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CC BY-NC-ND 4.0 · AJP Rep 2022; 12(04): e148-e152
DOI: 10.1055/a-1947-7501
Case Report

Paradoxical Continuous Left-to-Right Ductal Shunt during Circulatory Collapse due to Ductal Closure in an Infant with Duct-Dependent Systemic Circulation

Naoyuki Miyahara
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Mohamed Hamed Hussein
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Ryou Nishiguchi
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Masayo Kanai
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Akio Ishiguro
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Koichi Toda
2   Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
,
Takuro Kojima
2   Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
,
Shigeki Yoshiba
2   Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
,
Naokata Sumitomo
2   Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
,
Satoshi Masutani
1   Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
2   Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
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Abstract

Duct-dependent systemic circulation is accompanied by a right-to-left ductal shunt, at least during systole. Although observations of paradoxical continuous left-to-right shunts in duct-dependent systemic circulation have been reported, the mechanism remains unclear. We report a continuous left-to-right ductal shunt throughout the cardiac cycle during the initial recovery phase from circulatory collapse and right ventricular (RV) dysfunction due to ductal closure in an infant with hypoplastic left heart and severe aortic coarctation. Further recovery improved his RV function and changed the ductal flow from continuous left-to-right to bidirectional, which is usually seen in duct-dependent systemic circulation. Marked RV dysfunction may contribute to the continuous left-to-right ductal shunt. A continuous left-to-right ductal shunt should not be used to rule out duct-dependent systemic circulation.

Keywords

coarctation - ductus arteriosus - prostaglandin E1 - hypoplastic left heart


Publication History

Received: 29 April 2022

Accepted: 19 August 2022

Accepted Manuscript online:
20 September 2022

Article published online:
27 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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