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A right-to-left shunt is a cardiac shunt which allows blood to flow from the right heart to the left heart. This terminology is used both for the abnormal state in humans and for normal physiological shunts in reptiles.

Human medical

A right-to-left shunt occurs when:

1. there is an opening or passage between the atria, ventricles, and/or great vessels; and,
2. right heart pressure is higher than left heart pressure and/or the shunt has a one-way valvular opening.

Small physiological, or "normal", shunts are seen due to the return of bronchial artery blood and coronary blood through the Thebesian veins, which is deoxygenated, to the left side of the heart.

The most common cause of right-to-left shunt is the Tetralogy of Fallot, a congenital cardiac anomaly characterized by four co-existing heart defects. The four defects include:

1. Pulmonary stenosis (narrowing of the pulmonary valve and outflow tract, obstructing blood flow from the right ventricle to the pulmonary artery)
2. Overriding aorta (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)
3. Right ventricular hypertrophy (thickening of the muscular walls of the right ventricle, this is a result of the increased amount of work the heart has to do)
4. Ventricular septal defect (a hole exists in the septum that divides the left and right ventricles)

Some other causes of right-to-left shunting include Transposition of the great vessels and Persistent truncus arteriosus.

A right-to-left shunt frequently causes hypoxemia (which can be manifested by cyanosis), and it can be characterised by frequent chest infection.

Differentiation between a right-to-left shunt and pulmonary disease is often aided clinically by the results of a hyperoxia test. 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.

A mainstem intubation with an endotracheal tube can lead to right-to-left shunting. This occurs when the tip of the endotracheal tube is placed beyond the carina. 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.

Shunt equation

$Q_s/Q_t=(Cc{O}_2-Ca{O}_2)/(Cc{O}_2-Cv{O}_2)$

• Qs/Qt is the shunt fraction
• CcO2 is the end-capillary oxygen content
• CaO2 is the arterial oxygen content
• CvO2 is the mixed venous oxygen content.

Reptiles

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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. Potter or Ceramic Artist Truman Bedell from Rexton, has interests which include ceramics, best property developers in singapore developers in singapore and scrabble. Was especially enthused after visiting Alejandro de Humboldt National Park.

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