Can having a high Qp/Qs for 22 years cause my PA to rupture?

Question

Hello doctor,

Is it remarkable that, despite having such a high Qp/Qs ratio, I have not developed heart failure or any permanent complications? I have been living with this condition for 22 years and have been trying to understand it better.

Given how elevated my Qp/Qs ratio was, I read that potentially only about 12.5 percent of my blood flow might have been reaching my systemic circulation. Could this mean I was experiencing a form of hidden hypoxia, such as low oxygen delivery to my organs, even if my oxygen saturation levels appeared normal?

Could this be considered a type of perfusion or circulatory hypoxia in my case? I also recently received a report indicating that my pulmonary artery is dilated and that I have moderate pulmonary hypertension. Does this increase the risk of pulmonary artery rupture?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have provided two documents (attachments removed to protect the patient’s identity): one indicating a congenital heart defect (ASD) and valve regurgitation diagnosed 15 years ago, and a second document showing that the ASD was closed and the valve was replaced. Additionally, it says that you were admitted with cardiac tamponade, which was drained one year ago.

To assess your current status, I will need a recent and complete echocardiogram.

The information regarding a high Qp:Qs ratio (ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs)), indicating that your pulmonary circulation is 6.7 times greater than your systemic circulation, would typically suggest a risk of pulmonary hypertension, pulmonary artery dilation, right heart strain, right-sided chamber dilation, and eventually reduced cardiac function.

With a significant left-to-right shunt, less oxygenated blood usually reaches the body than the lungs. If growth and development were not affected despite this, it suggests that the heart was compensating well and managing to meet the body’s oxygen demands.

Hypoxia could occur if the shunt were to reverse direction (right-to-left). However, since the defect has been repaired and the valve replaced, the concerns related to a high Qp:Qs ratio would not apply unless there is a significant residual or recurrent shunt.

I hope this information is helpful.

Please do not hesitate to contact me if you need any further assistance.

Thank you, and best wishes.