Acyanotic congenital heart disease comprises numerous etiologies, which can be divided into those with increased pulmonary vascularity (pulmonary plethora) and those with normal vascularity:
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increased pulmonary vascularity
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normal pulmonary vascularity
small shunts (see above)
Note that certain congenital defects may initially cause acyanotic congenital heart disease and later cyanotic congenital heart disease. Conditions with a left-to-right shunt (e.g. VSD, ASD) may initially be acyanotic but over time can cause maladaptive changes in the right ventricle and pulmonary vasculature, leading to pulmonary hypertension and Eisenmenger syndrome. When this occurs, the shunt is reversed and deoxygenated blood enters the systemic circulation.
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