Left ventricular to right atrial communication (Gerbode-type defect) after mitral valve replacement

A 51-year-old woman with severe rheumatic mitral stenosis underwent mitral valve replacement. One week later, she was admitted with abdominal pain and lower extremities edema. On physical examination, her blood pressure was 120/60 mm Hg and holosystolic murmur (3/6) was heard at the left sternal border. Transesophageal echocardiography was done and revealed a shunt flow from the left ventricle to the right atrium in the 4-chamber and bicaval views. With careful examination of the interventricular septum, a small defect was seen in the membranous interventricular septum, which connects the left ventricle to the right atrium. The patient underwent surgical operation with diagnosis of iatrogenic left ventricular to right atrial communication (Gerbode-type defect). Intraoperative finding confirmed the preoperative diagnosis.