Acquired Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis

BACKGROUND: Communication between the left ventricle and right atrium, termed a Gerbode ventricular septal defect (VSD), was first described in 1838 later explained with varying etiologies, including congenital acquired forms. Most of LV-RA shunts are either postoperative or infective etiology. Among these endocarditis is rare cause, echocardiography mainstay its diagnosis clinical management. CASE REPORT: Here, we describe case patient bacterial as cause to atrium shunt, subsequent intraoperative surgical repair. A 38-year-old man history fever past 2 weeks diagnosed involving tricuspid, aortic, mitral valve. Pre-operative transesophageal revealed severe aortic regurgitation large vegetations on non-coronary cusps sizing about 1 cm2. The valve had mild some filiform side anterior leaflet. examination showed advanced tricuspid leaflets. cardiologists also measured pulmonary hypertension up 90 mmHg. During surgery, after careful observation, communication discovered area under junction underwent replacement 25-mm Regent mechanical (St. Jude Medical, St. Paul, MN), primary closure 5 mm ×5 using polyester 2.0 pledgeted sutures, 31-mm Epic bio-prosthesis, curettage patient’s course uneventful he transferred at hospital 10th post-operative day. After 4 parenteral antibiotic therapy, discharged good conditions. CONCLUSION: To best our knowledge, this unique reported triple treated surgery. We encourage meticulous patients find abnormal communications.