A child with VSD develops the following findings. There is no history of fever. What is the probable cause of these findings?

--> Clubbing & cyanosis in a child with VSD, with no history of fever, is suggestive of Eisenmenger syndrome. --> EISENMENGER SYNDROME: Any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypeension, reversal of flow , cyanosis. --> VSD + FEVER + CLUBBING --> suggestive of INFECTIVE ENDOCARDITIS --> CYANOTIC SPELL/ TET SPELL: Episodic central cyanosis due to total occlusion of right ventricle outflow in a patient with a congenital hea disease, such as Tetralogy of Fallot (TOF). --> PATENT DUCTUS AERIOSUS: Persistence of connection b/w pulmonary aery & aoa even after bih.