VACTERLS ASSOCIATIONWITH PULMONARY ARTERIAL HYPERTENSION AND LEAST VERTEBRAL ANOMALY
In early 1970’s VATER association was first named.  Clustering of featuresinvolves the idea of the “developmental field defect”, in which malformations that occur in blastogenesis tend to result in polytopic anomalies, or birth defects affecting multiple organ systems.The clinical manifestation of VACTERLS association includes vertebral anomalies, analatresia, congenital heart disease, tracheoesophageal fistula, renal dysplasiaand limb abnormalities, Single umbilical artery. As initially described, the condition included the statistically non-random co-occurrence of a group of congenitalmalformations. Because thesemalformations were observed to occur together more often than would be expected by chance, the condition was termed an association. However, there was not (and still remains no) evidence for a single, unifying cause that would result in the condition being termed a syndrome.As per Some authors VACTERLS  association would be more accurately described as a “primary polytopic developmental field defect” rather than an association . Congenital malformations are a major cause of fetal loss. Most of these fetuses are aborted at an early gestational age. The etiologyof these defects may be genetic, environmental or multi factorial. No definite etiology has been proved, but a defect in mesodermal differentiation, in early first trimester, has been suggested.