Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 21-22/2015

01.11.2015 | original article

Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas

verfasst von: MD, PhD Shi-Min Yuan

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 21-22/2015

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

The acquired left ventricle-to-right atrium (LV-RA) shunt (Gerbode defect) is rare but it can sometimes be a critical condition. The diagnosis is quite challenging largely due to its exotic anatomic features and diagnostic difficulties. This study aims to present the clinical features and diagnostic solutions of this rare lesion.

Methods

Data source was based on a comprehensive literature retrieval of acquired LV-RA shunts of 1990–2014.

Results

Most of the acquired LV-RA shunts are of either a postoperative or an infective etiology. Transthoracic echocardiography showed a 62.2 % accurate diagnosis, 13.4 % inclusive diagnosis, 9.8 % missed diagnosis, and 14.5 % misdiagnosis rate. The accurate diagnostic rate of transthoracic echocardiography was significantly lower than that of the transesophageal echocardiography or cardiac catheterization. The LV-RA shunts are often misinterpreted as mitral regurgitation, pulmonary hypertension, tricuspid regurgitation, Valsalva aneurysm rupture, and subaortic/high perimembrane/residual ventricular septal defect. Surgical, interventional, and conservative treatments were applied in 57.8, 24.4, and 17.8 % patients, respectively. Prognosis showed an event-free survival of 85 %, a comorbidity of 9.1 %, and a mortality of 13.6 %.

Conclusions

A high jet detected in the right atrium with uncertain origin and course has to appeal to additional diagnostic techniques including transesophageal echocardiography, cardiac catheterization, or cardiac magnetic resonance imaging for differential diagnoses. Small restrictive shunts are preferred with conservative treatments, high-risk patients are candidates of interventional therapy, and the patients with unstable hemodynamics warrant an open heart surgery. Careful operative maneuver, good control of intracardiac infection, preservation of heart function, etc., are mandatory for the prevention of the development of an acquired LV-RA shunt.

Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:

