The chest radiograph in pulmonary hypertension with central shunt

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Abstract
In the 125 patients studied, a decrease in heart size was usual with the onset of shunt reversal. In atrial septal defect, the aorta is small, the heart is usually enlarged and displaced to the left, the central arteries are huge, there is an abrupt reduction in size at segmental artery level and the caliber of the peripheral arteries is proportional to the pulmonary flow. In patients with an interventricular or aortopulmonary shunt, left atrial size is related to pulmonary flow, and without shunt reversal there is anterior bulging of the thorax and pulmonary arterial dilatation with no peripheral reduction in size. In ventricular septal defect with shunt reversal, the heart and pulmonary arteries may appear normal in children, and in adults arterial dilatation is seldom more than slight In patent duct the characteristic signs relating to the aorta are described and shunt reversal is usually associated with disproportionate dilatation of the main pulmonary artery. The significance of anterior bulging of the thorax in cyanosed patients with an interventricular or aortopulmonary defect is discussed.