Abstract
BACKGROUND: Acquired Gerbode defect is a complication of cardiac surgery. Diagnostic challenges arise because of frequent mischaracterization as severe tricuspid regurgitation on imaging, often delaying definitive management. CASE SUMMARY: After undergoing surgical tricuspid valve repair, a patient developed an acquired Gerbode defect located in the membranous septum beneath the noncoronary cusp of the aortic valve. The defect remained undetected for over 3 years owing to misinterpretation of echocardiographic findings as severe tricuspid regurgitation. Comprehensive transesophageal echocardiography enabled accurate diagnosis and anatomical localization. DISCUSSION: The defect was successfully closed percutaneously under transesophageal echocardiographic and fluoroscopic guidance using a 6-mm Amplatzer atrial septal defect occluder device. The procedure resulted in complete closure of the shunt, with no residual defect or complications. TAKE-HOME MESSAGE: This case highlights the importance of advanced imaging for the diagnosis of elusive acquired Gerbode defects and demonstrates that percutaneous device closure is a safe and effective therapeutic option for this uncommon postsurgical complication.