{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:46:29Z","timestamp":1791985589945,"version":"4.4.0"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    A circular shunt is a complex and often critical condition in neonates after cardiac surgery. We report a case of a newborn with refractory hypoxemia and a circular shunt following an arterial switch operation. Cardiac catheterization provided a precise hemodynamic characterization and guided intervention. A trial balloon occlusion confirmed that closure would resolve the shunt, leading to successful device deployment and resolution of the patient\u2019s condition. Hemodynamic changes due to inadvertent partial pressure of arterial carbon dioxide (PaCO\n                    <jats:sub>2<\/jats:sub>\n                    ) accumulation suggest that, in addition to focusing on inspired oxygen concentrations during shunt calculations, one needs to pay heed to PaCO\n                    <jats:sub>2<\/jats:sub>\n                    levels as well. This case highlights the indispensable role of catheterization for detailed hemodynamic assessment and guiding interventional strategies when non-invasive imaging is insufficient.\n                  <\/jats:p>","DOI":"10.4103\/aca.aca_29_26","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:00:08Z","timestamp":1791824408000},"page":"650-656","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic Characterization of a Circular Shunt After Arterial Switch in a Neonate to Guide Management Strategy"],"prefix":"10.4103","volume":"29","author":[{"given":"Mohan Madan","family":"Maddali","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim Nasser","family":"Al Maskari","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Mohammed","family":"Al Farqani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Abdelsalam","family":"Elmetwally","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman"},{"name":"Department of Anesthesia, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maziar Gholampour","family":"Dehaki","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamood Nasar","family":"Al-Kindi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"R1-20261014","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1053\/j.jvca.2024.11.036","article-title":"Circular shunt: A loop not to be ignored","volume":"39","author":"Maddali","year":"2025","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R2-20261014","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jtcvs.2024.04.018","article-title":"The American Association for Thoracic Surgery (AATS) 2024 expert consensus document: Management of neonates and infants with Ebstein anomaly","volume":"168","author":"Konstantinov","year":"2024","journal-title":"J Thorac Cardiovasc 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Surg"},{"key":"R6-20261014","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/S0735-1097(10)80355-9","article-title":"Transesophageal doppler color flow mapping assessment of atrial septal defect","volume":"16","author":"Mehta","year":"1990","journal-title":"J Am Coll Cardiol"}],"container-title":["Annals of Cardiac 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