P1254 Gerbode defect makes sense after 20 years of a prosthetic mitral valve

60 year old female has been checked for routine prosthetic mitral valve control for the first time in our outpatient clinic. She was also complaining about severe dyspnea for several months. Mitral valve replacement has been done 20 years ago, without tricuspide ring or any other repair.Transthoracic echocardiography showed high normal mitral prosthetic gradients and dilated right heart chambers with severe tricuspid regurgitation. Close to the tricuspid regurgitant flow; there was an additional left to right shunt from left ventricle to right atrium. As she had denied of having a congenital defect before surgery and as there should not have been a possibility of such a missed diagnosis by many echocardiographers for years; we suspected that it had become as a complication of mitral valve surgery, rather than being a congenital defect. Surgical closure of the defect and tricuspide ring annuloplasty repair have been planned. Abstract P1254 Figure.