Late presentation and diagnosis of concomitant ruptured sinus of valsalva and congenital gerbode defect in an elderly gentleman

Gerbode defect is a left ventricular-to-right atrial shunt. Sinus of Valsalva aneurysm is an abnormal outpouching at the base of the aorta caused by incomplete fusion between aortic media and annulus fibrosus. Both pathologies are rare entities, found as congenital heart disease mainly in pediatrics or young adults. A presentation of both pathologies in an elderly gentleman without evidence of acquired causes is extremely rare. We report a 58-year-old man who presented with acute congestive heart failure. Echocardiography showed features of ruptured Sinus of Valsalva aneurysm at the right coronary cusp and severe tricuspid regurgitation. With the intention of assessing the cardiac shunt in more detail, the echocardiography was repeated by an experienced pediatric cardiologist which yielded, to our surprise, a Gerbode defect on top of the ruptured Sinus of Valsalva aneurysm. The patient underwent repair of both defects with a single polytetrafluoroethylene patch through dual approach with good outcome. The diagnostic challenge, surgical technique and approach are discussed.