Patients with pulmonary stenosis and closed PAD usually appear cyanotic after birth. Conversely, patients with VSD and high pulmonary blood flow without stenotic pulmonary arteries present with signs of overt heart failure without cyanosis.

Patients with pulmonary stenosis and closed PAD usually appear cyanotic after birth. Physical examination may be remarkable for:^[1]

• Normal pulses
• Diminished right ventricle impulse
• Thrill due to ventricular septum defect (VSD) or severe Pulmonary stenosis(ps)
• Holosystolic murmured in left sternal border due to ventricular septum defect( VSD)
• The continuous murmur of patent ductus arteriosus (PDA), occasionally
• [[Systolic ejection murmur[[ in left upper sternal border due to PS
• clubbing in older patients and unrepaired disease.

Patients with high pulmonary blood flow without stenotic pulmonary arteries and with VSD are notcyanotic at birth. Physical examination may be remarkable for signs of overt heart failure include:

• Tachypnea
• poor feeding
• poor growth

The diagnosis of tricuspid atresia is made when at least of the following three diagnostic criteria are met in echocardiography:^[2]

• Absent of color flow doppler in[[ tricuspid valve] region

• Atrial septum defect (ASD) or patent foramen ovale(PFO)

• Small right ventricle

• Left atrium dilation

• Left ventricle dilation