THE ASSOCIATION OF TRACHEAL ANOMALIES AND TETRALOGY OF FALLOT

Objective: To determine the incidence of tracheal anomalies in childre n with tetralogy of Fallot. Design: Retrospective. Setting: A universi ty children's hospital. Participants: Forty four children with the dia gnosis of tetralogy of Fallot who underwent either primary or palliati ve cardiac surgery. Measurements and Main Results: Three criteria were used to identify tracheal abnormalities: (1) direct laryngoscopic evi dence; (2) radiographic evidence; and/or (3) inability to intubate the trachea with an endotracheal (ET) tube of appropriate size for age, f ollowed by insertion of a 2.5-mm ET tube. An 11% incidence (5/44) of t racheal anomalies was noted. These could be separated into two categor ies: isolated upper airway pathology (either glottic or subglottic ste nosis) and lower tracheal pathology. None of the five children identif ied with tracheal abnormalities manifested any preoperative signs or s ymptoms suggestive of airway problems. Four of the children experience d 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 tet ralogy of Fallot, leading to potential perioperative complications. Co pyright (C) 1996 by W.B. Saunders Company