Recurrent respiratory tract infections may occur in all of the following except –

Chest infections are frequent in the following two groups of congenital cardiac anomalies. a) Left to right shunts → This group includes Atrial septal defect Ventricular septal defect Patent ductus arteriosus This group of CHD's are characterized by frequent chest infections. There is large flow of blood in the lungs which causes lung infections. Each attack of cold seems to turn into Bronchopneumonia. It is not uncommon for these patients to have 6-8 attacks of pneumonia in the first year of life. b) Cyanosis with increased pulmonary blood flow. A large no. of conditions result in a combination of cyanosis with increased pulmonary blood flow. Common to these conditions is the presence of abnormal mixing of pulmonary venous blood with the systemic venous blood and absence of obstruction to pulmonary blood flow. The anomalies included in this group are Transposition of great vessels Total anomalous pulmonary venous connection Single ventricle without obstruction to pulmonary blood flow. Persistent truncus arteriosus Tricuspid atresia with absence of obstruction to pulmonary blood flow. Double outlet right ventricle without pulmonary stenosis. Clinically these patients are characterized by Cyanosis Cardiomegaly Almost 80% of these patients are lost due to congestive cardiac failure or pulmonary infection. Congenital heart diseases which are not predisposed to pulmonary infection 1) Right to left shunts                                                  This group includes                                                        Tetralogy of Fallot                                                      Ebstein's anamoly              2) Obstructive lesions          This group includes          Aortic stenosis              Coarctation of Aorta            Pulmonary stenosis Characteristic of this group is                                          Presence of cyanosis            The absence of chest infections           Clinical characteristic of this group The absence of frequent chest infections and cyanosis The absence of a precordial bulge Presence of forcible or heaving cardiac impulse.