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We thank Drs Noori and Seri for their thoughtful review of our study findings.1 We agree that the echocardiography data suggest that systemic hypotension in our study subjects may have been due to reduced systemic vascular resistance or a significant patent ductus arteriosus (PDA) shunt with unloading of the left heart due to an interatrial shunt. These physiological explanations carry the potential to represent states of uncompensated low afterload, which may imply a state of systemic hypoperfusion.

source https://www.jpeds.com/article/S0022-3476(21)00899-4/fulltext?rss=yes

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