FETAL ECHO PATHOLOGIES by SULLIVAN, RACHELLE https://padlet.com/rsullivan171/gh5c4baojpcmn43b en-us 2022-10-28 20:46:16 UTC 2024-11-18 02:40:22 UTC hello@padlet.com 3 Common Forms rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370558669 Sinus Venosus: Least common
Ostium Secundum: Next to Foramen Ovale, difficult to see in utero, most common!
Ostium Primum: Associated with trisomy 21

]]> 2022-11-04 18:54:53 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370558669 4 Heart Defects rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370635964 1. Pulmonary Stenosis
2. RV Hypertrophy
3. Overriding Aorta
4. VSD]]> 2022-11-04 20:28:26 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370635964 rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370639261 Abnormal opening between RA/LA that is not the normal Foramen Ovale.]]> 2022-11-04 20:33:31 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370639261 TRICUSPID ATRESIA/STENOSIS rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370708353 Interruption of growth of tricuspid leaflets, causing valve to be hypoplastic or atretic.

Atresia- opening between RA/RV completely occluded
  • Hypoplastic Right Ventricle
  • Echogenic, non-opening valve
  • Right Ventricular Outflow Tract (RVOT) & Pulmonary Artery (PA) generally are diminished in size
  • Cyanotic- no access for blood to travel to lungs unless ASD or VSD is present. ONLY WAY TO SURVIVE
Stenosis- valvular narrowing (varies in degree)
  • Valve may be echogenic or dysmorphic
  • If VSD is present, blood flows from high-pressure LV across VSD into hypertrophied RV and out pulmonary outflow tract. 



]]> 2022-11-04 22:46:24 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2370708353 rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387346752 Normal aortic valve comprises three semilunar cusps that open in systole and close completely in diastole. ]]> 2022-11-16 21:44:40 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387346752 Aortic Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387351668
  • More common in males
  • Associated with: increased risk of hydrops, mitral stenosis, pulmonic stenosis, coarctation of the aorta, VSD, Williams-Bourne Syndrome
  • Findings: Post-stenosis dilation of the ascending aorta, peak velocities >200 cm/sec, LT to RT shunt across Foramen Ovale 
  • 3 types: Valvular (most common), Supravalvular, Subvalvular (subaortic)
    • ]]>     2022-11-16 21:50:19 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387351668     Valvular Stenosis: Bicuspid Aortic Valve rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387400423
  • Happens during development issues during first trimester: 3 aortic cusps may not fully separate. 
  • Most common type diagnosed prenatally. Should be well visualized at 27 weeks, late 2nd trimester. 
    • ]]>     2022-11-16 22:57:21 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387400423     Subvalvular Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387406592
  • Membrane covers the LVOT
  • Doppler view shows increased velocity across obstructive membrane. 
  • Color flow imaging shows increased turbulence at area of narrowing. 
  • Described in patients with Turner’s syndrome, Noonan’s syndrome, and congenital rubella. 
  • Aortic stenosis and pulmonary stenosis associated with maternal rubella. 

    • ]]>     2022-11-16 23:06:52 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2387406592     Supravalvular Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390089606
  • Narrowing of the ascending aortic root; may be related to Williams’ syndrome
  • 50-75% will have hour glass deformity of aorta
    • ]]>     2022-11-18 15:34:32 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390089606     Critical Aortic Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390096852
  • Signifies end-stage left ventricular dysfunction
  • In 2nd or 3rd trimester, infection or other viral process caused aortic leaflet to thicken and close prematurely
  • Easier to detect due to abnormal 4-chamber view
  • LV enlarges from increased pressure in ventricle because LVOT is blocked
  • Ventricular walls are thin and bulge into RV cavity

