Вам нужен любой специалист по детской кардиологии, который знает нормальные показатели КЩР и при шунтах, как пример у взрослого-молодого человека:
Complete blood count showed polycythemia (hemoglobin 19.3 g/dL, hematocrit 56.4%) but JAK2 mutation was negative which suggests polycythemia was secondary change from hypoxemia.
No intra- or extra-cranial vascular obstruction was detected.
Interestingly, his initial blood gas analysis showed hypoxemia (PaO2 58.1 mm Hg, O2 saturation 90.7% at room air) with mild hypocapnea (PaCO2 27.3 mm Hg) which could not be corrected with oxygenation therapy (PaO2 70.8 mm Hg, O2 saturation 93.6% at 4 L oxygenation by nasal cannula).
Putting the laboratory tests together, intra- or extra-cardiac shunt was suspected. However, on initial transthoracic echocardiography (TTE), there were no signs of heart chambers enlargement and no definite intra-cardiac shunt flow was detected...
Тransesophageal echocardiography (TEE) with bubble test showed rapid filling of LA and left ventricle chambers with agitated bubble simultaneously within 3-4 cardiac cycles after filling right atrium (RA) and right ventricle chambers. TEE showed ASD with bidirectional shunt flow. Left to right shunt was dominant during most of the cardiac cycle, but right to left shunt was also visible during mid to late diastolic period.
The patient preferred surgical repair .... After the surgery, laboratory finding turned to normal with hemoglobin 12.3 g/dL, hematocrit 40.2%, blood gas analysis of PaO2 86.4 mm Hg, and O2 saturation 96.2% at room air.
по вышеизл.информации вы видите, что был высокий гемоглобин 193 (для 22М норма 140-175) или примерно на 20 г/л выше и снижен кислород и СО2 в артер. крови, которые не корригировалась при подаче кислорода (исключали проблемы с дыханием как причину), но на УЗИ сердца ничего не видели; пока не сделали трансэзоф. эхо сердца с введением пузырькового контраста - дефекты не были видны, после хирургии все нормализовалось и гемоглобин тоже
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