Abo für kostenpflichtige Inhalte

Literatur
1.
Zurück zum Zitat Gerbode F, Hultgren H, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt: successful surgical repair of defect in five cases with observation of bradycardia on closure. Ann Surg. 1958;148(3):433–6. CrossRefPubMedPubMedCentral Gerbode F, Hultgren H, Melrose D, Osborn J. Syndrome of left ventricular-right atrial shunt: successful surgical repair of defect in five cases with observation of bradycardia on closure. Ann Surg. 1958;148(3):433–6. CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Riemenschneider TA, Moss AJ. Left ventricular-right atrial communication. Am J Cardiol. 1967;19(5):710–8. CrossRefPubMed Riemenschneider TA, Moss AJ. Left ventricular-right atrial communication. Am J Cardiol. 1967;19(5):710–8. CrossRefPubMed
4.
Zurück zum Zitat Demirkol S, Gurkan Yesil F, Bozlar U, Balta S, Sahin MA, Guler A. Multimodality imaging of a congenital Gerbode defect. Kardiol Pol. 2013;71(1):104. PubMed Demirkol S, Gurkan Yesil F, Bozlar U, Balta S, Sahin MA, Guler A. Multimodality imaging of a congenital Gerbode defect. Kardiol Pol. 2013;71(1):104. PubMed
5.
Zurück zum Zitat Matt P, Winkler B, Gutmann M, Eckstein F. Acquired Gerbode defect after endocarditis. Eur J Cardiothorac Surg. 2009;36(2):402. CrossRefPubMed Matt P, Winkler B, Gutmann M, Eckstein F. Acquired Gerbode defect after endocarditis. Eur J Cardiothorac Surg. 2009;36(2):402. CrossRefPubMed
6.
Zurück zum Zitat Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(5):676–7. PubMed Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(5):676–7. PubMed
7.
Zurück zum Zitat Alphonso N, Dhital K, Chambers J, Shabbo F. Gerbode’s defect resulting from infective endocarditis. Eur J Cardiothorac Surg. 2003;23(5):844–6. CrossRefPubMed Alphonso N, Dhital K, Chambers J, Shabbo F. Gerbode’s defect resulting from infective endocarditis. Eur J Cardiothorac Surg. 2003;23(5):844–6. CrossRefPubMed
8.
Zurück zum Zitat Álvarez JAG, Alonso JL, Leiva GA, Baglioni P, Fernández Recalde ML, Rivas C, Manuale OD, Migliaro G, Lezica AM, Sciegata A. Unconventional applications of endovascular devices in acquired structural cardiopathies. Rev Argent Cardiol. 2013;81(2):147–51. CrossRef Álvarez JAG, Alonso JL, Leiva GA, Baglioni P, Fernández Recalde ML, Rivas C, Manuale OD, Migliaro G, Lezica AM, Sciegata A. Unconventional applications of endovascular devices in acquired structural cardiopathies. Rev Argent Cardiol. 2013;81(2):147–51. CrossRef
9.
Zurück zum Zitat Amirghofran AA, Emaminia A. Left ventricular-right atrial communication (Gerbode-type defect) following mitral valve replacement. J Card Surg. 2009;24(4):474–6. CrossRefPubMed Amirghofran AA, Emaminia A. Left ventricular-right atrial communication (Gerbode-type defect) following mitral valve replacement. J Card Surg. 2009;24(4):474–6. CrossRefPubMed
10.
Zurück zum Zitat Aoyagi S, Arinaga K, Oda T, Hori H. Left ventricular-right atrial communication following tricuspid annuloplasty. Eur J Cardiothorac Surg. 2008;34(3):680–1. CrossRefPubMed Aoyagi S, Arinaga K, Oda T, Hori H. Left ventricular-right atrial communication following tricuspid annuloplasty. Eur J Cardiothorac Surg. 2008;34(3):680–1. CrossRefPubMed
11.
Zurück zum Zitat Battin M, Fong LV, Monro JL. Gerbode ventricular septal defect following endocarditis. Eur J Cardiothorac Surg. 1991;5(11):613–4. CrossRefPubMed Battin M, Fong LV, Monro JL. Gerbode ventricular septal defect following endocarditis. Eur J Cardiothorac Surg. 1991;5(11):613–4. CrossRefPubMed
12.
Zurück zum Zitat Benisty J, Roller M, Sahar G, Paz R, Vidne B, Sagie A. Iatrogenic left ventricular-right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography. J Heart Valve Dis. 2000;9(5):732–5. PubMed Benisty J, Roller M, Sahar G, Paz R, Vidne B, Sagie A. Iatrogenic left ventricular-right atrial fistula following mitral valve replacement and tricuspid annuloplasty: diagnosis by transthoracic and transesophageal echocardiography. J Heart Valve Dis. 2000;9(5):732–5. PubMed
13.
Zurück zum Zitat Bergman R, Natour E, Wang A, Sakamuri S, Jainandunsing J, Mahmood F. A Gerbode-like defect after infective endocarditis. Anesth Analg. 2013;116(SCA Suppl):1–182. Bergman R, Natour E, Wang A, Sakamuri S, Jainandunsing J, Mahmood F. A Gerbode-like defect after infective endocarditis. Anesth Analg. 2013;116(SCA Suppl):1–182.
14.
Zurück zum Zitat Bochard-Villanueva B, Fabregat-Andrés O, Estornell-Erill J, Payá-Serrano R, Ridocci-Soriano F. Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiography. J Cardiovasc Comput Tomogr. 2012;6(5):355–6. CrossRefPubMed Bochard-Villanueva B, Fabregat-Andrés O, Estornell-Erill J, Payá-Serrano R, Ridocci-Soriano F. Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiography. J Cardiovasc Comput Tomogr. 2012;6(5):355–6. CrossRefPubMed
15.
Zurück zum Zitat Can I, Krueger K, Chandrashekar Y, Li JM, Dykoski R, Tholakanahalli VN. Images in cardiovascular medicine. Gerbode-type defect induced by catheter ablation of the atrioventricular node. Circulation. 2009;119(22):e553–6. CrossRefPubMed Can I, Krueger K, Chandrashekar Y, Li JM, Dykoski R, Tholakanahalli VN. Images in cardiovascular medicine. Gerbode-type defect induced by catheter ablation of the atrioventricular node. Circulation. 2009;119(22):e553–6. CrossRefPubMed
