Korinne was born 4 days earlier than 8 month. Weighing 4.5 lbs, at Mary Chiles Hospital, Manila, Philippines. Her immediate post-natal period was characterized by being in the isolette for 2 weeks, with few days of oxygenation only. She did not develop RDS or hyperbilirubinemia. After 1 month, she was discharged to the care of the parents and no mention of any heart defect.  At 3 months, mother noted cyanosis of her lips and hands especially when crying. She was brought to Philippine Heart Center for Asia, and was seen by a Pediatric cardiologist, and was tentativly diagnosed having a cyanotic heart diseas,  probably Tetralogy of Fallot. At 4 months, an ultrasound was done at the same center, and Tetralogy was diagnosed. EKG and cardiac series were also consistent with the diagnosis of TF. A cardiac catheterization was adviced, but was not satisfide up to the present.
Her developmental milestones were delayed, sitting alone at 10 months, standing with support at 15 months, and walking without support at 20 months.
As she started growing slowly, cyanosis became more evident and clubbing of the fingers and toes were noted after a year old. Aside from the usual squatting and being carried by parents when she gets tired, she is described as being active. She also has frequently  a dry cough. No episode of anoxic spell has been noted by parents. Her appetite is good, although she does not gain weight very much. She was hospitalized once for phlebotomy procedure at the age of 5 months.  (9-30-86)
On Physical Examination, revealed a cheerful child, with generalized cyanosis but no acute distress.
Pertinent P.E. are referabloe to the cardiac area, save for the generalized cynosis and clubbing of the fingers and toes. There is slight precordial prominence at the lower left sternal border and xiphoid area. On palpation, no thrill was appreciated, and the PMI is the 5th LICS, parasternal border. On auscultaion, SI is clear and nomal, S2 is single with the aortic closure very loud, a grade II/VI short ejection murmur is best heard at the left parasternal border on the 2nd LICS, no diastolic murmur or extra sounds heard. Abdomen- the liver edge is 2 cm below the right costal border, spleen was not palpable. Refelxes are brisk and negative for any neurological defict.

Impression: TETRALOGY OF FALLOT