Surgical Treatment for Gerbode Defect Caused by Infective Endocarditis

J INVASIVE CARDIOL 2021;33(12):E1009.

Key words: endocarditis, Gerbode defect

A 52-year-old woman with no known cardiac history developed infective endocarditis of the mitral and tricuspid valves caused by methicillin-sensitive Staphylococcus aureus following skin infection. She demonstrated complete heart block and severe mitral regurgitation (perforation in the anterior leaflet), moderate tricuspid regurgitation with vegetation at the base of the septal leaflet, and a shunt (left-right) from the left ventricle to the right atrium (Figure 1 and Video Series). At surgery, we debrided the mitral and tricuspid valves, and replaced them with tissue prosthetic valves. The inlet of the defect was confirmed to be immediately behind the A2 mitral leaflet. In the right atrium, we identified the shunting defect just in front of the anterior-septum commissure connecting to perimembranous septum (Figure 1). Infective tissue was also observed surrounding the outlet of the defect and was debrided. The defect was closed with autologous pericardium. Postoperative echocardiographic findings were satisfactory without residual shunt flow or perivalvular leak (Video Series). Postoperative recovery was uneventful without infection recurrence. Gerbode defect is a rare complication of infective endocarditis and careful preoperative echocardiographic work-up is imperative for successful repair.

From the ¹Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; and ²North York Diagnostic and Cardiac Centre, North York, Ontario, Canada.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted July 8, 2021.

The authors report patient consent for the images used herein.

Address for correspondence: Subodh Verma, MD, PhD, Professor and Cardiac Surgeon, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Email: subodh.verma@unityhealth.to

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