PMC9851412_01
Four-chamber images of transoesophageal echocardiography (A) and electrocardiogram-gated contrast-enhanced computed tomography (B) showed mass-like thickening in the right atrium in contact with the atrial septum (*). A colour jet towards the right atrium from the left ventricle was observed, suspecting communication among them. (C) Oblique four-chamber image of electrocardiogram-gated contrast-enhanced computed tomography revealed a mass-like thickened wall of the non-coronary aortic sinus of Valsalva and the membranous septum, thickening of the non-coronary aortic leaflet, and communication between the left ventricular outflow tract below the non-coronary aortic sinus and the right atrium above the septal tricuspid leaflet, which was consistent with a Gerbode defect (dashed circle). (D) Short-axis image of the virtual basal ring plane showed a mass-like thickened wall of the atrial septum and membranous septum. (E) An embolus was observed in the right pulmonary artery (arrow). LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; RA, right atrium; RV, right ventricle.
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Transthoracic echocardiography suspected mass-like thickening in the right atrium (RA) in contact with the atrial septum (see Supplementary material online, Figure S1). However, it was difficult to identify the shunt site (Figure 1A, Supplementary material online, Video S1). Non-coronary aortic leaflet thickening and communication between the LV outflow tract, below the non-coronary aortic sinus, and the RA, above the septal tricuspid leaflet, were observed, suggesting a Gerbode defect (Figure 1B-D). Moreover, an embolus was observed in the right pulmonary artery (Figure 1E).