In these types of shunts there is mixing of pulmonary and systemic blood, and thus a complex interplay between pulmonary (Qp) and systemic (Qs) blood flow exists.
Examples of complex shunts (parallel circulations are marked with an *):
Transposition of the great arteries*
Truncus arteriosus*
Double-outlet right ventricle*
Hypoplastic left heart syndrome*
Presence of a BT shunt*
Total anomalous pulmonary venous drainage
Southampton Cardiac Anaesthesia 