– O ram ▁synd rome ▁ ▁L ut emb acher ' s ▁synd rome ▁– ▁the ▁presence ▁of ▁a ▁con gen ital ▁AS D ▁along ▁with ▁acquired ▁mit ral ▁st en osis ▁ ▁Mechan isms ▁ ▁In ▁una ffect ed ▁individuals , ▁the ▁ch amb ers ▁of ▁the ▁left ▁side ▁of ▁the ▁heart ▁are ▁under ▁higher ▁pressure ▁than ▁the ▁ch amb ers ▁of ▁the ▁right ▁side ▁because ▁the ▁left ▁vent ric le ▁has ▁to ▁produce ▁enough ▁pressure ▁to ▁p ump ▁blood ▁throughout ▁the ▁entire ▁body , ▁while ▁the ▁right ▁vent ric le ▁needs ▁only ▁to ▁produce ▁enough ▁pressure ▁to ▁p ump ▁blood ▁to ▁the ▁l ungs . ▁ ▁In ▁the ▁case ▁of ▁a ▁large ▁AS D ▁( > ▁ 9   mm ), ▁which ▁may ▁result ▁in ▁a ▁clin ically ▁remarkable ▁left - to - right ▁sh unt , ▁blood ▁ ▁sh un ts ▁from ▁the ▁left ▁at rium ▁to ▁the ▁right ▁at rium . ▁ ▁This ▁extra ▁blood ▁from ▁the ▁left ▁at rium ▁may ▁cause ▁a ▁volume ▁over load ▁of ▁both ▁the ▁right ▁at rium ▁and ▁the ▁right ▁vent ric le . ▁ ▁If ▁un tre ated , ▁this ▁condition ▁can ▁result ▁in ▁en larg ement ▁of ▁the ▁right ▁side ▁of ▁the ▁heart ▁and ▁ultimately ▁heart ▁failure . ▁ ▁Any ▁process ▁that ▁increases ▁the ▁pressure ▁in ▁the ▁left ▁vent ric le ▁can ▁cause ▁w ors ening ▁of ▁the ▁left - to - right ▁sh unt . ▁ ▁This ▁includes ▁hy pert ension , ▁which ▁increases ▁the ▁pressure ▁that ▁the ▁left ▁vent ric