16.
Zurück zum Zitat Carpenter RJ, Price GD, Boswell GE, Nayak KR, Ramirez AR. Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis. J Card Surg. 2012;27(3):316–20. CrossRefPubMed Carpenter RJ, Price GD, Boswell GE, Nayak KR, Ramirez AR. Gerbode defect with Staphylococcus lugdunensis native tricuspid valve infective endocarditis. J Card Surg. 2012;27(3):316–20. CrossRefPubMed
17.
Zurück zum Zitat Chaturvedi A, Lau R, Kicska G, Reddy GP. MR findings in iatrogenic Gerbode defect. Int J Cardiovasc Imaging. 2013;29(1):3–4. CrossRefPubMed Chaturvedi A, Lau R, Kicska G, Reddy GP. MR findings in iatrogenic Gerbode defect. Int J Cardiovasc Imaging. 2013;29(1):3–4. CrossRefPubMed
18.
Zurück zum Zitat Cortez-Dias N, Varela MG, Marques J, Sargento L, Martins S, Ribeiro MA, Almeida AG, Diogo AN, Lopes MG. Acquired left ventricular-to-right atrial shunt (Gerbode defect) due to infective endocarditis. Rev Port Cardiol. 2009;28(6):735–9. PubMed Cortez-Dias N, Varela MG, Marques J, Sargento L, Martins S, Ribeiro MA, Almeida AG, Diogo AN, Lopes MG. Acquired left ventricular-to-right atrial shunt (Gerbode defect) due to infective endocarditis. Rev Port Cardiol. 2009;28(6):735–9. PubMed
19.
Zurück zum Zitat Dadkhah R, Friart A, Leclerc JL, Moreels M, Haberman D, Lienart F. Uncommon acquired Gerbode defect (left ventricular to right atrial communication) following a tricuspid annuloplasty without concomitant mitral surgery. Eur J Echocardiogr. 2009;10(4):579–81. CrossRefPubMed Dadkhah R, Friart A, Leclerc JL, Moreels M, Haberman D, Lienart F. Uncommon acquired Gerbode defect (left ventricular to right atrial communication) following a tricuspid annuloplasty without concomitant mitral surgery. Eur J Echocardiogr. 2009;10(4):579–81. CrossRefPubMed
20.
Zurück zum Zitat Dangol A, Bansal M, Al-Khatib Y. Transcatheter closure of acquired left ventricle-to-right atrium shunt: first case report in an infant and review of the literature. Pediatr Cardiol. 2013;34(5):1258–60. CrossRefPubMed Dangol A, Bansal M, Al-Khatib Y. Transcatheter closure of acquired left ventricle-to-right atrium shunt: first case report in an infant and review of the literature. Pediatr Cardiol. 2013;34(5):1258–60. CrossRefPubMed
21.
Zurück zum Zitat Doig JC, Au J, Dark JH, Furniss SS. Post-infarction communication between a left ventricular aneurysm and the right atrium. Eur Heart J. 1992;13(7):1006–7. PubMed Doig JC, Au J, Dark JH, Furniss SS. Post-infarction communication between a left ventricular aneurysm and the right atrium. Eur Heart J. 1992;13(7):1006–7. PubMed
22.
Zurück zum Zitat Dores H, Abecasis J, Ribeiras R, Neves JP, Mendes M. Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis. Cardiovasc Ultrasound. 2012;10:7. doi:10.1186/1476-7120-10-7. CrossRefPubMedPubMedCentral Dores H, Abecasis J, Ribeiras R, Neves JP, Mendes M. Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis. Cardiovasc Ultrasound. 2012;10:7. doi:10.1186/1476-7120-10-7. CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Dragicevic N, Schmidlin E, Hazelton TR, Nallamshetty L. Gerbode ventricular septal defect diagnosed using cardiac CTA imaging. Radiol Case Rep. 2011;6(3):1–3. CrossRef Dragicevic N, Schmidlin E, Hazelton TR, Nallamshetty L. Gerbode ventricular septal defect diagnosed using cardiac CTA imaging. Radiol Case Rep. 2011;6(3):1–3. CrossRef
24.
Zurück zum Zitat Dzwonczyk T, Davidson WR Jr. The spectrum of left ventricular-right atrial communications in the adult: essentials of echocardiographic assessment. J Am Soc Echocardiogr. 1995;8(3):263–9. CrossRefPubMed Dzwonczyk T, Davidson WR Jr. The spectrum of left ventricular-right atrial communications in the adult: essentials of echocardiographic assessment. J Am Soc Echocardiogr. 1995;8(3):263–9. CrossRefPubMed
25.
Zurück zum Zitat Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z. Acquired left ventricular-right atrial communication caused by infective endocarditis detected by transesophageal echocardiography: case report and review of the literature. J Am Soc Echocardiogr. 1995;8(1):108–10. CrossRefPubMed Elian D, Di Segni E, Kaplinsky E, Mohr R, Vered Z. Acquired left ventricular-right atrial communication caused by infective endocarditis detected by transesophageal echocardiography: case report and review of the literature. J Am Soc Echocardiogr. 1995;8(1):108–10. CrossRefPubMed
26.
Zurück zum Zitat Elmistekawy E, Dickie S, Nicholson D, Mesana T. Left ventricular outflow tract-right atrial fistula following aortic valve replacement. J Card Surg. 2012;27(5):570–2. CrossRefPubMed Elmistekawy E, Dickie S, Nicholson D, Mesana T. Left ventricular outflow tract-right atrial fistula following aortic valve replacement. J Card Surg. 2012;27(5):570–2. CrossRefPubMed
27.
Zurück zum Zitat Frigg C, Cassina T, Siclari F, Mauri R. Unusual complication after aortic valve replacement. Interact Cardiovasc Thorac Surg. 2008;7(1):149–50. CrossRefPubMed Frigg C, Cassina T, Siclari F, Mauri R. Unusual complication after aortic valve replacement. Interact Cardiovasc Thorac Surg. 2008;7(1):149–50. CrossRefPubMed
28.
