1. 4a. What are the chest x-ray findings in a left to right shunt?

2. Left-to-right shunts Acyanotic Includes: – Ventral septal defect – Atrial septal defect – Patent ductus arteriosus

3. Left-to-right shunts Left-to- Right Shunt Chambers Enlarged Prominent aortic knob Dilated MPAPulmonary Vascularity Ventral Septal Defect LA and LVNoYes↑ Atrial Septal Defect RA and RVNoYes (convex)↑ Patent Ductus Arteriosus LA and LVYes ↑

4. Left-to-right shunts Left-to- Right Shunt Chambers Enlarged Prominent aortic knob Dilated MPAPulmonary Vascularity Ventral Septal Defect LA and LVNoYes↑ Atrial Septal Defect RA and RVNoYes (convex)↑ Patent Ductus Arteriosus LA and LVYes ↑

5. RV Enlargement – PA view: lateral upward displacement of the cardiac apex – Lateral view: fullness of retrosternal space RA Enlargement – PA view: increased convexity of the lower right cardiac border

6. Normal PA viewPA view (ASD) SVC RV IVC Aortic knob MPA LV Dilated MPA Increased pulmonary vascularity

7. Right ventricular enlargement 2/3 1/3 Retrosternal space Normal Lateral viewLateral view (ASD) Retrosternal space