The right to left shunt in TOF occurs by which of the the following route ?
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RV- VSD- LV -Aorta
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RV- Aorta
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RV – VSD- Aorta
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All of the above can occur
Answer : 2 Most shunting occur by direct streaming of RV blood into Aorta . If the aortic override is near 50 % it need not even cross the VSD in it’s circuit. (Although theoretically all of the above can occur)
Dr.S.Venkatesan MD 
Sir reference for this..if aorta override nears fifty percent then it becomes DORV….then how do u stil say RV Blood passes directly into aorta
Aortic override > 50 % alone does not make a TOF a DORV
DORV is a different entity altogether .
In DORV VSD shunt is obligatory left to right and there should be aorto mitral discontinuity
venkatesan