Correct! Unfortunately, it looks like this tetralogy is turning into a pentalogy.

In addition to Tetralogy of Fallot, your patient has patent ductus arteriosus (PDA).

Typically, the muscularis of the ductus arteriosus contracts when the infant begins breathing, causing the ductus arteriosus to functionally close 24-48 hours after birth. It then completely closes 2-3 weeks after birth forming a fibrous structure known as the ligamentum arteriosum. When the ductus arteriosus remains open after birth infants may be subject to a left-to-right shunt, which increases pulmonary flow, decreases lung compliance, and causes dyspnea (shortness of breath) and tachycardia (abnormally high heart rate).

From which aortic arch does the ductus arteriosus derive?