the definition of a gerbode defect , according to the society of thoracic surgeons congenital heart nomenclature and database project is true left ventricular ( lv ) to right atrial ( ra ) communication .
however , no sources provide a definition encompassing congenital right ventricular ( rv ) to left atrial ( la ) communication .
zacharkiw and stimpson   recently described this pathology as a  mirror - image gerbode defect in a patient following atrioventricular ( av ) septal defect repair . in the present study , the case of a congenital la - rv shunt in an adult is presented and the classification of such defects is discussed .
a 74-year - old woman was referred to our center with a worsening history of orthopnea , paroxysmal nocturnal dyspnea , and peripheral edema .
transthoracic echocardiography revealed lv hypertrophy , a dilated left atrium , severe mitral valve insufficiency , and pulmonary hypertension ( 60 mmhg ) .
a careful review of the preoperative transesophageal echocardiography ( tee ) revealed a clear jet across a small defect between the rv and la ( figs . 1 , 2 ) .
the pericardium was entered through a midsternal incision and a patch was fixed using glutaraldehyde . following the establishment of cardiopulmonary bypass ( cpb ) ,
a vertical cleft separating the anterior leaflet into two hemileaflets was observed on the mitral valve ( fig .
aspirator - guided inspection showed that the defect was located between the la and the rv ( fig .
the cleft was closed without tension after resection of the abnormal chordae attached to its edges .
direct suture was not technically possible due to the fibrous reaction of the edges of the cleft with an area lacking valvular tissue .
instead , the edges of the cleft were resected and the anterior leaflet of the mitral valve was reconstructed using an autologous pericardial patch . however , the saline test revealed regurgitation at both commisures .
the patch was then replaced with a 27-mm porcine bioprosthetic valve ( biocor ; st .
paul , mn , usa ) which was implanted in a supra - annular fashion with the use of interrupted , pledgeted , 20 everting mattress sutures .
rewarming was initiated , the atriotomy was closed , the heart was de - aired , and the cross - clamp was removed .
the av junctions are the area of the heart where the atrial myocardium is inserted into the base of the ventricular mass .
partial av septal defects are malformations with two av valve orifices and no interventricular communication , whereas complete av septal defects have a common av valve orifice and extensive interventricular communication .
lv to ra atrial communications , known as gerbode defects and lv - ra shunts , are encountered from time to time and are caused by surgical mishaps , trauma , and endocarditis .
however , we could find only three cases of mirror - image gerbode defects ( la - rv shunts ) that have been reported to date in the literature [ 2,46 ] .
of those cases , only one was congenital , while in the other cases , the defect emerged after the repair of an av septum .
the previously reported congenital case was a 39-year - old woman with a common av junction and partially separated right and left av orifices , and the shunt was exclusively from the la to the rv due to overriding of the left av valve .
however , in our case , each atrium was connected to its own ventricle through separate leaflets . additionally , a cleft in the anterior mitral leaflet existed , which may have been linked developmentally , on the basis of different degrees of failure of fusion of the av endocardial cushions .
a literature review demonstrated that it is virtually impossible to categorize the spectrum of av septal defects into satisfactory and noncontroversial subgroups with regard to patients such as ours .
we believe that diagnosis and surgical treatment strategy will become easier if case - specific morphologic and functional variables are analyzed .
 gebode defect , that can accurately be treated surgical repair , is defined as a true communication between left ventricle and right atrium . 
 a 74-year - old woman with a worsening history of ortophnea and peripheral edema was hospitalised . 
 a communication between right atrium and left ventricle was diagnosed using transeusophageal echocardiography . 
 the defect was repaired and mitral valve was replaced with a biologic valve . 
 it would be beter to tailor surgical strategy for each case with atrioventricular canal defect after preoperative transeusophageal echocardiography and peroperative direct sight . 