204:, and can manifest as late as adult life. This switch in blood flow direction is precipitated by pulmonary hypertension due to increased pulmonary blood flow in a left-to-right shunt. The right ventricle hypertrophies to compensate for this pulmonary hypertension, so the right ventricular pressure becomes higher than the pressure in the left ventricle. Because of this switch in the pressure gradient, blood starts flowing right to left, forming a right-to-left shunt. As with any right-to-left shunt, there is decreased blood flow to the lungs, resulting in decreased oxygenation of blood and
416:
461:
279:. Using high levels of inspired oxygen should have little effect on the dissolved O2 in the blood because highly oxygenated blood is diluted by shunted (low oxygenation) blood.
180:. In this way only one lung is oxygenated and oxygen-poor blood from the non-ventilated lung dilutes the oxygen level of blood returning from the lungs in the left ventricle.
445:
Because most reptiles have a single ventricle and all reptiles have both a right aortic arch and a left aortic arch, all reptiles have the capacity for right-to-left shunt.
263:
is a symptom of a right-to-left shunt. A right-to-left shunt results in decreased blood flow through the pulmonary system, leading to decreased blood oxygen levels (
578:
233:(aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle, as occurs in normal hearts)
931:
629:
251:
Outside of heart-related conditions, right-to-left shunts of the heart can be seen with
Pulmonary Arteriovenous Malformations (PAVMs).
289:
634:
482:
Rao, PS (Aug 2013). "Consensus on timing of intervention for common congenital heart diseases: part II - cyanotic heart defects".
571:
240:(thickening of the muscular walls of the right ventricle, this is a result of the increased amount of work the heart has to do)
227:(narrowing of the pulmonary valve and outflow tract, obstructing blood flow from the right ventricle to the pulmonary artery)
166:
130:
93:
Small physiological, or "normal", shunts are seen due to the return of bronchial artery blood and coronary blood through the
466:
707:
666:
624:
564:
525:
Krishnan, U; Rosenzweig, EB (Dec 2013). "Pulmonary arterial hypertension associated with congenital heart disease".
884:
136:
A mnemonic to remember the conditions associated with right-to-left shunting involves the numbers 1-5, as follows:
275:
Differentiation between a right-to-left shunt and pulmonary disease is often aided clinically by the results of a
889:
779:
699:
148:
115:
774:
641:
612:
141:
109:
957:
604:
176:
can lead to right-to-left shunting. This occurs when the tip of the endotracheal tube is placed beyond the
46:. This terminology is used both for the abnormal state in humans and for normal physiological shunts in
681:
671:
617:
243:
193:
801:
769:
201:
926:
796:
587:
237:
188:
An uncorrected left-to-right shunt can progress to a right-to-left shunt; this process is termed
749:
728:
936:
839:
829:
648:
856:
834:
806:
735:
658:
197:
189:
8:
689:
595:
217:
160:
125:
507:
224:
35:
791:
542:
499:
177:
173:
154:
120:
67:
511:
921:
916:
534:
491:
230:
911:
851:
786:
764:
94:
220:, a congenital cardiac anomaly characterized by four co-existing heart defects.
276:
105:
Congenital defects can lead to right-to-left shunting immediately after birth:
82:
63:
538:
495:
951:
879:
723:
440:
71:
27:
901:
846:
824:
556:
546:
503:
16:
Cardiac shunt allowing blood to flow from the right heart to the left heart
894:
86:
39:
246:(a hole exists in the septum that divides the left and right ventricles)
906:
43:
264:
260:
205:
85:
is higher than left heart pressure and/or the shunt has a one-way
47:
411:{\displaystyle Q_{p}/Q_{s}=(CcO_{2}-CaO_{2})/(CcO_{2}-CvO_{2})}
31:
24:
267:). Hypoxemia manifests as cyanosis, causing "blue babies."
477:
475:
97:, which are deoxygenated, to the left side of the heart.
472:
292:
216:
The most common cause of right-to-left shunt is the
524:
410:
949:
572:
932:Anomalous aortic origin of a coronary artery
586:
62:there is an opening or passage between the
579:
565:
430:CvO2 is the mixed venous oxygen content.
