In children with left-to-right shunt type of precordial disease, such as ventricular septal defect, atrial septal defect, and patent ductus arteriosus, etc. Due to the presence of left-to-right shunts at the intracardiac or aortic level, some blood is shunted from the body circulation system to the pulmonary circulation. This results in a lower than normal volume of blood in the body circulation, which in turn affects the blood supply to organs throughout the body. As a result, growth is limited in children with cyanotic precordial disease. Growth and development will be affected because of significant systemic hypoxia.