<prompt> Cardiac abnormality seen with Noonans syndrome is -VSDASDPulmonary stenosisCoarctation of aorta  <response>: Noonan Syndrome :were previously thought to have a form of Turner syndrome, with which Noonan syndrome shares a number of clinical features.The observation that patients with Noonan syndrome have normal karyotypes was important in allowing the distinction to be made between the Turner and Noonan syndromes.Pathophysiology :The pathophysiology of Noonan syndrome is not fully understood. A disease-causing gene, PTPN11, has been identified. The gene product, SHP2, plays an important role in cardiac semilunar valve development.Sex :Noonan syndrome occurs in either a sporadic or autosomal dominant fashion. In either case, males and females are affected equally.Age :The disorder is present from birth, but age impacts upon the facial phenotype Infants with Noonan syndrome can be difficult to recognize by facial appearance alone. The phenotype becomes more striking in early childhood, but with advancing age, it may again become quite subtle. Careful examination of an affected childs parents may, in fact, reveal that they are affected mildly.Clinical features -Growth parametersSize at birth is usually within the reference range.Short stature is present in up to 80 of patients. Average adult height for males is 555 and for females is 5.Facial featuresTriangular-shaped faceHypertelorismDown-slanting eyesPtosisStrabismusAmblyopiaRefractive errorsLow-set ears with thickened helicesHigh nasal bridgeShort webbed neckChestback featuresPectus carinatumexcavatumScoliosisCardiac featuresThe characteristic lesion is a dysplasticstenotic pulmonic valve, but virtually all types of congenital heart defects have been described in patients with Noonan syndrome.Hypertrophic cardiomyopathy obstructive and nonobstructive types is present in up to 30 of patients.Abdominal featuresHepatosplenomegaly unrelated to cardiac status is present in approximately 25 of patients.Genitourinary features Renal anomalies are present in 10 of patients but are not clinically significant.More than half of male patients have undescended testes.Skeletal featuresJoint laxity is present in more than half of patients.Talipes equinovarus, radioulnar synostosis, cervical spine fusion, and joint contractures are less common findings.Skin findings LymphedemaProminent pads of fingers and toesFollicular keratosis of the face and extensor surfacedMultiple lentiginesNeurologic findingsHypotoniaSeizure disorderUnexplained peripheral neuropathy infrequent 