Interesting Images 3

A 16 year old boy that was found to be cyanosed after birth and diagnosed with Tetralogy fallot and pulmonary atresia referred to our adult congenital heart disease clinic with a history of palliative surgery in childhood and recent dyspnea on exertion, New York Heart Association (NYHA) functional class III. He was cyanosed with marked clubbing of the fingers and toes. Oxygen saturation in room air was %64.