424:CcO2 is the end-capillary oxygen content
53:
183:
167:Total anomalous pulmonary venous return
131:Total anomalous pulmonary venous return
950:
211:
560:
481:
427:CaO2 is the arterial oxygen content
58:A right-to-left shunt occurs when:
13:
667:Sinus venosus atrial septal defect
625:Transposition of the great vessels
14:
969:
282:
700:Atrioventricular septal defect
518:
455:
405:
367:
359:
321:
172:A mainstem intubation with an
149:Transposition of great vessels
116:Transposition of great vessels
1:
642:Persistent truncus arteriosus
613:Double outlet right ventricle
448:
142:Persistent truncus arteriosus
110:Persistent truncus arteriosus
605:Aortopulmonary septal defect
484:Indian Journal of Pediatrics
467:Dorland's Medical Dictionary
270:
7:
434:
421:Qp/Qs is the shunt fraction
254:
10:
974:
441:Reptile § Circulation
438:
871:
817:
757:
748:
716:
698:
682:Ventricular septal defect
680:
657:
603:
594:
539:10.1016/j.ccm.2013.08.011
527:Clinics in Chest Medicine
496:10.1007/s12098-013-1039-2
244:Ventricular septal defect
194:Ventricular septal defect
100:
588:Congenital heart defects
202:patent ductus arteriosus
927:Coronary artery anomaly
238:ventricular hypertrophy
750:Valvular heart disease
729:Cyanotic heart disease
672:Lutembacher's syndrome
412:
140:1 Combination Vessel:
937:Ventricular inversion
649:Aortopulmonary window
618:Taussig–Bing syndrome
462:"right-to-left shunt"
413:
54:Clinical Significance
736:Eisenmenger syndrome
659:Atrial septal defect
290:
198:Atrial septal defect
190:Eisenmenger syndrome
184:Eisenmenger syndrome
147:2 Vessels involved:
958:Medical terminology
690:Tetralogy of Fallot
596:Heart septal defect
218:Tetralogy of Fallot
212:Tetralogy of Fallot
161:Tetralogy of Fallot
126:Tetralogy of Fallot
21:right-to-left shunt
408:
225:Pulmonary stenosis
192:. This is seen in
144:(minimal cyanosis)
112:(minimal cyanosis)
945:
944:
867:
866:
807:Ebstein's anomaly
744:
743:
174:endotracheal tube
159:4 Tetra- prefix:
155:Tricuspid atresia
121:Tricuspid atresia
965:
922:Brugada syndrome
917:Crisscross heart
787:tricuspid valves
765:pulmonary valves
755:
754:
601:
600:
581:
574:
567:
558:
557:
551:
550:
522:
516:
515:
479:
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459:
417:
415:
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409:
404:
403:
385:
384:
366:
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357:
339:
338:
317:
316:
307:
302:
301:
231:Overriding aorta
973:
972:
968:
967:
966:
964:
963:
962:
948:
947:
946:
941:
912:Cor triatriatum
878:Underdeveloped
863:
813:
740:
712:
694:
676:
653:
590:
585:
555:
554:
523:
519:
480:
473:
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362:
353:
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334:
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308:
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297:
293:
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287:
285:
273:
257:
250:
214:
186:
103:
95:Thebesian veins
56:
17:
12:
11:
5:
971:
961:
960:
943:
942:
940:
939:
934:
929:
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919:
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909:
904:
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897:
892:
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880:heart chambers
875:
873:
869:
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859:
854:
844:
843:
842:
837:
832:
821:
819:
815:
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811:
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804:
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772:
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733:
732:
731:
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710:
