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Management of a Patient with Left-to-Right Shunt

  • Christian Bauerfeld
  • Ashok P. Sarnaik
  • Kathleen Meert
Chapter

Abstract

We describe the basic pathophysiology of common congenital heart defects with left-to-right shunt. These defects include ostium primum atrial septal defect (ASD), ostium secundum ASD, sinus venosus ASD, coronary sinus ASD, ventricular septal defects, atrioventricular septal defects, patent ductus arteriosus, and aortopulmonary window. The underlying pathophysiology of these defects is a communication between the systemic and pulmonary circulations. This communication allows return of oxygenated blood back to the lungs (left-to-right shunt) leading to volume overload of the right heart and lungs. The amount of shunting determines the degree of symptoms and depends on the size of the defect and the resistance and pressure properties of the pulmonary and systemic circulations. Unrecognized large left-to-right shunts can lead to irreversible pulmonary vascular disease and Eisenmenger syndrome. Medical management includes careful attention to fluid balance, avoidance of indiscriminate oxygen therapy, and appropriate use of inotropic agents, systemic afterload reduction, and positive pressure ventilation.

Keywords

Left-to-right shunt Atrial septal defect Ventricular septal defect Qp/Qs ratio Eisenmenger syndrome 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christian Bauerfeld
    • 1
  • Ashok P. Sarnaik
    • 1
  • Kathleen Meert
    • 1
  1. 1.Division of Pediatric Critical Care Medicine, Department of PediatricsChildren’s Hospital of Michigan, Wayne State UniversityDetroitUSA

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