REVERSED INTERATRIAL SHUNT FOLLOWING COMPLETE RELIEF OF PULMONARY VALVE STENOSIS

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Abstract
Reversed interatrial shunt following complete relief of pulmonary valve stenosis has been described in 6 patients. In 4, one or more recognizable factors prevented or delayed restoration of normal right ventricular function after operation. Three of the patients were not operated upon until adult life and in the youngest patient the effects of ventriculotomy, potassium citrate cardiac arrest, and postoperative pulmonary incompetence were additional factors. Even a small right-to-left shunt must carry a substantial risk of paradoxical embolism when present over a lifetime, and secondary polycythmia may add thrombotic hazards also. Although persistent cyanosis indicated their right ventricular dysfunction, the outcome of surgery in these 6 patients is in contrast to the excellent long-term results in the other patients operated upon.