ABSTRACT
Gerbode defect is a communication between the left ventricle and right atrium. It is usually congenital rather than acquired, but can occur as a complication of endocarditis, myocardial infarction, trauma, or cardiac surgery. We report a case of surgical repair of acquired Gerbode defect resulting from infective endocarditis. A 69-year-old woman with aortic regurgitation due to infective endocarditis was referred to our hospital with a diagnosis of congestive heart failure. She was hospitalized and underwent medical treatment (intensive antibiotic therapy). Preoperative transthoracic and transesophageal echocardiography were performed and revealed a mobile mass (vegetation) on the aortic valve. The patient also had severe aortic regurgitation and a communication between the left ventricle and right atrium. The communication was visualized in the atrioventricular membranous septum. Due to the mobility of the mass (vegetation) and uncontrollable congestive heart failure caused by severe aortic regurgitation, surgical treatment was advised. Surgery was performed through a median sternotomy with the patient on cardiopulmonary bypass. After aortic cross-clamping, the vegetation was approached through a horizontal incision in the ascending aorta and a right atriotomy. The communication site from the left view was below the commissure between the right coronary and non-coronary cusps ; from the right view, it was just above the tricuspid annulus of the septal leaflet. The defect was closed with two 0.4-mm thick Gore-Tex cardiovascular patches : one was placed on the LV side and the other on the RA side. The aortic valve was replaced with a bioprosthetic valve (SJM Epic 21 mm). The operation was finished and her clinical course was almost uneventful.
ABSTRACT
<p>Calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass composed of nodules of calcium with a background of amorphous fibrous material and was first described in 1997. This report describes a 61-year-old man, who had been on hemodialysis for 10 years and was referred to our hospital with a diagnosis of acute myocardial infarction. He had percutaneous coronary intervention (PCI) for stenosis of the left anterior descending artery (LAD). He was hospitalized and under medical treatment. A follow-up echocardiogram was performed and revealed a normal ejection fraction of 0.60. Moderate mitral annular calcification with mild-to-moderate mitral stenosis was seen. An ultrasound-mobile mass was visualized in the left ventricular outflow tract (LVOT). There was no hemodynamic evidence of LVOT obstruction on Doppler echocardiography. Transesophageal echocardiography showed a mobile mass attached to the LVOT in the mitral valve annulus that extended almost to the membranous septum. Due to the mobility of the mass and potential for embolism, surgical removal was advised. Concomitant procedures (coronary artery bypass grafting (CABG) and a full maze operation) were proposed because he still had symptoms of chest pain with myocardial ischemia and palpitations due to chronic atrial fibrillation. Surgery was performed through a median sternotomy on cardiopulmonary bypass. After aortic cross-clamping, the mass was approached through a horizontal incision in the ascending aorta. The white tumor was resected easily from the membranous septum. The operation was finished after CABG and a full maze procedure, and his clinical course was uneventful. Histological examination showed that the tumor contained many calcified nodules and fibrino-sanguineous deposits ; these findings are compatible with CAT.</p>