Zurück zum Zitat Garg R, Garcia R, Cubeddu RJ. Gerbode defect misinterpreted as pulmonary hypertension. J Cardiol Cases. 2013;7(2):e34–6. CrossRef Garg R, Garcia R, Cubeddu RJ. Gerbode defect misinterpreted as pulmonary hypertension. J Cardiol Cases. 2013;7(2):e34–6. CrossRef
29.
Zurück zum Zitat Gorki H, Loulmet DF, Lessnau KD. A postoperative Gerbode defect in aortic prosthesis endocarditis with non-typhoid Salmonella. J Heart Valve Dis. 2009;18(3):325–6. PubMed Gorki H, Loulmet DF, Lessnau KD. A postoperative Gerbode defect in aortic prosthesis endocarditis with non-typhoid Salmonella. J Heart Valve Dis. 2009;18(3):325–6. PubMed
30.
Zurück zum Zitat Hansalia S, Manda J, Pothineni KR, Nanda NC. Usefulness of live/real time three-dimensional transthoracic echocardiography in diagnosing acquired left ventricular-right atrial communication misdiagnosed as severe pulmonary hypertension by two-dimensional transthoracic echocardiography. Echocardiography. 2009;26(2):224–7. CrossRefPubMed Hansalia S, Manda J, Pothineni KR, Nanda NC. Usefulness of live/real time three-dimensional transthoracic echocardiography in diagnosing acquired left ventricular-right atrial communication misdiagnosed as severe pulmonary hypertension by two-dimensional transthoracic echocardiography. Echocardiography. 2009;26(2):224–7. CrossRefPubMed
31.
Zurück zum Zitat Hilberath JN, Shook D, Shernan SK, Rosenberger P. Left ventricular outflow tract to right atrial fistula diagnosed by intraoperative transesophageal echocardiography. Anesth Analg. 2007;104(2):261–2. CrossRefPubMed Hilberath JN, Shook D, Shernan SK, Rosenberger P. Left ventricular outflow tract to right atrial fistula diagnosed by intraoperative transesophageal echocardiography. Anesth Analg. 2007;104(2):261–2. CrossRefPubMed
32.
Zurück zum Zitat Hole T, Wiseth R, Levang O. Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J. 1995;16(6):866–8. PubMed Hole T, Wiseth R, Levang O. Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography. Eur Heart J. 1995;16(6):866–8. PubMed
34.
Zurück zum Zitat Hori D, Tanaka M, Yamaguchi A, Adachi H. Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Gerbode defect. Gen Thorac Cardiovasc Surg. 2010;58(5):255–9. CrossRefPubMed Hori D, Tanaka M, Yamaguchi A, Adachi H. Surgically treated infective endocarditis involving the aortic bicuspid valve and ventricular septum revealing aortic regurgitation and a Gerbode defect. Gen Thorac Cardiovasc Surg. 2010;58(5):255–9. CrossRefPubMed
35.
Zurück zum Zitat Hsu SY, Shen TC. A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging. 2014;15(4):471. CrossRefPubMed Hsu SY, Shen TC. A spontaneously closed, acquired supravalvular Gerbode defect mimicking an unruptured sinus of Valsalva aneurysm. Eur Heart J Cardiovasc Imaging. 2014;15(4):471. CrossRefPubMed
36.
Zurück zum Zitat Hussain ST, Mawulawde K, Kapadia SR, Blackstone EH, Pettersson GB. Lessons learned from failed attempt at transcatheter closure of postoperative Gerbode defect. J Thorac Cardiovasc Surg. 2014;148(5):e228–30. Hussain ST, Mawulawde K, Kapadia SR, Blackstone EH, Pettersson GB. Lessons learned from failed attempt at transcatheter closure of postoperative Gerbode defect. J Thorac Cardiovasc Surg. 2014;148(5):e228–30.
37.
Zurück zum Zitat Inoue H, Iguro Y, Kinjo T, Matsumoto H, Yotsumoto G, Sakata R. Acquired left ventricular-right atrial communication and severe aortic valve regurgitation caused by infective endocarditis. Thorac Cardiovasc Surg. 2009;57(1):54–6. CrossRefPubMed Inoue H, Iguro Y, Kinjo T, Matsumoto H, Yotsumoto G, Sakata R. Acquired left ventricular-right atrial communication and severe aortic valve regurgitation caused by infective endocarditis. Thorac Cardiovasc Surg. 2009;57(1):54–6. CrossRefPubMed
38.
Zurück zum Zitat Jainandunsing JS, Bergman R, Wilkens J, Wang A, Michielon G, Natour E. Ventriculo-atrial defect after bioprosthetic aortic valve replacement. J Cardiothorac Surg. 2014;9(1):137. CrossRefPubMedPubMedCentral Jainandunsing JS, Bergman R, Wilkens J, Wang A, Michielon G, Natour E. Ventriculo-atrial defect after bioprosthetic aortic valve replacement. J Cardiothorac Surg. 2014;9(1):137. CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y, Dewilde J, Barra JA, Blanc JJ, Boschat J. Postinfarction atrioventricular septal rupture. J Am Soc Echocardiogr. 1997;10(6):680–4. CrossRefPubMed Jobic Y, Verdun F, Guillo P, Bezon E, Gilard M, Etienne Y, Dewilde J, Barra JA, Blanc JJ, Boschat J. Postinfarction atrioventricular septal rupture. J Am Soc Echocardiogr. 1997;10(6):680–4. CrossRefPubMed
40.
Zurück zum Zitat Joyce ES, McCarthy PM, Stewart WJ, Tomford JW, Rehm SJ, Heupler F A, Trohman RG. Left ventricular to right atrial fistula after aortic homograft replacement for endocarditis. Eur J Cardiothorac Surg. 1994;8(2):100–2. CrossRefPubMed Joyce ES, McCarthy PM, Stewart WJ, Tomford JW, Rehm SJ, Heupler F A, Trohman RG. Left ventricular to right atrial fistula after aortic homograft replacement for endocarditis. Eur J Cardiothorac Surg. 1994;8(2):100–2. CrossRefPubMed
41.
Zurück zum Zitat Karaci AR, Aydemir NA, Harmandar B, Sasmazel A, Saritas T, Tuncel Z, Yekeler I. Surgical treatment of infective valve endocarditis in children with congenital heart disease. J Card Surg. 2012;27(1):93–8. CrossRefPubMed Karaci AR, Aydemir NA, Harmandar B, Sasmazel A, Saritas T, Tuncel Z, Yekeler I. Surgical treatment of infective valve endocarditis in children with congenital heart disease. J Card Surg. 2012;27(1):93–8. CrossRefPubMed
