Four heterozygous missense variants in RIPPLY3 were identified in 4 unrelated CTD patients out of the 577 CTD patients without 22q11.2 deletion/duplication, all the variants were absent from the 391 controls in our cohort: p.P30L in TOF, p.T52S in TOF, p.D113N in TGA/PA/VSD, and p.V179D in PA/VSD and patent ductus arteriosus (PDA) (Table 2). This evidence concerns the gene RIPPLY3 and Patent ductus arteriosus.