A child after 4 weeks of birth, is acyanotic. Ejection systolic murmur detected on auscultation. Probable diagnosis is:

Ans. D. (Coarctation of aorta) Stepwise approach toward answerAcyanotic Heart ds: VSD, PDACyanotic heart ds. TOFIn coarctation of aorta there is late ejection systolic murmui to O.P. Ghai 7th/420Coarctation of Aorta Harrison 17th/1562Narrowing or constriction of the lumen of the aorta most common distal to the origin of the left subclavian artery near the insertion of the Hgamentum arteriosumIndentation of the aorta at the site of coarctation and pre- and poststenotic dilatation (the "3" sign) along the left paramediastinal shadow are almost pathognomonic.Murmurs O.P. Ghai 7th/420Late ejection systolicContinuousTetralogy of Fallot (TOF) O.P. Ghai 7th/408-10 - Examination findingsCyanosis and clubbingSingle second heart sound (S2)Since the pulmonary artery pressure is reduced, P2, is reduced in intensity. The late and soft P2 is generally inaudible in TOF. The S2 is, therefore, single and the audible sound is A2.Slightly prominent "a" waves in JVP or normal JVP.Mild parasternal impulse.Normal first heart soundEjection systolic murmur in 2nd intercostals space which ends before A2.RememberTOF is the commonest congenital lesion where squatting is noted.Thorax X-ray reveal Cor-en sabot or boot shapedheart because of the absence of main pulmonary artery segment