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Updated: Apr 3 2018


  • Overview
    • A shunt refers to a portion of cardiac output or blood flow that is diverted or rerouted
    • Physiologic shunt
      • approximately 2% of cardiac output normally bypasses alveoli
        • e.g., bronchial blood flow (bronchial veins empty into left atrium)
          • physiologic right-to-left shunt
    • Right-to-left shunt
      • shunting of blood from right heart to left heart
        • e.g., interventricular septal defect (long-standing with Eisenmeiger syndrome)
        • pulmonary arteriovenous malformation
      • hypoxemia results because oxygen-poor blood mixes with oxygen-rich blood
        • admixture of venous blood and arterial blood in left heart
          • left heart normally receives high O2 (arterial) blood
          • low O2 shunted (venous) blood dilutes high O2 (arterial) blood → ↓ PaO2
        • degree of hypoxemia depends on location of shunt and amount of shunted blood flow
        • cannot be corrected by O2 treatment because shunted blood never traverses pulmonary capillary to exchange gas with alveolus
    • Left-to-right shunt
      • shunting of blood from left heart to right heart
        • more common as pressures are higher in left heart
      • e.g., VSD in newborn, patent ductus arteriosus, and traumatic injury
      • does not cause hypoxemia
        • admixture of venous blood and arterial blood in right heart
          • right heart normally receives low O2 (venous) blood
          • high O2 shunted (arterial) blood adds to low O2 (venous ) blood → ↑ PaO2
          • "Step-up" in oxygen on right side on right heart catheterization
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