42.
Zurück zum Zitat Katta S, Akosah K, Stambler B, Salter D, Guerraty A, Mohanty PK. Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient. J Am Soc Echocardiogr. 1994;7(4):405–9. CrossRefPubMed Katta S, Akosah K, Stambler B, Salter D, Guerraty A, Mohanty PK. Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient. J Am Soc Echocardiogr. 1994;7(4):405–9. CrossRefPubMed
43.
Zurück zum Zitat Katz ES, Tunick PA, Kronzon I. To-and-fro left ventricular-to-right atrial shunting after valve replacement shown by transesophageal echocardiography. Am Heart J. 1991;121(1 Pt 1):211–4. CrossRefPubMed Katz ES, Tunick PA, Kronzon I. To-and-fro left ventricular-to-right atrial shunting after valve replacement shown by transesophageal echocardiography. Am Heart J. 1991;121(1 Pt 1):211–4. CrossRefPubMed
44.
Zurück zum Zitat Kautzner J, Munclinger MJ, Kozáková M. Acquired left ventricular-right atrial and right ventricular communication due to infective endocarditis after aortic valve replacement. Am Heart J. 1990;120(5):1233–4. CrossRefPubMed Kautzner J, Munclinger MJ, Kozáková M. Acquired left ventricular-right atrial and right ventricular communication due to infective endocarditis after aortic valve replacement. Am Heart J. 1990;120(5):1233–4. CrossRefPubMed
45.
Zurück zum Zitat Kumar PA, Sale S, Arora H, Petterson G. Acquired “Gerbode-like” defect in aortic valve endocarditis: an imposter for tricuspid regurgitation? J Cardiothorac Vasc Anesth. 2011;25(4):751–2. CrossRefPubMed Kumar PA, Sale S, Arora H, Petterson G. Acquired “Gerbode-like” defect in aortic valve endocarditis: an imposter for tricuspid regurgitation? J Cardiothorac Vasc Anesth. 2011;25(4):751–2. CrossRefPubMed
46.
Zurück zum Zitat Lax D, Bhatt RD, Klewer SE, Sorrell VL. Are all ventricular septal defects created equal? J Am Soc Echocardiogr. 2010;23(7):791.e5–7. CrossRef Lax D, Bhatt RD, Klewer SE, Sorrell VL. Are all ventricular septal defects created equal? J Am Soc Echocardiogr. 2010;23(7):791.e5–7. CrossRef
47.
Zurück zum Zitat Lee SY, Song JY, Baek JS. Percutaneous closure of the acquired Gerbode shunt using the Amplatzer duct occluder in a 3-month old patient. Korean Circ J. 2013;43(6):429–31. CrossRefPubMedPubMedCentral Lee SY, Song JY, Baek JS. Percutaneous closure of the acquired Gerbode shunt using the Amplatzer duct occluder in a 3-month old patient. Korean Circ J. 2013;43(6):429–31. CrossRefPubMedPubMedCentral
48.
Zurück zum Zitat Lorber A, Nair P, Gruberg L. Transcatheter closure of acquired Gerbode defect following mitral valve replacement using the Amplatzer duct occluder. J Invasive Cardiol. 2006;18(10):E264–6. PubMed Lorber A, Nair P, Gruberg L. Transcatheter closure of acquired Gerbode defect following mitral valve replacement using the Amplatzer duct occluder. J Invasive Cardiol. 2006;18(10):E264–6. PubMed
49.
Zurück zum Zitat Matt P, Winkler B, Carrel T, Eckstein F. Plicated patch repair for acquired Gerbode defect involving the tricuspid valve. Ann Thorac Surg. 2010;89(2):643–5. CrossRefPubMed Matt P, Winkler B, Carrel T, Eckstein F. Plicated patch repair for acquired Gerbode defect involving the tricuspid valve. Ann Thorac Surg. 2010;89(2):643–5. CrossRefPubMed
50.
Zurück zum Zitat Mendoza DD, Wang Z, Gaglia MA, Taylor AJ. Gerbode defect. J Cardiovasc Comput Tomogr. 2009;3(4):279–81. CrossRefPubMed Mendoza DD, Wang Z, Gaglia MA, Taylor AJ. Gerbode defect. J Cardiovasc Comput Tomogr. 2009;3(4):279–81. CrossRefPubMed
51.
Zurück zum Zitat Michel C, Rabinovitch MA, Huynh T. Sinus node dysfunction as a complication of Gerbode’s defect associated with acute infective endocarditis. Heart. 1996;76(4):379. CrossRefPubMedPubMedCentral Michel C, Rabinovitch MA, Huynh T. Sinus node dysfunction as a complication of Gerbode’s defect associated with acute infective endocarditis. Heart. 1996;76(4):379. CrossRefPubMedPubMedCentral
52.
Zurück zum Zitat Moaref AR, Aslani A, Zamirian M, Sharifkazemi MB. Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement. J Am Soc Echocardiogr. 2008;21(4):408.e1–2. CrossRef Moaref AR, Aslani A, Zamirian M, Sharifkazemi MB. Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement. J Am Soc Echocardiogr. 2008;21(4):408.e1–2. CrossRef
53.
Zurück zum Zitat Mohapatra S, Minhas HS, Virmani S, Mishra BB, Mukherjee K, Banerjee A. Acquired left atrial-to-right ventricular shunt with mitral valve incompetence: a rare sequela after repair of atrioventricular septal defect. Tex Heart Inst J. 2009;36(1):69–71. PubMedPubMedCentral Mohapatra S, Minhas HS, Virmani S, Mishra BB, Mukherjee K, Banerjee A. Acquired left atrial-to-right ventricular shunt with mitral valve incompetence: a rare sequela after repair of atrioventricular septal defect. Tex Heart Inst J. 2009;36(1):69–71. PubMedPubMedCentral
54.
Zurück zum Zitat Mousavi N, Shook DC, Kilcullen N, Aranki S, Kwong RY, Landzberg MJ, Blankstein R. Multimodality imaging of a Gerbode defect. Circulation. 2012;126(1):e1–2. CrossRefPubMed Mousavi N, Shook DC, Kilcullen N, Aranki S, Kwong RY, Landzberg MJ, Blankstein R. Multimodality imaging of a Gerbode defect. Circulation. 2012;126(1):e1–2. CrossRefPubMed
