Taskesen Tuncay, Prouse Andrew Fred, Goldberg Steven Lewis, Gill Edward Allen
Division of Cardiology, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA,
Int J Cardiovasc Imaging. 2015 Apr;31(4):753-64. doi: 10.1007/s10554-015-0620-3. Epub 2015 Feb 14.
Acquired type of LV to RA shunt (Gerbode defect) is rare form of intracardiac shunt which is due to complications of invasive cardiac procedures, endocarditis, trauma or myocardial infarction. Increasing invasive and recurrent cardiovascular procedures have led to more acquired cases of what used to be a predominant congenital heart defect. Advanced cardiac imaging techniques and awareness of this rare pathology may account for the increased number of case reports in the last two decades Advanced cardiac imaging tools such as cardiac CT, MRI and Real-time 3D echocardiography provide definitive diagnosis and anatomic characterization of the shunt. Real-time 3D echocardiography is an imaging technique with arguably the most advantages. It is not only a diagnostic tool; it has also become an integral part of percutaneous and surgical treatment. Although surgical repair is the usual treatment for this shunt, percutaneous catheter-based closure has seen significant success as a less invasive treatment in selected patients in the last decade. In summary, a beneficial side effect of the increasing frequency of acquired Gerbode defect has been the corresponding development of newer diagnostic tools and less invasive treatments. This article presents etiologic, diagnostic and treatment changes of acquired LV-RA shunts over the last two decades.
获得性左心室至右心房分流（Gerbode缺损）是一种罕见的心内分流形式，其病因是侵入性心脏手术、心内膜炎、创伤或心肌梗死等并发症。侵入性和复发性心血管手术的增加导致了更多过去主要为先天性心脏缺陷的获得性病例。先进的心脏成像技术以及对这种罕见病理的认识可能是过去二十年病例报告数量增加的原因。心脏CT、MRI和实时三维超声心动图等先进的心脏成像工具可对分流进行明确诊断和解剖特征描述。实时三维超声心动图是一种优势最为明显的成像技术。它不仅是一种诊断工具，还已成为经皮和手术治疗不可或缺的一部分。虽然手术修复是这种分流的常用治疗方法，但在过去十年中，经皮导管封堵术作为一种侵入性较小的治疗方法，在特定患者中取得了显著成功。总之，获得性Gerbode缺损发生率增加的一个有益副作用是相应地开发了更新的诊断工具和侵入性较小的治疗方法。本文介绍了过去二十年来获得性左心室至右心房分流的病因、诊断和治疗变化。
