Figure 1: Different shunting options for first stage palliation of HLHS, shown from idealized drawings: (A) modified Blalock-Taussig shunt from the innominate artery to the right pulmonary artery; (B) Sano shunt from the right ventricle (Rv) to the pulmonary artery (Pa); (C) central shunt from the ascending aorta (Ao) to the pulmonary artery.
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Atrial septal defect causes left to right shunt due to the high compliance of the right atrium and the difference in pressure between the two atria. Secondary to this mechanism, the pressure in the pulmonary circulation is increased.