Solution: Tetralogy of Fallot is the diagnosis in this case. In the images that I have given you, that diagnosis is not completely clear, but you can see the Ventricular septal defect and the over-riding aorta. Pulmonary stenosis can be inferred because you do not see the pulmonary outflow tract on any of the images and there is not any convincing RV hypertrophy in this case, although this aspect tends to develop over time and is often not present in utero. Almost half of these patients will have another associated heart defect, such as a coronary artery anomaly, right sided aortic arch, or bicuspid pulmonary valve. The reason I presented you with multiple unrelated images in this case is because that is how you are presented with these cases in real practice. You have to get used to identifying an abnormality when presented with the entire scan.