56.
Zurück zum Zitat Newman JN Jr., Rozanski L, Kreulen T. Acquired left ventricular to right atrial intracardiac shunt after myocardial infarction: a case report and review of the literature. J Am Soc Echocardiogr. 1996;9(5):716–20. CrossRefPubMed Newman JN Jr., Rozanski L, Kreulen T. Acquired left ventricular to right atrial intracardiac shunt after myocardial infarction: a case report and review of the literature. J Am Soc Echocardiogr. 1996;9(5):716–20. CrossRefPubMed
57.
Zurück zum Zitat Ota T, Yamaguchi R, Tanigawa T, Otuka K, Hayashi Y, Nishiyama H, Tsumori T, Kamimori K, Yanagi S, Ishikawa I. Left ventricular–right atrial communication by perforation of the atrioventricular portion of the membranous septum and severe aortic valve regurgitation caused by infective endocarditis. J Echocardiogr. 2011;9(1):30–2. CrossRef Ota T, Yamaguchi R, Tanigawa T, Otuka K, Hayashi Y, Nishiyama H, Tsumori T, Kamimori K, Yanagi S, Ishikawa I. Left ventricular–right atrial communication by perforation of the atrioventricular portion of the membranous septum and severe aortic valve regurgitation caused by infective endocarditis. J Echocardiogr. 2011;9(1):30–2. CrossRef
58.
Zurück zum Zitat Ozdogan O, Cinar CS. Left ventricle-right atrium communication along with a membranous septum aneurysm. J Cardiovasc Med (Hagerstown). 2012;13(9):597–9. CrossRef Ozdogan O, Cinar CS. Left ventricle-right atrium communication along with a membranous septum aneurysm. J Cardiovasc Med (Hagerstown). 2012;13(9):597–9. CrossRef
59.
Zurück zum Zitat Ozeke O, Celik E, Grbovic E, Colak A, Dogan P, Tufekcioglu O, Golbasi Z, Kisacik HL. Delayed left ventricular-to-right atrial communication (acquired Gerbode defect) after aortic valve replacement. Herz. 2015;40(1):157–8. Ozeke O, Celik E, Grbovic E, Colak A, Dogan P, Tufekcioglu O, Golbasi Z, Kisacik HL. Delayed left ventricular-to-right atrial communication (acquired Gerbode defect) after aortic valve replacement. Herz. 2015;40(1):157–8.
60.
Zurück zum Zitat Pillai V, Menon S, Kottayil B, Karunakaran J. Tricuspid endocarditis with indirect Gerbode: septal translocation of posterior leaflet. Heart Lung Circ. 2011;20(6):362–4. CrossRefPubMed Pillai V, Menon S, Kottayil B, Karunakaran J. Tricuspid endocarditis with indirect Gerbode: septal translocation of posterior leaflet. Heart Lung Circ. 2011;20(6):362–4. CrossRefPubMed
61.
Zurück zum Zitat Portet N, Riu B, Bounes V, Minville V, Fourcade O. Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma. J Emerg Med. 2012;43(6):e385–8. CrossRefPubMed Portet N, Riu B, Bounes V, Minville V, Fourcade O. Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma. J Emerg Med. 2012;43(6):e385–8. CrossRefPubMed
62.
Zurück zum Zitat Primus C, Grabscheit G, Ng CK, Auer J. Unusual cause of dyspnoea: a case presentation of an echocardiographic pitfall. J Cardiothorac Surg. 2013;8:230. doi:10.1186/1749-8090-8-230. CrossRefPubMedPubMedCentral Primus C, Grabscheit G, Ng CK, Auer J. Unusual cause of dyspnoea: a case presentation of an echocardiographic pitfall. J Cardiothorac Surg. 2013;8:230. doi:10.1186/1749-8090-8-230. CrossRefPubMedPubMedCentral
63.
Zurück zum Zitat Pursnani AK, Tabaksblat M, Saric M, Perk G, Loulmet D, Kronzon I. Acquired Gerbode defect after aortic valve replacement. J Am Coll Cardiol. 2010;55(25):e145. CrossRefPubMed Pursnani AK, Tabaksblat M, Saric M, Perk G, Loulmet D, Kronzon I. Acquired Gerbode defect after aortic valve replacement. J Am Coll Cardiol. 2010;55(25):e145. CrossRefPubMed
64.
Zurück zum Zitat Raja Y, Jenkins N, Chauhan A, Millner RW. Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation. Int J Cardiol. 2006;113(3):E79–80. CrossRefPubMed Raja Y, Jenkins N, Chauhan A, Millner RW. Acquired post-infarct Gerbode defect complicated by infective endocarditis with giant right atrial vegetation. Int J Cardiol. 2006;113(3):E79–80. CrossRefPubMed
65.
Zurück zum Zitat Rothman A, Galindo A, Channick R, Blanchard D. Amplatzer device closure of a tortuous Gerbode (left ventricle-to-right atrium) defect complicated by transient hemolysis in an octogenarian. J Invasive Cardiol. 2008;20(9):E273–6. PubMed Rothman A, Galindo A, Channick R, Blanchard D. Amplatzer device closure of a tortuous Gerbode (left ventricle-to-right atrium) defect complicated by transient hemolysis in an octogenarian. J Invasive Cardiol. 2008;20(9):E273–6. PubMed
66.
Zurück zum Zitat Saiki Y, Kawase M, Ida T, Mannouji E, Kasegawa H, Takahashi Y, Kikuchi T, Tatsuno K. The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: report of a case. Surg Today. 1994;24(7):655–8. CrossRefPubMed Saiki Y, Kawase M, Ida T, Mannouji E, Kasegawa H, Takahashi Y, Kikuchi T, Tatsuno K. The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: report of a case. Surg Today. 1994;24(7):655–8. CrossRefPubMed
67.
Zurück zum Zitat Scully RE, Mark EJ, McNeely WF, Ebeling SH. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1998. New Engl J Med. 1998;393(20):1457–65. Scully RE, Mark EJ, McNeely WF, Ebeling SH. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1998. New Engl J Med. 1998;393(20):1457–65.
68.
