pouch through incorporating adjacent tricuspid valve tissue. Endocarditis is responsible for this shunt by re-opening the defect. Diagnosis is based on the transesophageal echocardiography. Surgical closure demonstrated an excellent outcome. We present 2 cases with this uncommon congenital shunt complicated by infective endocarditis and septic embolism.

Transcatheter closure of post-operative type 1 Gerbode defect by Amplatzer Duct Occluder 2

Acquired and congenital left ventricular to right atrial communication is rare, but nowadays, the frequency of the iatrogenic subgroup is increasing. Successful transcatheter closure of these defects with different devices has been reported. Herein, we presented successful closure of left ventricular to right atrial communication with Amplatzer Duct Occluder 2 after attempting to close with a failed Amplatzer Vascular Plug II device in a 7-year-old girl. This report supports that transcatheter closure of iatrogenic Gerbode defect with Amplatzer Duct Occluder 2 device is safe and effective.

Perioperative Management of Patients with Ventricular Septal Defect, Severe Tricuspid Regurgitation and Gerbode Defects

<p>Ventricular Septal Defect (VSD) is a congenital heart disease that causes the connection between left and right ventricles called a Gerbode defect. Manifestation of a Gerbode defect is damage to the opening tricuspid valve caused regurgitation of the tricuspid valve. Delay in diagnosis and intervention will affect pre-operative nutritional status and malnutrition.</p><p>We reported a boy aged 2 months, weighing 3100 grams with biliary atresia followed by VSD, severe TR, and Gerbode defect who will undergo the Kasai procedure. Preoperative physical examination showed GCS E4V5M6, SpO2 100%. The skin gets icteric all over the body and conjunctiva. The cardiovascular system has a regular I-II heart sound, 2/3 mid clavicular S noise as high as 2 ICS and a pansystolic murmur. The examination of the abdomen is slight distended. Child pug score 8. Hemoglobin value 6.7gr%, hematocrite 37%, APTT 44.8 seconds, SGOT 443 U / L, SGPT 560 U / L, total bilirubin 23.89 mg / dl, direct bilirubin 13.92 mg / dl, and indirect bilirubin 9.97 mg / dl.</p><p>The goal of anesthesia in VSD, Severe Tricuspid Regurgitation (TR) with Gerbode Defect is preventing excessive ventilation to avoid severe pulmonary hypertension. The choice of anesthetic agent is based on the patient's physiology and balancing pulmonary and systemic blood flow. Perioperative management of cases of VSD, TR Severe with Gerbode defect in the following report describes the importance of understanding the pathophysiology of VSD and Gerbode defects to obtain a good outcome.</p><p>Perioperative management of VSD patients, severe tricuspid regurgitation with Gerbode defect requires more supervision, especially to minimize the increase in PVR, maintain systemic vascular resistance (SVR) and avoid excessive ventilation to prevent severe pulmonary hypertension.</p>