A 7-month-old female infant was referred because of hypothyroidism, seizure, respiratory distress syndrome, and tetralogy of Fallot (TOF) with hypoxic spell. Her father and 24-year-old mother were healthy and nonconsanguineous. There was no family history of congenital malformations. The mother denied any exposure to alcohol, teratogenic agents or infectious diseases during this pregnancy. She received regular prenatal examinations at a local clinic. The infant was born prematurely at 35 weeks of gestation. However, bradycardia, restlessness, cyanosis, gasping respiration, upgaze, and episodes of seizure developed soon after delivery. The infant’s external appearance was grossly normal, and the extremities were freely movable. The body weight was less than third percentile with growth restriction. Serial studies were arranged. Echocardiography revealed an atrial septal defect, a large ventricular septal defect, right ventricular hypertrophy, and severe pulmonary stenosis that were consistent with TOF. Brain sonography revealed moderate dilatation of lateral and third ventricles, in favor of the diagnosis of benign extracerebral fluid collection. Conventional cytogenetic studies performed on the