Miss, K.S.

A Female 66-year-old, underlying disease of severe mitral regurgitation due to flail A2 and triple vessel disease.Post operation of CABG(LIMA to LAD, SVG to RCA, SVG to DG, SVG to OM) and MVR Epic tissue valve No.29 2 years ago.Present with progressive dyspnea and bilateral legs edema.PE: Pan systolic murmur grade III at left lower parasternal border

- Right heart Cath was done before procedure shoed Qp:Qs = 1.78 and TEE was done under light sedation.- Ventriculogram was done and showed Lt to Rt shunt.- Terumo wire was passed from left ventricle to right atrium. Then Jaw snare number 10 was passed through right femoral to catch distal part of Terumo wire.- Duct occluder sheath was inserted through the wire. - Position was confirmed by transesophageal echocardiography- Cocoon 10/12 mm was deployed.- Post device closure ventriculogram showed minimal Lt to Rt shunt.

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Acquired Gerbode defect may occasionally be found after operation. However, clinical follow up, physical examination and appropriate investigation are main keys for diagnosis. Echocardioghy also plays important role from sizing, characteristic of defect and also landing location.