The association of tracheal anomalies and tetralogy of fallot

Objective: To determine the incidence of tracheal anomalies in children with tetralogy of Fallot. Design: Retrospective. Setting: A university children's hospital. Participants: Forty four children with the diagnosis of tetralogy of Fallot who underwent either primary or palliative cardiac surgery. Measurements and Main Results: Three criteria were used to identify tracheal abnormalities: (1) direct laryngoscopic evidence; (2) radiographic evidence; and/or (3) inability to intubate the trachea with an endotracheal (ET) tube of appropriate size for age, followed by insertion of a 2.5-mm ET tube. An 11% incidence (5/44) of tracheal anomalies was noted. These could be separated into two categories: isolated upper airway pathology (either glottic or subglottic stenosis) and lower tracheal pathology. None of the five children identified with tracheal abnormalities manifested any preoperative signs or symptoms suggestive of airway problems. Four of the children experienced significant perioperative complications resulting directly from the underlying tracheal pathology. This represented a 9% morbidity (4/44) for patients presenting for repair of tetralogy of Fallot. Conclusions: A significant incidence of tracheal anomalies is associated with tetralogy of Fallot, leading to potential perioperative complications. Copyright (C) 1996 by W.B. Saunders Company