Abstract
Cyanosis due to right to left shunt across an atrial septal defect (ASD) brings up lots of questions in an inquisitive mind! Systemic desaturation at rest or during exercise can limit physical ability and impair the quality of life of patients with congenital heart defect (CHD). Traditionally, ASD is taught as an acyanotic CHD, but we encountered a child with a different clinical presentation. Understanding the mechanism of early onset systemic desaturation in the presence of an ASD is vital for surgical planning and decision-making. A comprehensive TEE examination always compliments clinical and haemodynamic data for an aetiology based patient management. This brief clinical communication attempts to discuss the role of perioperative TEE examinations in a case of ASD with central cyanosis.