Balta, Sevket

Bozlar, Ugur

Demirkol, Sait

Guler, Adem

Gurkan Yesil, Fahri

Sahin, Mehmet Ali

Via Medica Journals

www.kardiologiapolska.plKardiologia Polska 2013; 71, 1: 104 ISSN 0022–9032STUDIUM PRZYPADKU / CLINICAL VIGNETTEAddress for correspondence:Sait Demirkol, MD, Assistant Professor of Cardiology, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St.,06018 Etlik-Ankara, Turkey, tel: +90-312-3044281, fax: +90-312-3044250, e-mail: saitdemirkol@yahoo.comConflict of interest: none declaredMultimodality imaging of a congenitalGerbode defectWrodzony ubytek typu Gerbode’a — obrazowanie nieinwazyjneSait Demirkol1, Fahri Gurkan Yesil2, Ugur Bozlar3, Sevket Balta1, Mehmet Ali Sahin2, Adem Guler21Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey2Department of Cardiovascular Surgery, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey3Department of Radiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, TurkeyA 21 year-old male patient was admitted to our outpatient clinic due to shortness of breath. He had been diagnosed with a ventricularseptal defect ten years previously. A systolic murmur was heard at the left sternal border. A 12-lead ECG showed a right bundle branchblock. Two-dimensional transthoracic echocardiography (2D TTE) short-axis view revealed a tunnel-like appearance (Fig. 1A); 3D TTEen-face view after manual cropping of a full-volume acquisition demonstrated the defect at the membraneous septum (Fig. 1B, C). Tofurther define shunt anatomy, we applied 2D and 3D transoesophageal echocardiography (TEE), and cardiac magnetic resonanceangiography (MRA). 2D and 3D TEE short-axis view revealed a tunnel-like appearance (Fig. 1D, F). 2D colour Doppler TEE showeda systolic flow between left ventricle (LV) and right atrium (RA) (Fig. 1E). Cardiac MRA coronal and short-axis views confirmed the defectat membraneous septum and the shunt between the LV and RA (Fig. 2A, B). The membraneous septum can be divided into atrioven-tricular and interventricular segments, based upon their relationship to the septal leaflet of the tricuspid valve. Defects in the atrioven-tricular portion of the membraneous septum can result in LV to RA communications, also known as the Gerbode defect. LV-RAcommunications are mostly congenital, and account for approximately 0.08% of all congenital cardiac anomalies. Acquired LV-RAcommunications can result from endocarditis, trauma, valve replacement, or myocardial infarction. We herein demonstrated 2D and3D echocardiographic and cardiac MRA features of a congenital Gerbode defect in an adult patient. Multimodal imaging of theGerbode defect may be useful in revealing the localisation, shape, and size of the defect in detail.Figure 1. A. 2D TTE short-axisview revealed a tunnel-likeappearance; B, C. 3D TTE en-faceview after manual cropping ofa full-volume acquisition demon-strated the defect at the membra-neous septum; D, F. 2D and 3DTEE short-axis view revealeda tunnel-like appearance; E. 2Dcolour Doppler TEE showeda systolic flow between leftventricle (LV) and right atrium (RA);RV — right ventricle; LV — leftventricle; LA — left atrium;Ao — aorta; IVS — interventricu-lar septum; MS — membraneousseptum; arrow — Gerbode defectFigure 2. Cardiac MRA coronal(A) and short-axis (B) viewsconfirmed the defect atmembraneous septum and theshunt between the leftventricle (LV) and right atrium(RA); LV— left ventricle;arrow — Gerbode defect

Wrodzony ubytek typu Gerbode’a — obrazowanie nieinwazyjne

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Wrodzony ubytek typu Gerbode’a — obrazowanie nieinwazyjne

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