The pathological consequences of a _________________ are directly caused by the amount of blood being shunted. Volume overload occurs in the _________ of the heart. This leads to pulmonary hypertension, right ventricular hypertrophy (secondary to pulmonary HTN), left ventricular hypertrophy (secondary to increased blood return to the LV), and later a reversal of the shunt because the right side of the heart will end up with higher pressures than the left and the shunt reverses. This is known as _______________________.