704:
702:
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686:
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674:
669:
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622:
621:
620:
609:
607:
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591:
584:
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569:
561:
553:
552:
517:
471:
453:
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436:
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431:
428:
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345:
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337:
333:
329:
326:
323:
320:
315:
311:
306:
300:
296:
284:
283:Shunt equation
281:
277:hyperoxia test
272:
269:
256:
253:
248:
247:
241:
234:
228:
213:
210:
185:
182:
170:
169:
163:
157:
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145:
134:
133:
128:
123:
118:
113:
102:
99:
91:
90:
79:
55:
52:
15:
9:
6:
4:
3:
2:
970:
959:
956:
955:
953:
938:
935:
933:
930:
928:
925:
923:
920:
918:
915:
913:
910:
908:
905:
903:
900:
896:
893:
891:
888:
886:
883:
882:
881:
877:
876:
874:
870:
858:
857:regurgitation
855:
853:
850:
849:
848:
847:mitral valves
845:
841:
838:
836:
835:insufficiency
833:
831:
828:
827:
826:
825:aortic valves
823:
822:
820:
816:
808:
805:
803:
800:
798:
797:regurgitation
795:
793:
790:
789:
788:
785:
781:
778:
776:
775:insufficiency
773:
771:
768:
767:
766:
763:
762:
760:
756:
753:
751:
747:
737:
734:
730:
727:
726:
725:
724:Cardiac shunt
722:
721:
719:
715:
709:
708:Ostium primum
706:
705:
703:
701:
697:
691:
688:
687:
685:
683:
679:
673:
670:
668:
665:
664:
662:
660:
656:
650:
647:
646:
643:
640:
636:
633:
631:
628:
627:
626:
623:
619:
616:
615:
614:
611:
610:
608:
606:
602:
599:
597:
593:
589:
582:
577:
575:
570:
568:
563:
562:
559:
548:
544:
540:
536:
533:(4): 707–17.
532:
528:
521:
513:
509:
505:
501:
497:
493:
490:(8): 663–74.
489:
485:
478:
476:
469:
468:
463:
458:
454:
446:
442:
429:
426:
423:
420:
419:
418:
400:
396:
392:
389:
386:
381:
377:
373:
370:
363:
354:
350:
346:
343:
340:
335:
331:
327:
324:
318:
313:
309:
304:
298:
294:
280:
278:
268:
266:
262:
252:
245:
242:
239:
235:
232:
229:
226:
223:
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221:
219:
209:
207:
203:
199:
195:
191:
181:
179:
175:
168:
164:
162:
158:
156:
152:
150:
146:
143:
139:
138:
137:
132:
129:
127:
124:
122:
119:
117:
114:
111:
108:
107:
106:
98:
96:
88:
84:
80:
77:
73:
72:great vessels
69:
65:
61:
60:
59:
51:
49:
45:
41:
37:
33:
30:which allows
29:
26:
22:
902:Dextrocardia
717:Consequences
530:
526:
520:
487:
483:
465:
457:
444:
286:
274:
258:
249:
215:
187:
171:
153:3 Leaflets:
135:
104:
92:
81:right heart
75:
57:
20:
18:
895:Uhl anomaly
40:right heart
907:Levocardia
449:References
439:See also:
68:ventricles
44:left heart
387:−
341:−
271:Diagnosis
265:hypoxemia
165:5 Words:
70:, and/or
38:from the
952:Category
852:stenosis
840:bicuspid
830:stenosis
802:stenosis
770:stenosis
547:24267300
512:39106680
504:23640699
435:Reptiles
261:cyanosis
255:Symptoms
206:cyanosis
89:opening.
87:valvular
83:pressure
48:reptiles
792:atresia
780:absence
42:to the
25:cardiac
630:dextro
545:
510:
502:
259:Early
236:Right
200:, and
178:carina
101:Causes
885:right
872:Other
758:Right
508:S2CID
64:atria
32:blood
28:shunt
23:is a
890:left
818:Left
635:levo
543:PMID
500:PMID
36:flow
535:doi
492:doi
464:at
76:and
34:to
954::
541:.
531:34
529:.
506:.
498:.
488:80
486:.
474:^
208:.
196:,
74:;
66:,
50:.
19:A
580:e
573:t
566:v
549:.
537::
514:.
494::
406:)
401:2
397:O
393:v
390:C
382:2
378:O
374:c
371:C
368:(
364:/
360:)
355:2
351:O
347:a
344:C
336:2
332:O
328:c
325:C
322:(
319:=
314:s
310:Q
305:/
299:p
295:Q
78:,
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