Pediatric Cardiology is the branch of medicine that addresses the heart condition of, infants, children and teenagers. Pediatric Cardiology treatment in the world has greatly evolved in the past few years and has helped thousands of children to lead normal lives today. The rate of around 8 for every thousand live births are taking place, 1 congenital cardiac defects are the most common forms of human malformation. With the current advances in pediatric cardiac surgery and percutaenous cardiac interventional procedures, more and more infants and children will survive and reach adulthood. It is estimated that the number of such patients will grow at a rate of 5% per year. 2There is thus a very high likelihood that many primary care pediatricians (PCP) will experience and be called upon to deal with this developing patient populace.Tetralogy of Fallot (TOF) was originally described as the spectrum of a large mal-aligned VSD, with over-riding of the aorta, pulmonary outflow obstruction due to anterior deviation of the outlet septum, and right ventricular hypertrophy. The degree of cyanosis is determined by the severity of right heart obstruction, which may range from mild pulmonary stenosis to atresia of the pulmonary trunk. When obstruction to the right ventricular outpouring tract (RVOT) is mild, cyanosis is insignificant or even nonexistent, the alleged "pink tets. The other extreme, pulmonary atresia, results in severe cyanosis once the PDA closes, in the absence of significant aorto-pulmonary artery collateral vessels.