We present a case of Gerbode type defect (left ventricular to right atrial communication) discovered in a 52 year-old man with atrial and ventricular septal defects. The patient was diagnosed using two-dimensional colour Doppler and transoesophageal echocardiography. We describe the echocardiographic features and review the anatomical consequences of such defects. Our aim was to remind readers about this rare organic heart disease that an inexperienced echocardiography specialist might easily mistake for a recoil wave of tricuspid valve incompetence and thus diagnose pulmonary hypertension.