A 2,700-g male infant was delivered by cesarean section due to breech presentation. His Apgar score was 10. Initial examination showed an imperforate anus and a right clubhand with an absent thumb. The umbilical cord contained only two vessels. The angle of the mouth pulled to the left during crying. On the fourth day after delivery, a 3/6 systolic murmur was heard along the lower left sternal border, compatible with a ventricular septal defect. Typical roentgenograms of the vertebral column and of the right upper limb are shown in Figs 1 and 2, respectively. Contrast medium was injected transperineally through the anal dimple (Fig 3).
Denouement and Discussion
The VATER Association
The VATER association is an acronym describing the concurrence of specific congenital anomalies that occur in a greater-than-random frequency without hereditary factors.1