The tetralogy of Fallot,1consisting of pulmonary stenosis, right ventricular hypertrophy, interventricular septal defect and dextroposition of the aorta, is the most common combination of congenital cardiac defects attended by cyanosis. This case is presented because it had, in addition to the classic features of the tetralogy, an interauricular septal defect, a functional foramen ovale and a widely patent ductus arteri-osus. The coronary venous sinus was received by the left auricle. There was no innominate artery. The right subclavian and the right common carotid arteries arose directly from the aortic arch. REPORT OF CASE B. A. P., a white girl aged 2½ years, seen July 23, 1944, had been cyanotic since birth. Clubbing of the fingers and toes was first noted at the end of the first year. Growth and development had been retarded. The birth weight was 7 pounds 11 ounces (3,487 Gm.). Fretfulness and dyspnea had been