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Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension

DOI: 10.1186/1476-7120-8-44

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Abstract:

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's defect is a rare form of VSD that allows for communication between the LV and RA. Two types of LV-to-RA communication are described: supravalvular and infravalvular, depending on whether the defect in the membranous septum is above or below the tricuspid valve [1,2]. Although the majority appears to attribute the Gerbode defect to congenital origins, there have been publication in the past that have credited the defect's formation secondary to bacterial endocarditis, especially supravalvular form [3].We present a case of our patient with this uncommon complication of endocarditis, simulating severe pulmonary hypertension.A 41 year old lady, from Kosovo, was referred to our hospital for severe pulmonary arterial hypertension and a mass in right atrium suspected for vegetation. About one month before, she presented to the ER of her local hospital with pyrexia and malaise. She was given medication and nutrition through the right internal jugular site for a few days since her peripheral venous system was unavailable. Cardiology was consulted because her blood culture grew methacilin sensitive Staphylococcus aureus and she had persistent fever, despite antibiotics treatment. At that time the echocardiogram was interpreted as following: normal valves and cardiac chambers, but a mobile mass consistent with vegetation in right atrium was present. The tricuspid regurgitation was considered mild- to- moderate with estimated pulmonary arterial systolic pressure about 80-90 mmHg (figure 1A)

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