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Forum Name: Congenital Heart Disease in Adults

Question: Extra cardiac shunt


 glenp - Mon Mar 03, 2008 1:12 am

I am a 57 year old female, have crouzons, and 5 years ago was diagnosed with CFS. I had many of the CFS symptoms when I was young, but only the last 5 years has it severely affected me. My blood pressure is normal, Cortisol levels in the am are 204 and 334 in the pm, lymphocyte count is usually low or low normal. IgA is 0.92 (low normal). My worst symptom is the exhaustion and not being able even keep up my home. I get out of breath easily.

My question concerns the results of a recent echo gram. Much of it seems to be normal except for:

Following injection of agitated dextrose into the right arm, the right heart cavities become markedly echogenic. During spontaneous respiration <5 bubbles, and with cough <5 bubbles are identified in the left heart in a single frame consistent with a mild extracardiac shunt. No right to left shunt is identified with Valsalva maneuver.

A few contrast bubbles are noted late in the LV cavity. This is consistent with minimal intra-pulmonary shunting. Borderline abnormal study.

My question is, How much does this affect me concerning my CFS. Would the symptoms be significant? Any help or advise would be much appreciated.
This is the only heart test that I have ever had.
 Dr. A. Madia - Mon Mar 17, 2008 12:18 pm

User avatar Hi,

First let me discuss the normal circulation.

Oxygen depleted blood turns around from tissues and reaches back to the heart via the Inferior and Superior vena cava. It then enters the Right artium and then Right Ventricle. Right Ventricle pumps it up through the Pulmonary Artery to the lungs so that this de-oxygentated blood could release the carbon dioxide to the atmosphere and saturate itself with fresh oxygen.

This oxygenated blood now comes back to the heart via the Pulmonary veins to the Left Atrium , thence to Left Ventricle and LV in turn pumps it out again to the tissues.

Suppose there is a hole in the heart which causes a communication between the right and left hearts. Thus either the Fresh oxygenated blood will mix with the de-oxygenated blood of the right heart system or vice versa depending on the pressure differences bet the two hearts. This type of situation commonly occurs in congenital heart disease and is called a 'Shunt'.

Rarely this shunt situation is mimicked even though there is no such hole or communication bet the two hearts. The culprit here is something called an 'Arteriovenous malformation' or communication bet the venous and arterial systems in the Lung tissue. This effectively serves as a Shunt. This being outside the heart perimeter is called "extra cardiac shunt."

The important thing is the severity of such shunt. If the quantum of shunted blood is very small, the mixing of de-oxygenated blood with fresh blood is miniscule and can be ignored. This can be judged from the Oxygen saturation measurted through a monitor in the clinics. If O2 saturation is above 96%, this shunt of yours can be ignored. If it is significantly less than 96% then probably you have an answer to the reason foryour CFS.

I hope I am clear and this is useful to you.


Apurva

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