RT Book, Section
A1 Cedars, Ari M.
A1 Kutty, Shelby
A1 Doshi, Ashish
A2 Fuster, Valentin
A2 Narula, Jagat
A2 Vaishnava, Prashant
A2 Leon, Martin B.
A2 Callans, David J.
A2 Rumsfeld, John S.
A2 Poppas, Athena
SR Print(0)
ID 1202451553
T1 Shunt Lesions
T2 Fuster and Hurst's The Heart, 15e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264257560
LK accessmedicine.mhmedical.com/content.aspx?aid=1202451553
RD 2024/04/16
AB Chapter  SummaryThis  chapter  discusses  the  various  types  of  congenital  cardiac  shunt  lesions,  their  anatomy,  physiologic  impact,  epidemiology,  clinical  presentation,  work-up,  and  management.  In  congenital  shunt  lesions,  a  fundamentally  important  link  exists  between  anatomy  and  physiology,  such  that  the  location  of  a  shunt  dictates  its  physiologic  impact  and  likely  sequelae.  As  a  general  rule,  shunts  upstream  of  the  tricuspid  valve  (including  atrial  septal  defects  and  accompanying  partially  anomalous  pulmonary  venous  return)  lead  to  volume  overloading  of  the  right  atrium  and  right  ventricle  with  consequences  related  to  right-sided  chamber  dilatation  and  dysfunction.  By  contrast,  shunts  downstream  of  the  tricuspid  valve  (including  ventricular  septal  defects  and  patent  ductus  arteriosus)  result  in  volume  loading  of  the  left  atrium  and  left  ventricle  with  accompanying  consequences.  Each  lesion  has  unique  associations  with  other  cardiac  abnormalities  and  genetic  syndromes.  Fundamentally  important  to  all  cardiac  shunts  is  the  downstream  impact  of  pulmonary  overcirculation  on  the  pulmonary  vascular  bed.  Changes  in  pulmonary  vascular  physiology,  including  the  development  of  pulmonary  arterial  hypertension,  play  a  major  role  in  dictating  prognosis  and  therapeutic  decision-making.