Zurück zum Zitat Sharma AK, Chander R, Singh JP. AV nodal ablation-induced Gerbode defect (LV-RA Shunt). J Cardiovasc Electrophysiol. 2011;22(11):1288–9. CrossRefPubMed Sharma AK, Chander R, Singh JP. AV nodal ablation-induced Gerbode defect (LV-RA Shunt). J Cardiovasc Electrophysiol. 2011;22(11):1288–9. CrossRefPubMed
69.
Zurück zum Zitat Shen WK, Khandheria BK. Transesophageal echocardiography: detection of an acquired left ventricular-right atrial shunt. J Am Soc Echocardiogr. 1991;4(2):199–202. CrossRefPubMed Shen WK, Khandheria BK. Transesophageal echocardiography: detection of an acquired left ventricular-right atrial shunt. J Am Soc Echocardiogr. 1991;4(2):199–202. CrossRefPubMed
71.
Zurück zum Zitat Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M. The Gerbode defect: left ventricular to right atrial communication-anatomic, hemodynamic, and echocardiographic features. Echocardiography. 2009;26(8):993–8. CrossRefPubMed Silbiger JJ, Kamran M, Handwerker S, Kumar N, Marcali M. The Gerbode defect: left ventricular to right atrial communication-anatomic, hemodynamic, and echocardiographic features. Echocardiography. 2009;26(8):993–8. CrossRefPubMed
72.
Zurück zum Zitat Sinisalo J, Sreeram N, Qureshi SA. Transcatheter closure of acquired left ventricle to right atrium shunts. Catheter Cardiovasc Interv. 2013;82(6):E809–14. CrossRefPubMed Sinisalo J, Sreeram N, Qureshi SA. Transcatheter closure of acquired left ventricle to right atrium shunts. Catheter Cardiovasc Interv. 2013;82(6):E809–14. CrossRefPubMed
73.
Zurück zum Zitat Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(6):801–2. PubMed Sun X, Yang C, Zhou G, Wang C. Acquired left ventricular-right atrial communication following mitral valve replacement. J Heart Valve Dis. 2010;19(6):801–2. PubMed
74.
Zurück zum Zitat Taskesen T, Goldberg SL, Gill EA. Role of three-dimensional echocardiography in management of acquired intracardiac shunts. Echocardiography. 2014;31(8):E250–3. CrossRefPubMed Taskesen T, Goldberg SL, Gill EA. Role of three-dimensional echocardiography in management of acquired intracardiac shunts. Echocardiography. 2014;31(8):E250–3. CrossRefPubMed
76.
Zurück zum Zitat Toprak C, Kahveci G, Akpinar S, Tabakçi MM, Güler Y. Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis. Echocardiography. 2013;30(8):E231–5. CrossRefPubMed Toprak C, Kahveci G, Akpinar S, Tabakçi MM, Güler Y. Concomitant Gerbode-like defect and anterior mitral leaflet perforation after aortic valve replacement for endocarditis. Echocardiography. 2013;30(8):E231–5. CrossRefPubMed
77.
Zurück zum Zitat Trehan V, Ramakrishnan S, Goyal NK. Successful device closure of an acquired Gerbode defect. Catheter Cardiovasc Interv. 2006;68(6):942–5. CrossRefPubMed Trehan V, Ramakrishnan S, Goyal NK. Successful device closure of an acquired Gerbode defect. Catheter Cardiovasc Interv. 2006;68(6):942–5. CrossRefPubMed
78.
Zurück zum Zitat Uslu N, Kayacioglu I, Ates M, Eren M. ‘Acquired’ left ventricular to right atrial shunt after mitral valve replacement: detection by transthoracic colour Doppler echocardiography. Can J Cardiol. 2007;23(9):735–6. CrossRefPubMedPubMedCentral Uslu N, Kayacioglu I, Ates M, Eren M. ‘Acquired’ left ventricular to right atrial shunt after mitral valve replacement: detection by transthoracic colour Doppler echocardiography. Can J Cardiol. 2007;23(9):735–6. CrossRefPubMedPubMedCentral
79.
Zurück zum Zitat Vallakati A, Nerella N, Lodha A, Sadiq A, Shani J. Unusual presentation of Gerbode defect. Tex Heart Inst J. 2012;39(3):446–7. PubMedPubMedCentral Vallakati A, Nerella N, Lodha A, Sadiq A, Shani J. Unusual presentation of Gerbode defect. Tex Heart Inst J. 2012;39(3):446–7. PubMedPubMedCentral
80.
Zurück zum Zitat Velebit V, Schöneberger A, Ciaroni S, Bloch A, Maurice J, Christenson JT, Simonet F, Schmuziger M. “Acquired” left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis. Tex Heart Inst J. 1995;22(1):100–2. PubMedPubMedCentral Velebit V, Schöneberger A, Ciaroni S, Bloch A, Maurice J, Christenson JT, Simonet F, Schmuziger M. “Acquired” left ventricular-to-right atrial shunt (Gerbode defect) after bacterial endocarditis. Tex Heart Inst J. 1995;22(1):100–2. PubMedPubMedCentral
81.
Zurück zum Zitat Venkatesh G, Lonn EM, Holder DA, Williams WG, Mulji A. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma. Can J Cardiol. 1996;12(4):349–52. PubMed Venkatesh G, Lonn EM, Holder DA, Williams WG, Mulji A. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma. Can J Cardiol. 1996;12(4):349–52. PubMed
82.
Zurück zum Zitat Wasserman SM, Fann JI, Atwood JE, Burdon TA, Fadel BM. Acquired left ventricular-right atrial communication: Gerbode-type defect. Echocardiography. 2002;19(1):67–72. CrossRefPubMed Wasserman SM, Fann JI, Atwood JE, Burdon TA, Fadel BM. Acquired left ventricular-right atrial communication: Gerbode-type defect. Echocardiography. 2002;19(1):67–72. CrossRefPubMed
83.
Zurück zum Zitat Watanabe A, Kazui T, Tsukamoto M, Komatsu S. Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis. Ann Thorac Surg. 1993;55(5):1236–9. CrossRefPubMed Watanabe A, Kazui T, Tsukamoto M, Komatsu S. Left ventricular pseudoaneurysm and intracardiac fistulas after replacement of mitral valve prosthesis. Ann Thorac Surg. 1993;55(5):1236–9. CrossRefPubMed
