Shunting is when the blood avoids pulmonary circulation; thus, it does not receive oxygen from the alveolar. Typically, a shunt is within the lungs or heart, and oxygen alone cannot fix the problem. Anatomic shunting occurs during bronchial circulation, which gets blood to the tissues of the lung. Shunting travels by the smallest cardiac veins, which empty directly into the left ventricle of the heart. Comparatively, physiological shunting occurs due to gravity. The highest concentration of blood in pulmonary circulation is in the base of the pulmonary tree, compared to the highest pressure of gas in the apexes of the lungs; shallow breathing can fail to oxygenate the alveolar. Shunting can also occur during disease states.

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