<prompt> Recurrent respiratory tract infections may occur in all of the following exceptVentricular septal defectTetrology of FallotTransposition of great arteriesTotal anomalous venous return  <response>: Chest infections are frequent in the following two groups of congenital cardiac anomalies.a Left to right shunts This group includesAtrial septal defectVentricular septal defectPatent ductus arteriosusThis group of CHDs are characterized by frequent chest infections.There is large flow of blood in the lungs which causes lung infections.Each attack of cold seems to turn into Bronchopneumonia.It is not uncommon for these patients to have 6-8 attacks of pneumonia in the first year of life.b Cyanosis with increased pulmonary blood flow.A large no. of conditions result in a combination of cyanosis with increased pulmonary blood flow.Common to these conditions is the presence of abnormal mixing of pulmonary venous blood with the systemic venous blood and absence of obstruction to pulmonary blood flow.The anomalies included in this group areTransposition of great vesselsTotal anomalous pulmonary venous connectionSingle ventricle without obstruction to pulmonary blood flow.Persistent truncus arteriosusTricuspid atresia with absence of obstruction to pulmonary blood flow.Double outlet right ventricle without pulmonary stenosis.Clinically these patients are characterized byCyanosisCardiomegalyAlmost 80 of these patients are lost due to congestive cardiac failure or pulmonary infection.Congenital heart diseases which are not predisposed to pulmonary infection1 Right to left shunts This group includes Tetralogy of Fallot Ebsteins anamoly 2 Obstructive lesions This group includes Aortic stenosis Coarctation of Aorta Pulmonary stenosisCharacteristic of this group is Presence of cyanosis The absence of chest infections Clinical characteristic of this groupThe absence of frequent chest infections and cyanosisThe absence of a precordial bulgePresence of forcible or heaving cardiac impulse. 