Left ventricular-to-right atrial communications are rare types of ventricular septal defect known collectively as the Gerbode defect. These defects are usually congenital and they have also been reported after bacterial endocarditis and after acute myocardial infarction. Echocardiography is the most useful diagnostic method. We describe a case of echocardiographic diagnosis of Gerbode defect in a 68-year-old Italian woman.