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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 most common cause of right-to-left shunt is the Tetralogy of Fallot, a congenital cardiac anomaly characterized by four co-existing heart defects. Pulmonary stenosis (narrowing of the pulmonary valve and outflow tract, obstructing blood flow from the right ventricle to the pulmonary artery)
Atrial septal defect with left-to-right shunt. The left and right sides of the heart are named from a dorsal view, i.e., looking at the heart from the back or from the perspective of the person whose heart it is. There are four chambers in a heart: an atrium (upper) and a ventricle (lower) on both the left and right sides. [1]
In patients with pulmonary atresia, there is complete failure of forward flow from the right ventricle to the pulmonary arterial vasculature. As such, pulmonary blood flow is entirely dependent on shunting from the systemic circulation, typically through a patent ductus arteriosus.
The mechanism of many of the risks and complications related to failure of the Glenn bidirectional shunt is thought to be thrombosis. Right-side dominant circulation, elevated pulmonary vascular resistance, and prolonged operative and recovery time are the major factors that increase the risk of complications and failure.
Arrhythmias: Abnormal heart rhythms can occur due to the congenital defect or secondary to manipulation of cardiac tissue during surgery. [31] Shunt Obstruction: The shunt (mBTTs or Sano) placed during the Norwood procedure that re-establishes pulmonary circulation can become narrowed or obstructed, necessitating urgent intervention. [27]
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