Also known as: Right-to-left cardiac shunt and Right-to-left circulatory shunt
- Blood that is low in oxygen (blue blood) returns from the body to the right side of the heart.
- The right side of the heart then pumps the blood to the lungs, where it picks up more oxygen and becomes red.
- The oxygen-rich blood returns from the lungs to the left side of the heart. From there, it is pumped to the rest of the body.
- The blood that is pumped out to the body is lower in oxygen.
- Less oxygen delivered to the body can make the skin look blue (cyanosis).
- Tricuspid valve (the valve between the 2 chambers on the right side of the heart) may be absent or unable to open wide enough.
- Pulmonary valve (the valve between the heart and the lungs) may be absent or unable to open wide enough.
- Aortic valve (the valve between the heart and the blood vessel to the rest of the body) is unable to open wide enough.
- Coarctation or complete interruption of the aorta
- Ebstein anomaly
- Hypoplastic left heart syndrome
- Tetralogy of Fallot
- Total anomalous pulmonary venous return
- Transposition of the great arteries
- Truncus arteriosus
- Chemical exposure
- Genetic and chromosomal syndromes, such as Down syndrome, trisomy 13, Turner syndrome, Marfan syndrome, and Noonan syndrome
- Infections (such as rubella) during pregnancy
- Poorly controlled blood sugar level in women who have diabetes during pregnancy
- Medicines prescribed by your doctor or bought on your own and used during pregnancy
- Street drugs used during pregnancy
- Breathing too quickly (hyperventilation)
- Sudden increase in bluish color to the skin
- Feeding problems or reduced appetite, leading to poor growth
- Grayish skin
- Puffy eyes or face
- Tiredness all the time
- Chest x-ray
- Checking oxygen level in the blood using an arterial blood gas test or by checking it through the skin with a pulse oximeter
- Complete blood count (CBC)
- ECG (electrocardiogram)
- Looking at the heart structure and blood vessels using echocardiogram or MRI of the heart
- Passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin (cardiac catheterization)
- Transcutaneous oxygen monitor (pulse oximeter)
- Testing the heart's electrical system
- Get rid of extra fluids
- Help the heart pump harder
- Keep certain blood vessels open
- Treat abnormal heartbeats or rhythms
- Abnormal heart rhythms and sudden death
- Chronic high blood pressure in the blood vessels of the lung
- Heart failure
- Infection in the heart
- Bluish skin (cyanosis) or grayish skin
- Breathing difficulty
- Chest pain or other pain
- Dizziness, fainting, or heart palpitations
- Feeding problems or reduced appetite
- Fever, nausea, or vomiting
- Puffy eyes or face
- Tiredness all the time
- Avoid using alcohol and drugs during pregnancy.
- Tell your doctor that you are pregnant before taking any prescribed medicines.
- Get a blood test early in the pregnancy to see if you are immune to rubella. If you are not immune, you must avoid any exposure to rubella and should get immunized right after delivery.
- Pregnant women with diabetes should try to get good control over their blood sugar level.
Cyanotic heart disease refers to a group of many different heart defects that are present at birth (congenital). They result in a low blood oxygen level. Cyanosis refers to a bluish color of the skin and mucous membranes.
Normally, blood returns from the body and flows through the heart and lungs.
Heart defects that children are born with can change the way blood flows through the heart and lungs. This causes non-oxygenated blood to be pumped out to the body without going through the lungs to pick up oxygen. As a result:
Many of these heart defects involve the heart valves. Heart valves are found between the heart and the large blood vessels that bring blood to and from the heart. These valves open up enough for blood to flow through. Then they close, keeping blood from flowing backward.
Heart valve defects that can cause cyanosis include:
Other heart defects that may cause cyanosis include:
Cyanotic heart diseases may be caused by:
Some heart defects cause major problems right after birth.
The main symptom is cyanosis. This is a bluish color of the lips, fingers, and toes that is caused by the low oxygen content in the blood. It may occur while the child is resting or only when the child is active.
Some children have breathing problems (dyspnea). They may get into a squatting position after physical activity to relieve breathlessness.
Others have spells, in which their bodies are suddenly starved of oxygen. During these spells, symptoms may include:
Infants may get tired or sweat while feeding and may not gain as much weight as they should.
Fainting (syncope) and chest pain may occur.
Other symptoms depend on the type of cyanotic heart disease, and may include:
Exams and Tests
The doctor will listen to the heart and lungs with a stethoscope. Abnormal heart sounds, a heart murmur, and lung crackles may be heard.
Tests will vary depending on the cause, but may include:
Some infants may need to stay in the hospital after birth so they can receive oxygen or be put on a breathing machine. They may receive medicines to:
The treatment of choice for most congenital heart diseases is surgery to repair the defect. There are many types of surgery, depending on the kind of birth defect. Surgery may be needed soon after birth, or it may be delayed for months or even years.
Your child may need to take water pills (diuretics) and other heart medicines before or after surgery. Be sure to follow the correct dosage. Regular follow-up with the doctor is important.
Many children who have had heart surgery must take antibiotics before, and sometimes after having any dental work or other medical procedures. Make sure you have clear instructions from your child's heart doctor.
Ask your child's doctor before getting any immunizations. Most children can follow the recommended guidelines for childhood vaccinations.
The outlook depends on the specific disorder.
Complications of cyanotic heart disease include:
When to Contact a Medical Professional
Call your health care provider if your baby has:
Women who are pregnant should get good prenatal care.
Some inherited factors may play a role in congenital heart disease. Many family members may be affected. If you are planning to get pregnant, talk to your doctor about screening for genetic diseases.
Bernstein D. Cyanotic congenital heart disease. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 429.
Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.
- Review date:
- December 07, 2016
- Reviewed by:
- Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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