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Old 02-18-2012
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Heart Left to Right Shunts and Hypertrophy

Hey all this is my first post on the forum, and I'm hoping to participate here as often as I can since my Step 1 date is on the horizon. YIKES!:sorry:

Having some problems with L-->R Shunts..

Correct me if I'm wrong, so uncorrected VSDs (with no Eisenmengers) cause
1) increase BP in Pulm Circuit
2) increase LV preload

Soo MY reasoning is the following..
#1 can predispose to PHT which can lead to RV Hypertrophy
#2 can predispose to LVH (Eccentric)

Now Goljan pg 158 says VSD cause LVH
But Robbins says VSDs cause RVH via PHT

I see both happening. But my qualm is... which one happens first?
Say if RVH happened earlier, it would cause Eisenmengers which would NOT cause LVH.

Any thoughts...
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Old 02-18-2012
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Pressure in the LV is greater than the RV (key concept that answers your question).

VSD starts as L -> R shunt which would account for the LVH.
Since LV blood gets shunted to RV, increase volume in RV, increase pulmonary artery pressure -> Pulmonary Hypertension -> RVH

In short, LVH happens first then RVH.
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Old 02-18-2012
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Normally left ventricular pressure is greater than rt that is responsible for the shunt..Now according to me because of increase flow of blood from lt to rt it will lead to rt ventricular hypertrophy followed by lt ventricular hypertrophy....
The reversal of shunt is due to increase in rt ventricular pressure after increase pulmonary htn...
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Old 02-18-2012
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I stand corrected.

Goljan RR 2nd ed. p. 179

In congenital heart disease: L -> R-sided shunts
Volume overload occurs in the R side of the heart; complications:
1. Pulmonary hypertension
2. RVH due to pulmonary hypertension
3. LVH due to excess blood originating from the R side of the heart
4. Reversal of the shunt

Thus, pulmo HPN -> RVH -> LVH

@mohitkmc: my ego took a big hit but thank you for your input!
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Old 02-18-2012
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Quote:
Originally Posted by d_wiqed View Post
I stand corrected.

Goljan RR 2nd ed. p. 179

In congenital heart disease: L -> R-sided shunts
Volume overload occurs in the R side of the heart; complications:
1. Pulmonary hypertension
2. RVH due to pulmonary hypertension
3. LVH due to excess blood originating from the R side of the heart
4. Reversal of the shunt

Thus, pulmo HPN -> RVH -> LVH

@mohitkmc: my ego took a big hit but thank you for your input!
Ah I can't believe I missed that in Goljan...
Thanks to both of you for the responses.

Anyway, not to stray too far away from the original question, in FA 2012 pg 284 it mentions ASDs as having fixed splitting... Now I would also think that VSDs would have the same type of splitting, or am I wrong to assume this?

Increased BF thru Pulmonic Valve = Later closing of PV i.e. splitting..
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