Total anomalous pulmonary venous drainage associated with tetralogy of Fallot: report of a case.

The association of total anomalous pulmonary venous drainage and Tetralogy of Fallot is a rare occurrence; only six cases have been reported and only in one of these was the pulmonary drainage by the infracardiac route. A further such case is reported in a girl twin, with cleft palate and umbilical hernia and a normal spleen, who died at the age of three weeks and the clinical and post mortem features are described. The masking effect of the pulmonary outflow stenosis on pulmonary venous obstruction is discussed together with the relevance to clinical diagnosis and surgical intervention as "palliative" surgery may be dangerous.