    • ]]>     2022-11-18 15:39:49 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390096852     EFE rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390311833
  • EFE results from blood entering a chamber being unable to exit efficiently, so fibrin develops and is deposited along the walls
  • Classified according to LV size; can be dilated (most common) or contracted. Regardless of size, EFE results in stiff, poorly contracting chamber
  • Ultrasound findings; dilated LV with poor contractibility and a hypoechoic thickening of the endocardia surface. 
    • ]]>     2022-11-18 18:27:04 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390311833     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390313445 2022-11-18 18:28:22 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390313445 Aortic stenosis, atresia, or absence can lead to HLHS rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390323817
  • Small, hypertrophied LV w/ aortic and/or mitral atresia & small LA
  • Associated with Turner syndrome, IUGR, Trisomy 13 & 18, Noonan, and Holt-Oram, premature closure of Foramen Ovale
  • MOST COMMON CHD CAUSE AND DEATH OF NEONATE
  • Most common cause is Mitral Atresia; higher incidence in males. Blood cannot fill LV to provide volume. Aortic valve becomes atretic, Hypoplastiv LV
  • If cause is Aortci Atresia (w/ patent Mitral Valve); LV will be enlarged, echogenic. Myocardium shows extreme hypertrophy and increased pressure overload.  
    • ]]>     2022-11-18 18:36:58 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390323817     Ultrasound Findings rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390330805
  • Echogenic AV (stenotic or atretic)
  • Hypoplastic arch
  • Small LV and LA
  • Echogenic endocardium (EFE)
  • Mitral stenosis and atresia
    • HEMODYNAMICS
    ALWAYS retrograde flow in aortic arch (when present), and LT-RT atrial flow across Foramen Ovale. 
    ]]>     2022-11-18 18:42:57 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390330805     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390332287 2022-11-18 18:43:48 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390332287 rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390332803 2022-11-18 18:44:16 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390332803 Treatment for HLHS rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390336826
  • Prognosis for fetus has improved with cardiac transplantation
  • NORWOOD developed series of surgical repairs that are performed in the newborn 
  • Followed by the GLENN procedure at 4-6 months
  • Followed by a FONTAN operation between 18 mo-3 yrs
  • WITHOUT SURGICAL INTERVENTION HLHS IS ALWAYS LETHAL!
    • ]]>     2022-11-18 18:47:40 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2390336826     D-TGA rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393238851
  • Abnormal condition that exists when aorta connected to RV and PA connected to LV (opposite connections): VENTRICULOARTERIAL DISCORDANCE
  • When ventricles are opposite from atriums but great arteries are still connected to right ventricles: ATRIOVENTRICULAR CONCORDANCE
    • ]]>     2022-11-21 22:37:03 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393238851     D-TGA rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393244856
  • Transposition occurs when the conotruncal septum doesn’t spiral but grows in a straight line causing a parallel relationship between the aorta and pulmonary artery. 
  • Usually aorta is anterior and to the right of pulmonary artery in this pathology. 
  • Associated cardia anomalies: VSD (40%) & Plumonary stenosis + VSD (30%)
  • Extracardiac and chromosomal abnormalities are very rare
  • Surgical Correction involves MUSTARD/SENNING REPAIR

    • ]]>     2022-11-21 22:47:39 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393244856     Type I Diabetes Mellitus rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393246379
  • Septal Defects
  • Conotruncal abnormalities
  • Hypertrophic CMO
    • ]]>     2022-11-21 22:50:25 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393246379     Phenylketotonuria rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393246628
  • CHD
  • Tetralogy of Fallot
    • ]]>     2022-11-21 22:50:57 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393246628     Lupus Erythematosus rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393247222
  • Complete heart block
  • CMO
  • ASD
  • Pulmonary Stenosis
  • L-TGA
    • ]]>     2022-11-21 22:52:00 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393247222     Hyperthyroidism rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393247622
  • Fetal goiter- fetal tachycardia & hydrops
    • ]]>     2022-11-21 22:52:31 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393247622     Rubella rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393248768
  • Aortic and pulmonic stenosis
  • Septal defects
  • PDA
    • ]]>     2022-11-21 22:53:33 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393248768     Parvo Virus (Fifth’s Disease) rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249158
  • Non-immune hydrops
    • ]]>     2022-11-21 22:54:12 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249158     Cytomegalovirus rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249578
  • Non-immune hydrops
  • Decreased motion or occlusion of the Foramen Ovale
  • Right heart overload

