Unilateral chronic pulmonary edema and pleural effusion after systemic-pulmonary artery shunts for cyanotic congenital heart disease∗

Abstract

1.1. Unilateral pulmonary edema and pleural effusions have been observed in 3 patients following the creation of a systemic-pulmonary artery shunt. The pulmonary changes were on the same side as the shunt in each case. The pulmonary artery contralateral to the shunt was proved to be occluded or hypoplastic in each patient.2.2. The pathogenesis of this complication is thought to be a combination of increased pulmonary venous pressure, caused by an excessive shunt flow, and local pulmonary vascular damage, caused by direction of all or of a large part of the shunt flow to one lung or a segment of one lung. Analogous experimental data are discussed.3.3. We conclude that, when possible, situations should be avoided in which all or a large part of the flow through systemic-pulmonary anastomoses may be directed to one lung or a segment of one lung. If these situations cannot be avoided, the anastomosis should be made as small as possible to avoid the complication reported here.