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Approach to Cyanotic Congenital Heart Disease in Children. Early recognition and timely management of cyanotic congenital heart disease (CCHD) is necessary for good outcome. CCHD is an umbrella term encompassing many diseases with variable pathophysiology, which determines clinical presentation of CCHD. Conditions like total anomalous pulmonary venous connection (TAPVC) and transposition of great arteries (TGA) usually present in neonatal period. Tetralogy of Fallot (TOF) and related conditions present with squatting, cyanotic spells and silent chest with no evidence of congestive heart failure, whereas transposition physiology presents with congestive heart failure with cyanosis.