During systole, blood flows through the defect from the left to the right ventricle, through the pulmonary valve into the low resistance pulmonary vascular bed. The blood returns to the left atrium and then to the left ventricle. Some blood then recirculates to the lungs via the ventricular shunt. Recirculation of the blood results in volume overload of both ventricles and the left atrium.
The magnitude of shunt depends on:
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