    • ]]>     2022-11-21 22:55:02 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249578     HIV rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249683
  • IUGR
  • Fetal demise
    • ]]>     2022-11-21 22:55:14 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393249683     Cocaine, Anti-convulsants, Hparin rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393250796
  • IUGR
  • Non-specific heart defects
    • ]]>     2022-11-21 22:57:01 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393250796     Cortisone rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393250972
  • VSD
  • Coarctation of the aorta
    • ]]>     2022-11-21 22:57:21 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393250972     *Alcohol* rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393251577
  • VSD, ASD
  • Tetralogy of Fallot
  • Coarctation of the aorta
  • Pulmonary Stenosis
  • PDA
    • ]]>     2022-11-21 22:58:15 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393251577     *Lithium* rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393251912
  • Epstein Anomaly
  • Tricuspid Atresia
  • ASD
    • ]]>     2022-11-21 22:58:52 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393251912     Methotrexate rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393252120
  • IUGR
  • Dextroposition
    • ]]>     2022-11-21 22:59:16 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393252120     Nicotine rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393252349
  • IUGR
  • Placental insufficiency
    • ]]>     2022-11-21 22:59:36 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393252349     Rhabdomyoma rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393255188
  • MOST COMMON (60%)
  • Usually multiple (90%) & in ventricles or IVS
  • Echogenic, non-shadowing
  • Usually detected between 20-30 weeks and may regress after birth (<80%)
    • ]]>     2022-11-21 23:04:56 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2393255188     Poor Prognosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395845461 Heart lesion in which ONE GREAT ARTERY arises from the base of the heart, from which arise the pulmonary trunk, the systemic arteries, and the coronary arteries. 

    Develops in the early embryologic period when the conotruncus fails to separate into 2 great arteries.

    Associated anomalies: mitral atresia, atrial septal defect, univentricular heart, and aortic arch abnormalities. ]]>     2022-11-23 17:12:26 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395845461     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395849617 2022-11-23 17:16:06 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395849617 rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395854777 A discrete shelflike lesion present in the isthmus of the arch, or more commonly, at the site of the ductal insertion near the left subclavian artery. 
    May be discrete, long segment, or tubular. 

    90% of cases include intracardiac malformations: aortic stenosis, aortic insufficiency, septal defects, transposition of the great arteries, Truncus arteriosus, & double-outlet right ventricle. 

    Connected to TURNERS SYNDROME: coarctation of the aorta and ventricular septal defects]]>     2022-11-23 17:21:22 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395854777     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395855239 2022-11-23 17:21:53 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395855239 rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395863272 The normal pulmonic valve comprises three semilunar cusps that open in systole and close completely in diastole.]]> 2022-11-23 17:30:56 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395863272 Hypoplastic Right Heart Syndrome rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395867671 The right side of the heart is underdeveloped because of obstruction of the right ventricular outflow tract secondary to pulmonary stenosis. 

    Several forms: pulmonary atresia with an intact interventricular septum, pulmonary valve fusion with an intact interventricular septum and atrial septal defect, & pulmonary atresia with a normal aortic root diameter. ]]>     2022-11-23 17:36:01 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395867671     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395875296 Most common congenital lesion of the heart, accounting for 30% of all the structural heart defects. ]]> 2022-11-23 17:44:20 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2395875296 Teratoma rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400941203
  • 25% of congenital cardiac tumors 
  • Benign germ cell tumor
  • Usually single, encapsulated attached to base, impinges on right atrium
  • Almost always accompanied by pericardial effusion
  • Mixed echogenicity with cystic areas
    • ]]>     2022-11-28 21:28:51 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400941203     Fibroma rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400942476
  • 12% of all fetal cardiac tumors
  • Single, non-encapsulated, echogenic
  • Usually in Left Ventricle free wall or IVS
  • Do not regress postnatal, may require resection
  • Associated with pericardial effusion

