Background: Left ventricular to right atrial (LV—RA) shunt is an unusual type of ventricular septal defect (VSD). Acquired LV—RA shunts may be due to complications of cardiac operation, endocarditis, trauma or myocardial infarction. A previous cardiac operation is the most common cause. The diagnosis of LV—RA communication is not easy, and it should be remembered in patients who do not recover normally. Diagnosis can be confirmed with ultrasound or magnetic resonance image (MRI) or multi-slice CT. Surgical correction is usually the treatment of choice, but closing the communication percutaneously should be considered as an option. Objective: Aim of this case presentation was to show the clinical scenario of a rare post-operative complication (after aortic valve replacement). Patient and methods: Male patient aged 35 years, during hospital admission in the CCU post-operative after aortic valve replacement was complaining of dyspnea, orthopnea, paroxysmal nocturnal dyspnea and by echocardiographic examination revealed Gerbode defect, not improved by modification of medical treatment necessitating cardio-thoracic surgery consultation who recommend conservative treatment and follow up if the patient still symptomatic surgical repair versus percutaneous closure could be done. Conclusion: Acquired left ventricular to right atrium shunt (Gerbode′s defect) can result from septal trauma after valve replacement, infective endocarditis, or myocardial infarction. In addition to the usual causes of cardiac decompensation following aortic valve surgery, one should consider the possibility of a left-to-right shunt secondary to an iatrogenic left ventricular-right atrial communication, particularly if either septal trauma or extensive valvular calcification was encountered during the surgical procedure.