Xhabija Nereida, Prifti Edvin, Allajbeu Iris, Sula Fatmir
Department of Cardiology and Cardiac-Surgery, American Hospital, Tirana, Albania.
Cardiovasc Ultrasound. 2010 Sep 30;8:44. doi: 10.1186/1476-7120-8-44.
A Gerbode-type defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis. This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. However, identification of an actual communication is often extremely difficult, so a careful and meticulous echocardiogram should be done in order to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension. The large systolic pressure gradient between the left ventricle and the right atrium would expectedly result in a high velocity systolic Doppler flow signal in right atrium and it can be sometimes mistakably diagnosed as tricuspid regurgitant jet simulating pulmonary arterial hypertension. We present a rare case of young woman, with endocarditis who presented with severe pulmonary arterial hypertension. The preoperative diagnosis of left ventricle to right atrial communication (acquired Gerbode defect) was suspected initially by echocardiogram and confirmed at the time of the surgery. A point of interest, apart from the diagnostic problem, was the explanation for its mechanism and presentation. The probability of a bacterial etiology of the defect is high in this case.
Gerbode型缺损是指左心室与右心房直接相通的室间隔缺损。它通常是先天性的，但作为心内膜炎的并发症而获得性的情况极为罕见。从解剖学角度来看这是可能的，因为正常的三尖瓣比二尖瓣更靠近心尖移位。然而，确定实际的相通情况往往极其困难，因此应进行仔细且细致的超声心动图检查，以防止将这种缺损在超声心动图上错误地解释为肺动脉高压。左心室与右心房之间较大的收缩期压力梯度预计会导致右心房出现高速收缩期多普勒血流信号，有时可能会被误诊为模拟肺动脉高压的三尖瓣反流束。我们报告一例年轻女性心内膜炎患者，其表现为严重的肺动脉高压。术前通过超声心动图初步怀疑存在左心室至右心房相通（获得性Gerbode缺损），手术时得以证实。除了诊断问题外，一个有趣的点是对其机制和表现的解释。在这种情况下，缺损由细菌病因引起的可能性很大。