    • ]]>     2022-11-28 21:30:20 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400942476     Hemangioma rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400945864
  • 3% of all fetal heart tumors
  • Can involve any chamber
  • Benign
  • Highly Vascular with feeding vessel
  • Hypoechoic, polypoid
    • ]]>     2022-11-28 21:34:14 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400945864     Hamartoma rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400946938
  • Benign and very rare
  • Mixture of cells arranged in bizarre fashion
  • Mixed echogenicity
  • May be associated with pericardial effusion
    • ]]>     2022-11-28 21:35:27 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400946938     Tricuspid Regurgitation rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400950482
  • Mostly due to TV dysplasia
  • Associated with poor outcome
  • Associate with pulmonary hypoplasia
  • Enlarged Right Atrium
  • Associated with: Dilated cardiomyopathy, Trisomy 21, Puolmonary stenosis, PA-IVS, Ebstein Anomaly

    • ]]>     2022-11-28 21:39:46 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400950482     POOR PROGNOSIS rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400955114
  • Atrialization of the Right Ventricle
  • Most commonly displacement of SEPTAL tricuspid valve leaflet
  • Septal and posterior leaflets may be dsyplastic or absent
  • Anterior leaflet of tricuspid valve least affected of the three leaflets
  • Associated with: ASD present in 60%, RVOT obstruction, Arrhythmias, cardiomegaly, severe levocardia may be associated
  • Extracardiac Association: Patau syndrome, Down syndrome, Edwards syndrome period, Lithium carbonate during maternal use
  • 45% die in utero
    • ]]>     2022-11-28 21:45:57 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400955114     Mitral Atresia/Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400960214 When endocardial cushion development is interrupted (day 33), mitral valve may not fully develop.
    • Usually associated with other forms of left heart obstruction- AO coarctation & VSD
    • Parachute Mitral Valve: 
    • Mitral Atresia: may appear thickened and dysplastic with shortened chordate and closely spaced 
    ]]>     2022-11-28 21:52:17 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2400960214     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403774082
  • Associated with hypoplastic left heart syndrome (HLHS)
  • Whole left side of heart may no develop due to mitral atresia
    • ]]>     2022-11-30 15:50:14 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403774082     Mitral Regurgitation rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403780726
  • Fetal mitral regurgitation probably from cleft mitral valve or congenital mitral stenosis
  • Cleft Mitral Valve:
  • Left Atrial cavity would become enlarged because of leakage of blood from defective mitral valve
  • Color Doppler flow pattern of disturbed flow in left atrial cavity is seen on A4CV and PLA
    • ]]>     2022-11-30 15:54:04 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403780726     Pulmonic Stenosis rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403789644
  • MOST COMMON FORM OF RVOT OBSTRUCTION; 2ND MOST COMMON CHD
  • 3 forms: Valvular, Subvalvular, Supravalvular
  • Valvular: Abnormal cusps become thickened or fused. Visible through cardiac cycle
  • Subvalvular: muscular thickening or fibrosis of infundibulum, just inferior to cusp opening (recipient of TTTS)
  • Supravalvular: narrowing of pulmonary artery distal to valve (Williams Syndrome)
  • COMMONLY ASSOCIATED WITH: Noonan syndrome, maternal rubella, the most common cardiac finding in fetuses affected with twin-twin transfusion
  • Can progress to Pulmonic Atresia
    • ]]>     2022-11-30 15:59:39 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2403789644     Pulmonary Atresia (HYPOPLASTIC RIGHT HEART) rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2405720120
  • Pulmonary atresia with intact interventricular septum (IVS) - most common form: Hypoplastic RV- ALWAYS CYANOTIC FOR NEONATE AFTER BIRTH
  • Hypoplastic right ventricle has been associated with maternal condition of rubella 
  • NOT CYANOTIC FOR FETUS: Foramen Ovale provides pathway for oxygenated blood from the placenta to 
    • ]]>     2022-12-01 20:20:12 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2405720120     rsullivan171 https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2405723112  VSD changes how blood flows through the heart and lungs. Oxygen-rich blood gets pumped back to the lungs instead of out to the body. The oxygen-rich blood mixes with oxygen-poor blood. These changes may increase blood pressure in the lungs and require the heart to work harder to pump blood.]]> 2022-12-01 20:22:32 UTC https://padlet.com/rsullivan171/gh5c4baojpcmn43b/wish/2405723112