From the Research
The management of a Gerbode defect primarily involves surgical repair, but percutaneous closure should be strongly considered for patients who may be poor surgical candidates, as evidenced by a case report in the European heart journal, Case reports 1. The treatment approach for a Gerbode defect, an abnormal communication between the left ventricle and right atrium, depends on the severity of symptoms, defect size, and hemodynamic impact.
- Surgical closure of the defect is typically performed via median sternotomy with cardiopulmonary bypass, using patch closure with either autologous pericardium or synthetic material to seal the defect.
- Percutaneous transcatheter closure may be considered for smaller defects or high-risk patients, using occluder devices similar to those used for atrial septal defects, as reported in Interactive cardiovascular and thoracic surgery 2.
- Medical management before surgery focuses on treating heart failure symptoms with diuretics, ACE inhibitors, and beta-blockers, as well as antibiotic prophylaxis for endocarditis following repair.
- The timing of intervention depends on symptom severity, defect size, and hemodynamic impact, with surgical repair necessary to prevent left-to-right shunting that can lead to right heart failure, pulmonary hypertension, and arrhythmias if left untreated, as highlighted in the Journal of cardiothoracic surgery 3.
- Regular follow-up with echocardiography is essential post-repair to monitor for residual shunting or complications, as noted in the European heart journal, Case reports 4. Key considerations in the management of Gerbode defects include:
- Early diagnosis and timely surgery or referral for successful outcome, as emphasized in the Journal of clinical and diagnostic research 5.
- Collaboration between adult cardiology, cardiothoracic surgery, and congenital cardiology services to develop an optimal treatment plan, as reported in the European heart journal, Case reports 1.