 I will be speaking a little bit about hyperplastic left-hat syndrome. So it is a spectrum of malformations and there is significant under development of left ventricle and LVOT which causes decreased systemic cardiac output. The incidence is almost 0.1 to 0.2 per thousand live birds with little male preponderance. So normally in this lie diagram we can see that the cavity of the left ventricle is very small and there is very thinning out of the left ventricle output tract. This is present in two main forms. In one form there is atresia of both mitral and aortic valve with practically no communication between left atrium and left ventricle and nearly absent or severe hyperplastic left ventricle. In the second form there is visible left ventricle which has hyper-equic walls. It is globular in shape and shows poor contractility in association with severe stenosis or atresia of aortic valve. It is a sequelae of critical aortic stenosis. So in ultrasound what we see in the fourth chamber in the first form we will see small hypokinetic left ventricle which shows decreased contraction and this is better appreciated on M mode. Typically the apex is formed by the right ventricle which is a very important point of this disease. There is minimal or no flow through mitral valve, LA is small in size and flap of foramen ovale we will see it showing two and four movement between left atrium and right atrium and typically the pulmonary vein has findings and because the pulmonary vein flow is directed into the left atrium but it cannot go through the mitral valve so it goes either through the right atrium or reverses back in the pulmonary veins. So the pulmonary vein will show reversal of flow. In pulse Doppler we can see there is characteristic and diastolic pronounced A wave reversal which is due to increased LA pressure but this might be absent in case of wide foramen ovale. In the second form there is dilated globular left ventricle with ecogenic walls due to fibro elastosis and this also shows decreased contractility. It is like this because this is a sequelae of aortic stenosis which later develops into critical aortic stenosis and then there is no forward flow and LA may be dilated due to presence of mitral regurgitation. In five chamber view or the LVOT view there is absent or narrow ascending aorta and flow across LVOT is not visible. In three vessel and three vessel trachea view we can see dilated pulmonary artery which is a compensatory mechanism and non-visible or hyperplastic transverse arch is there and the typical finding is that there is reversal flow in the transverse arch. HLHS can be diagnosed in first trimester also where we can see that instead of two parallel flows we will be able to see only flow through the right heart but if there is a normal heart in the first trimester it doesn't mean that it cannot develop later into HLHS. So it can also be seen later even if it is normal in the first trimester. So there is chromosomal abnormality associated in four to five percent of cases and majority are terminal trisomy 13 and 18 and some of the syndromes may be associated which are non-Smith-Lemley opposite syndrome and Holterarm and extracardic anomalies can be seen in 10 to 25 percent of cases and there can be growth restriction due to decreased cardiac output. So coming to some of the images in this we can see that there is dilated right atrium right ventricle whereas the left ventricle is very small in size and typically if we see that the apex is formed by the right ventricle and in the diastole we can see that the tricuspid valve is opening but there is no opening of the mitral valve it is thickened and ecogenic. In the color flow the finding can be confirmed that there is no forward flow through the mitral valve and in the three vessel trachea view we can see dilated pulmonary artery and a very narrow transverse arch which shows reversal of flow this is another case where we can see almost absent left ventricle which is just not visible and dilated right ventricle and right atrium and another point here is that the stomach is on the opposite side so this is a case of Cytus ambiguous as well and this we can see in the color flow as well that there is univentricular flow only. If you look at this a heart the four chamber doesn't look that grossly abnormal but if you look carefully then we can see one thing that the left ventricle is not showing contraction there is only rocking movement of the left ventricle the wall is ecogenic and the apex is formed by the right ventricle and if we look at the trachea spit wall there is good movement of the trachea spit wall which is visible but hardly any movement in the mitral valve and the finding can be confirmed in the color flow where we can see good flow in the right heart but not forward flow through the mitral valve and we can see a small regurgitant jet through the mitral valve and in the TUI we can see all the findings together where there is forward flow in the right ventricle and reversal in the transverse arch so this was a case of a second form and another similar kind of case where left ventricle is very small in size with very thick and ecogenic walls and in color flow we can see flow through the right heart but no flow through the left and apex is formed by the right ventricle and dilated pulmonary artery and reversal can be seen in the transverse arch and in this we can see prominent pulmonary veins and no forward flow through the mitral valve it has a very poor prognosis because of very under development of left ventricle and LVOT if aorta is thread like then there is no hope for the surgery if aortic caliber is more than 2 millimeter surgery can be recommended. However still there is 55% survival at the end of first year so it has to be differentiated with some other anomalies such as coctation of aorta critical aortic stenosis, mitral atrasia with BSD, unbalanced AVSD, DORV and CCDGA so presenting some of the cases here you can see that the left ventricle is very small in size and the mitral valve is thick and ecogenic and we do not see any opening of the flap whereas the right heart is grossly dilated and some arrhythmia is also noted a flap of the foramine oval is opening into the right atrium and no forward flow is seen in the color Doppler through the left heart and in this particular case both the outflows were arising from the right ventricle so this was a case of mitral atrasia with BORV in this case we can see that there is thick and ecogenic mitral valve whereas tricuspid valve looked normal because on sine we can see good movement in the right ventricle but almost no movement in the mitral valve and on this color Doppler we could see flow through the right heart so this was a case of mitral atrasia with VSD the size of left ventricle was due to presence of VSD and it was getting flow through the right ventricle in this case also we can see a large VSD present here right heart is dilated whereas left heart is quite small in size and we can see the tricuspid valve is opening normally but no opening of the mitral valve is visible and on color flow we can see flow through the right heart but no flow through the left heart and here also the left ventricle is getting flow from the right ventricle through VSD and in the three vessel trachea view we can see dilated pulmonary artery very narrow transverse arch but there is no reversal so this is a case of mitral atrasia with coactation of aorta thank you so much