Prolonged left-to-right shunting in piglets does not further aggravate pulmonary vasculopathy, but is a cause of RV failure, which appears related to an activation of apoptosis and inflammation.
Rondelet, B., Dewachter, C., Kerbaul, F., Kang, X., Fesler, P., Brimioulle, S., Naeije, R., & Dewachter, L. (2012). Prolonged overcirculation-induced pulmonary arterial hypertension as a cause of right ventricular failure. European Heart Journal (English Edition), 33(8), 1017-1026. https://doi.org/10.1093/eurheartj/ehr111 (Original work published 2012)