The cervical aortic arch.

NAB, a nine-year-old Malay female, presented at the age of five months with poor weight gain and recurrent upper respiratory tract infection; it was diagnosed as Tetralogy of Fallot. She had no hypercyanotic spells but was severely restricted in her activities. She was a full-term, spontaneous vertex delivery. Antenatal and postnatal periods were uneventful and her milestones were normal. She was small for age, blood pressure 90/60 mmHg; clinically she was not distressed but was cyanosed and clubbed. Her pulse rate was 100/ min but her peripheral pulses were not well felt in comparison with the carotid pulse. The praecordium was relatively quiet. Both Sl and 82 were heard, 82 was single. A high pitched long systolic murmur (3/6) was audible at the midleft sternal edge. No significant diastolic murmurs