Objectives Left ventricular-right atrium (LV-RA) shunt (Gerbode defect), is a rare type of ventricular septal defect. The purpose of this study was to discuss the role of the echocardiography in LV-RA shunt in the perioperative period.
Methods The clinical and echocardiographic characteristics of 4 patients diagnosed as LV-RA shunt by echocardiography in our hospital were analysed.
Results Two of the 4 patients were congenital LV-RA shunt, and the other two patients were acquired LV-RA shunt which both caused by the repair of the ventricle septal defect. Before operation, transthoracic echocardiography (TTE) revealed a defect of the membranous septum between the mitral valve and the septal tricuspid valve leaflet. Colour Doppler showed a prominent systolic flow disturbance in the right atrium with a high velocity, originated from the left ventricular outflow tract. The real time three-dimensional echocardiography (RT3DE) provided exact visualisation of the origin and course of the shunt in three dimension and accurate assessment of its shape and size. Except one of the 4 patients quitted therapy, two of them accepted transesophageal echocardiography (TEE) guided minimal invasive intraoperative device closure, and the another one accepted transcatheter device closure. Post-operation, no residual shunt and the stable occluder were detected immediately by TEE.
Conclusions Echocardiography is not only the first choice of the diagnostic approach for LV-RA shunt, but also pays an important role in guiding the device closure and evaluating the therapy effect, especially the RT3DE with rapid, detailed 3D appreciation of the shunt can help design optimal surgical or catheter-based therapy.