Gerbode septal defect after surgery for aortic valve endocarditis

Gerbode is a rare septal defect that causes a shunt between the left ventricle and the right atrium. We present the case of a 68 -year -old patient with moderate aortic regurgitation under follow-up and a history of recent neurosurgery for resection of a cerebral arteriovenous malformation, with residual epilepsy difficult to control. He was admitted to our center due to fever secondary to thrombophlebitis and positive blood cultures for methicillin-resistant Staphylococcus aureus. Transesophageal echocardiogram showed no signs of endocarditis and targeted antibiotic treatment was started. 6 days later, he presented cardiorespiratory arrest in the context of complete atrioventricular block and low cardiac output. He was admitted to the ICU, where a temporary pacemaker was implanted, suffering a tonic-clonic seizure that required intubation. A new echocardiogram showed massive aortic insufficiency and thickening of the mitro-aortic continuity, so emergent aortic valve replacement was indicated. The patient had a good initial post -surgical evolution but, a week later, a mass in the right atrium associated with a Gerbodetype communication was detected in a control echo. Conservative management was decided, but 15 days after the diagnosis of the shunt, coinciding with a clear clinical worsening, a significant increase in the shunt was observed, and he underwent urgent surgical correction by closing the outlet orifice in the right atrium. Post -surgery control echo showed normally functioning aortic prosthesis, absence of residual shunt and competent tricuspid valve. Postoperative recovery was uneventful and patient was discharge after finishing antibiotic treatment. (c) 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativccommons.org/ licenses/by-nc/4.0)