Cardiac magnetic resonance imaging flow analysis in a patient with Gerbode septal defect. (QF_TH_054)

Description of Clinical Presentation: A 77 year old male is seen in the clinic with history of biologic aortic valve replacement 10 years ago due to severe aortic stenosis. In the postoperative period he required multiple surgeries for mediastinitis treatment. Follow up echocardiogram showed slightly increase in pulmonary pressure but normal prosthetic valve function. In his recent visit he was asymptomatic, nonetheless a systolic heart murmur and increased velocity in the prosthetic valve was found (3.8 m/s); as well as suspected intracardiac shunt, due to dilated right chambers.

Diagnostic Techniques and Their Most Important Findings: A cardiac magnetic resonance (CMR) was performed at a 1.5 Tesla magnet. Electrocardiogram gated steady state free precession (SSFP) cine images, phase contrast and 4D flow sequences were acquired. SSFP cines showed the shunt between the left ventricle (LV) and right atrium (RA). Multiple planes demonstrate the jet passing above the tricuspid valve (type 1). In the flow analysis the shunt was found to be present in systole and diastole; QP/QS: 1.5. 
A Gerbode type septal defect was concluded and the patient proposed for aortic valve replacement and closure of the septal defect.

Learning Points from this Case:

• Gerbode defect is uncommon but has to be suspected when there is an intracardiac shunt with the corresponding clinical findings in a patient with history of aortic valve replacement and mediastinal or heart infections and no previous diagnosis of congenital heart disease.


• Describing the exact location of the defect is important for planning the appropriate correction, which could be surgical or percutaneous. 


• Flow analysis helps to understand the hemodynamics of the defect and its consequences such as chamber dilation and increased pulmonary blood flow.