left-to-right shunt


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shunt

 [shunt]
1. to turn to one side; to divert; to bypass.
2. a passage or anastomosis between two natural channels, especially between blood vessels. Such structures may be formed physiologically (e.g., to bypass a thrombosis), or they may be structural anomalies.
3. a surgical anastomosis.
arteriovenous shunt a U-shaped plastic tube inserted between an artery and a vein (usually between the radial artery and cephalic vein), bypassing the capillary network, a formerly common means of arteriovenous access.
cardiovascular shunt an abnormality of the blood flow between the sides of the heart or between the systemic and pulmonary circulation; see left-to-right shunt and right-to-left shunt.
jejunoileal shunt an intestinal bypass performed to control obesity.
left-to-right shunt diversion of blood from the left side of the heart to the right side, or from the systemic to the pulmonary circulation through an anomalous opening such as a septal defect or patent ductus arteriosus.
LeVeen shunt peritoneovenous shunt.
mesocaval shunt a portosystemic shunt between the superior mesenteric vein and the inferior vena cava to reduce portal hypertension.
peritoneovenous shunt a device whose purpose is to remove excess ascitic fluid from the peritoneal cavity and return it to the venous system; called also LeVeen shunt.



The shunt consists of a peritoneal tube, a one-way valve, and a tube leading to a large vein, usually the superior vena cava or the jugular vein. The perforated peritoneal tube is placed in the peritoneal cavity and attached to the one-way valve which opens at a pressure of 3 cm H2O. The valve controls the direction of the flow of ascitic fluid and prevents a backflow of blood from the vein. A tube leading from the valve empties into the venous system.

The shunt is triggered into action by the patient's breathing. Upon inspiration, the diaphragm descends toward the abdominal cavity and causes a rise in fluid pressure in the thoracic superior vena cava. The difference in pressure, usually about 5 cm H2O, opens the shunt valve, allowing the flow of ascitic fluid into the large vein. The action of the shunt can be enhanced by the patient's inspiring against pressure, as when using a blow bottle.

A disadvantage of the shunt is dilution of the blood and a resultant drop in hematocrit, which necessitates transfusion of packed cells and perhaps a slowing of the rate of flow of ascitic fluid into the venous system. Other inherent risks are infection, leakage of ascitic fluid from the operative site, elevated bilirubin, gastrointestinal bleeding, and disseminated intravascular coagulation.
Peritoneovenous (LeVeen) shunt for chronic ascites moves fluid from the peritoneal (abdominal) cavity into the superior vena cava. From Ignatavicius and Workman, 2000.
portacaval shunt a portosystemic shunt between the portal vein and the vena cava.
portosystemic shunt a surgically created shunt that connects the portal and systemic circulations, such as a mesocaval, portacaval, or splenorenal shunt.
postcaval shunt portacaval shunt.
pulmonary shunt an anomaly in which blood moves from the venous circulation to the arterial circulation without participating in gas exchange, resulting in hypoxemia.
reversed shunt right-to-left shunt.
right-to-left shunt diversion of blood from the right side of the heart to the left side or from the pulmonary to the systemic circulation through an anomalous opening such as septal defect or patent ductus arteriosus.
splenorenal shunt an anastomosis of the splenic vein and the left renal vein, created to lower portal hypertension following splenectomy.
ventriculoatrial shunt the surgical creation of a communication between a cerebral ventricle and a cardiac atrium by means of a plastic tube; done for relief of hydrocephalus.
ventriculoperitoneal shunt a communication between a cerebral ventricle and the peritoneum by means of plastic tubing; done for the relief of hydrocephalus.
ventriculovenous shunt a communication between a lateral ventricle and the venous system by means of a plastic tube; done for relief of hydrocephalus.

left-to-right shunt

a diversion of blood from the left side of the heart to right (as through a septal defect), or from the systemic circulation to the pulmonary (as through a patent ductus arteriosus).

left-to-right shunt

(left-rīt shŭnt)
A diversion of blood from the left side of the heart to right (as through a septal defect), or from the systemic circulation to the pulmonary (as through a patent ductus arteriosus).
References in periodicals archive ?
Indications for surgery include the presence of a large fistula, increasing left-to-right shunt, left ventricular volume overload, myocardial ischaemia, left ventricular dysfunction, congestive cardiac failure and for prevention of endocarditis.9
The aim of surgical correction is (I) eliminate the left-to-right shunt and (II) to establish dual coronary circulation.
In contrast, with a Blalock-Taussig shunt (end-to-side anastomosis of a subclavian artery to the ipsilateral pulmonary artery) the size of the anastomosis and left-to-right shunt is limited by the size of the subclavian artery, and Eisenmenger's reaction virtually never occurs.
The pulmonary veins make an abnormal connection to the right atrium, with coronary sinus or systemic veins resulting physiologically in an extracardiac left-to-right shunt. This anomaly is accompanied by an intracardiac right-to-left shunt through a patent foramen ovale or an atrial septal defect.(1) Clinical and radiological features depend on the location of the anomalous pulmonary venous connection.
Should the disease progress without any medical or surgical intervention, the left-to-right shunt could convert into a right-to-left one, namely Eisenmenger syndrome.
The echocardiogram showed a large ventricular septal defect with a bidirectional, mainly left-to-right shunt, overriding the aorta, right ventricular (RV) hypertrophy, and a stenotic RV outflow tract with a peak velocity of 4.9 m/s (Figure 2).
A left-to-right shunt without a jet was classified as a trivial RS, with a jet of <2 mm in diameter as a small shunt and with a jet diameter of >2 mm as a large shunt.
(9) Other electrocardiographic findings may include varying degrees of atrioventricular block and right ventricular hypertrophy if a large left-to-right shunt and/or pulmonary arterial hypertension are present.
This anomaly is accompanied by an intracardiac left-to-right shunt through a patent foramen ovale or an atrial septal defect.
On right heart catheterization, there was a step-up of oxygen saturation from 82% in the right ventricle to 87.5% in the pulmonary artery, raising suspicion of left-to-right shunt. The ventricular stroke volume was measured at 113 ml, and cardiac output was high at 11.1 L/min.
Hoffman et al suggested that an atrial left-to-right shunt resulting from an incompetent foramen ovale may exist in patients without heart disease for more than a year, with eventual closure of the communication.