Hemodynamics in congenital heart disease.

This paper introduces a very general and flexible model for the study of hemodynamic changes in congenital heart disease. The generality of the model makes it possible to use the same computer program (which is included in an Appendix) to study both the fetal circulation and the adult circulation, as well as such diverse disease states as patent ductus arteriosus, ventricular septal defect, atrial septal defect, tetralogy of Fallot and transposition of the great arteries. In this paper, only patent ductus and ventricular or atrial septal defect are studied, with special emphasis on the influence of increasing pulmonary vascular resistance on the shunt flow. In the case of patent ductus and ventricular septal defect, the computed shunt flow is very time-dependent and the left-to-right shunt becomes first bidirectional and then right-to-left as the pulmonary resistance increases. By contrast, the computed shunt flow of atrial septal defect is nearly time-independent and is also somewhat less sensitive to the pulmonary vascular resistance.