By Nicholas S. Assali (Eds.)
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Extra resources for Fetal and Neonatal Disorders
Elevation of right atrial pressure is usual and is due to significant tricuspid valve incompetence as well as resistance to filling offered by a poorly compliant hypertrophied right ventricle. This is associated with a massively dilated and hypertensive right atrium which results in a right to left shunt across the foramen ovale with subsequent hypoxemia. T e m p o r a r y improvement in arterial P02 m a y result from 1. DISORDERS OF CIRCULATION 47 left to right shunt across the ductus b u t generally this is inadequate and in most babies the ductus closes within a few days.
T h e carotid and subclavian arteries are perfused in a retrograde manner from the ductus arteriosus. Coronary arterial blood m a y also be derived from the ductus arteriosus, which provides the conduit to the hypoplastic ascending aorta. Small volumes of blood m a y enter the ascending aorta from the left ventricle if there is a minute opening 38 SAMUEL KAPLAN AND NICHOLAS S. ASSALI in the aortic valve. P u l m o n a r y arterial hypertension is usual since the right ventricle which perfuses the lungs via large pulmonary arteries is also ejecting blood against systemic vascular resistance.
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