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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 ventilation perfusion scan or lung scintigraphy can be used to diagnose areas of lungs being ventilated but not adequately perfused. This results in a raised Alveolar-arterial (A-a) gradient which is responsive to supplemental oxygen. In conditions with right to left shunts, there are also ventilation perfusion defects with high A-a gradients.
Ventilation–perfusion coupling is the relationship between ventilation and perfusion processes, which take place in the respiratory system and the cardiovascular system. [1] Ventilation is the movement of gas during breathing, and perfusion is the process of pulmonary blood circulation , which delivers oxygen to body tissues. [ 2 ]
An area with perfusion but no ventilation (and thus a V/Q of zero) is termed shunt. An area with ventilation but no perfusion (and thus a V/Q undefined though approaching infinity) is termed "dead space". [6] Of note, few conditions constitute "pure" shunt or dead space as they would be incompatible with life, and thus the term V/Q mismatch is ...
Pulmonary shunts exist when there is normal perfusion to an alveolus, but ventilation fails to supply the perfused region. A portosystemic shunt (PSS), also known as a liver shunt, is a bypass of the liver by the body's circulatory system. It can be either a congenital or acquired condition.
Therefore it includes, firstly those units that are ventilated but not perfused, and secondly those units which have a ventilation-perfusion ratio greater than one. Alveolar dead space is negligible in healthy individuals, but it can increase dramatically in some lung diseases due to ventilation-perfusion mismatch.
Hypoxemia is caused by five categories of etiologies: hypoventilation, ventilation/perfusion mismatch, right-to-left shunt, diffusion impairment, and low PO 2. Low PO 2 and hypoventilation are associated with a normal alveolar–arterial gradient (A-a gradient) whereas the other categories are associated with an increased A-a gradient.