Tetralogy of Fallot, Small Pulmonary Annulus, and Low Nakata Index
A 23-year-old man presented with dyspnea on exertion (functional class III), hemoptysis, and cyanosis. Physical examination revealed severe cyanosis (O2 saturation of 76 % in air room) as well as a systolic ejection murmur in the pulmonic area at the left sternal border. He had undergone surgery at childhood for a shunt. The electrocardiogram showed right-axis deviation and right ventricular hypertrophy.
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