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A pulmonary shunt is the passage of deoxygenated blood from the right side of the heart to the left without participation in gas exchange in the pulmonary capillaries. It is a pathological condition that results when the alveoli of parts of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.
The Shunt equation (also known as the Berggren equation) quantifies the extent to which venous blood bypasses oxygenation in the capillaries of the lung.. “Shunt” and “dead space“ are terms used to describe conditions where either blood flow or ventilation do not interact with each other in the lung, as they should for efficient gas exchange to take place.
A cardiac shunt is when blood follows a pattern that deviates from the systemic circulation, i.e., from the body to the right atrium, down to the right ventricle, to the lungs, from the lungs to the left atrium, down to the left ventricle and then out of the heart back to the systemic circulation.
In healthy lungs where the alveolar dead space is small, Fowler's method accurately measures the anatomic dead space using a single breath nitrogen washout technique. [ 4 ] [ 5 ] The normal value for dead space volume (in mL) is approximately the lean mass of the body (in pounds), and averages about a third of the resting tidal volume (450-500 mL).
A pulmonary-to-systemic shunt is a cardiac shunt which allows, or is designed to cause, blood to flow from the pulmonary circulation to the systemic circulation. [1] [2] This occurs when: there is a passage between two or more of the great vessels; and, pulmonic pressure is higher than systemic pressure and/or the shunt has a one-way valvular ...
Physiological shunts, occur due to the effect of gravity. The highest concentration of blood in the pulmonary circulation occurs in the bases of the pulmonary tree compared to the highest pressure of gas in the apexes of the lungs. Alveoli may not be ventilated in shallow breathing. Shunting may also occur in disease states:
The fetal lungs are collapsed, and blood passes from the right atrium directly into the left atrium through the foramen ovale (an open conduit between the paired atria) or through the ductus arteriosus (a shunt between the pulmonary artery and the aorta).
right heart pressure is higher than left heart pressure and/or the shunt has a one-way valvular opening. Small physiological, or "normal", shunts are seen due to the return of bronchial artery blood and coronary blood through the Thebesian veins, which are deoxygenated, to the left side of the heart.