The mirror image of Gerbode defect acquired right ventricular-to-left atrial communicationLeemasawat, Krit; Kanjanavanit, Rungsrit; Phrommintikul, ArintayaJournal of Cardiovascular Medicine: December 2016 - Volume 17 - Issue - p e212–e213 doi: 10.2459/JCM.0000000000000125 Images in cardiovascular medicine Buy Abstract Author InformationAuthors Article MetricsMetrics Left ventricular-to-right atrial communication, known as Gerbode defect, is rare. However, right ventricular-to-left atrial communication is much rarer. We present a case of a middle-aged woman with a past history of primum atrial septal defect surgery who presented with dyspnea on exertion. Echocardiographic studies showed dehiscence of the pericardial atrial patch from atrioventricular junction, causing a right ventricular-to-left atrial communication with bidirectional shunt. A three-dimensional transesophageal echocardiographic reconstruction revealed a defect of septal tricuspid valve leaflet. In atrioventricular septal defect, the apical displacement of mitral valve insertion, together with a congenital defect of septal tricuspid valve leaflet, contributes to predisposing conditions for this communication. Cardiovascular Unit, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Correspondence to Krit Leemasawat, MD, The Northern Cardiac Center, Sripat Building 8th Floor, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai 50200, Thailand Tel: +66 53 946 716; fax: +66 53 289 177; e-mail: email@example.com Received 19 February, 2014 Revised 2 March, 2014 Accepted 4 April, 2014 © 2016 Italian Federation of Cardiology. All rights reserved.