84.
Zurück zum Zitat Weinrich M, Graeter TP, Langer F, Schäfers HJ. Left ventricular-right atrial fistula complicating redo mitral valve replacement. Ann Thorac Surg. 2001;71(1):343–5. CrossRefPubMed Weinrich M, Graeter TP, Langer F, Schäfers HJ. Left ventricular-right atrial fistula complicating redo mitral valve replacement. Ann Thorac Surg. 2001;71(1):343–5. CrossRefPubMed
85.
Zurück zum Zitat Winslow TM, Friar DA, Larson AW, Barry MJ. A rare complication of aortic valve endocarditis: diagnosis with transesophageal echocardiography. J Am Soc Echocardiogr. 1995;8(4):546–50. CrossRefPubMed Winslow TM, Friar DA, Larson AW, Barry MJ. A rare complication of aortic valve endocarditis: diagnosis with transesophageal echocardiography. J Am Soc Echocardiogr. 1995;8(4):546–50. CrossRefPubMed
86.
Zurück zum Zitat Xhabija N, Prifti E, Allajbeu I, Sula F. Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension. Cardiovasc Ultrasound. 2010;8:44. CrossRefPubMedPubMedCentral Xhabija N, Prifti E, Allajbeu I, Sula F. Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension. Cardiovasc Ultrasound. 2010;8:44. CrossRefPubMedPubMedCentral
87.
Zurück zum Zitat Xin W, Hong T. GW24-e3091: The perioperative role of the echocardiography in left ventricular-right atrium shunt (Gerbode defect). Heart. 2013;99:A265. doi:10.1136/heartjnl-2013-304613.748. CrossRef Xin W, Hong T. GW24-e3091: The perioperative role of the echocardiography in left ventricular-right atrium shunt (Gerbode defect). Heart. 2013;99:A265. doi:10.1136/heartjnl-2013-304613.748. CrossRef
88.
Zurück zum Zitat Yared K, Solis J, Passeri J, King ME, Levine RA. Three-dimensional echocardiographic assessment of acquired left ventricular to right atrial shunt (Gerbode defect). J Am Soc Echocardiogr. 2009;22(4):435.e1–3. CrossRefPubMedCentral Yared K, Solis J, Passeri J, King ME, Levine RA. Three-dimensional echocardiographic assessment of acquired left ventricular to right atrial shunt (Gerbode defect). J Am Soc Echocardiogr. 2009;22(4):435.e1–3. CrossRefPubMedCentral
89.
Zurück zum Zitat Yoo YP, Kang KW, Yoon HS, Yoo S, Lee MS. Infective endocarditis caused by Neisseria elongata on a native tricuspid valve and confirmed by DNA sequencing. Tex Heart Inst J. 2014;41(2):227–30. CrossRefPubMedPubMedCentral Yoo YP, Kang KW, Yoon HS, Yoo S, Lee MS. Infective endocarditis caused by Neisseria elongata on a native tricuspid valve and confirmed by DNA sequencing. Tex Heart Inst J. 2014;41(2):227–30. CrossRefPubMedPubMedCentral
90.
Zurück zum Zitat Yurdakul S, Tayyareci Y, Sezgiç M, Aytekin S. Case images: acquired Gerbode type ventricular septal defect after aortic valve replacement. Turk Kardiyol Dern Ars. 2012;40(5):471. CrossRefPubMed Yurdakul S, Tayyareci Y, Sezgiç M, Aytekin S. Case images: acquired Gerbode type ventricular septal defect after aortic valve replacement. Turk Kardiyol Dern Ars. 2012;40(5):471. CrossRefPubMed
91.
Zurück zum Zitat Zhu D, Liu B, Tang H. Intraoperative device closure of acquired left ventricular-right atrium shunt in a pediatric patient with pulmonary hypertension. J Card Surg. 2012;27(2):235–7. CrossRefPubMed Zhu D, Liu B, Tang H. Intraoperative device closure of acquired left ventricular-right atrium shunt in a pediatric patient with pulmonary hypertension. J Card Surg. 2012;27(2):235–7. CrossRefPubMed
92.
Zurück zum Zitat Rajiah P, Kanne JP. Cardiac MRI: Part 1, cardiovascular shunts. AJR Am J Roentgenol. 2011;197(4):W603–20. CrossRefPubMed Rajiah P, Kanne JP. Cardiac MRI: Part 1, cardiovascular shunts. AJR Am J Roentgenol. 2011;197(4):W603–20. CrossRefPubMed
93.
Zurück zum Zitat Panduranga P, Mukhaini M. A rare type of Gerbode defect. Echocardiography. 2011;28(6):E118–20. CrossRefPubMed Panduranga P, Mukhaini M. A rare type of Gerbode defect. Echocardiography. 2011;28(6):E118–20. CrossRefPubMed
94.
Zurück zum Zitat Millan R, Pericas P, Forteza JF, Rodriguez A, Pascual M, Vidal L, Bonnin O, Bethencourt A. Real-time three-dimensional transesophageal echocardiography of the Gerbode defect. Int J Cardiol. 2012;157(3):e52–3. CrossRefPubMed Millan R, Pericas P, Forteza JF, Rodriguez A, Pascual M, Vidal L, Bonnin O, Bethencourt A. Real-time three-dimensional transesophageal echocardiography of the Gerbode defect. Int J Cardiol. 2012;157(3):e52–3. CrossRefPubMed
95.
Zurück zum Zitat Wu MH, Wang JK, Lin MT, Wu ET, Lu FL, Chiu SN, Lue HC. Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure. Pediatrics. 2006;117(2):e262–7. CrossRefPubMed Wu MH, Wang JK, Lin MT, Wu ET, Lu FL, Chiu SN, Lue HC. Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure. Pediatrics. 2006;117(2):e262–7. CrossRefPubMed
96.
Zurück zum Zitat Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr., Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833. CrossRefPubMed Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr., Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833. CrossRefPubMed
Metadaten
Titel
Acquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas
verfasst von
MD, PhD Shi-Min Yuan
Publikationsdatum
01.11.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 21-22/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0710-1