The ventricular septal defect of TOF is always large enough to allow free exit to the right to left shunt. Since the right ventricle is effectively decompressed by VSD, Congestive cardiac failure never occurs in TOE Exceptions to this rule are : - Anemia Infective endocarditis iii) Systemic hypertension iv) Myocarditis complicating TOF V) Aortic or pulmonic regurgitation. Remember: Following do not occur in TOF --> o Cardiomegaly o CHF o Recurrent chest infections
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