Preoperative diagnosis by electron beam computed tomography and perioperative management of primary tracheal anomalies in tetralogy of Fallot

Purpose: To investigate the usefulness of electron beam computed tomography (EBCT) in the preoperative detection and perioperative management of insid ious concomitant primary tracheobronchial anomalies in patients with tetral ogy of Fallot (TF). Methods: From July 1995 to October 1999, 88 children (38 girls, 50 boys) wi th TF were enrolled in this study. EBCT examinations provided information n eeded to plan management. The final diagnoses of airway abnormalities were correlated with the findings of bronchoscopy in five patients and confirmed during surgery. Results: Fourteen (16%) of the 88 patients had associated primary tracheobr onchial anomalies. Nine patients had tracheal bronchi, which were combined with tracheobronchial stenosis in two patients and with tracheal stenosis i n one patient. Two patients had tracheal diverticulum, which was combined w ith lower tracheal stenosis in one patient. Two patients had congenital tra cheal stenosis. Tracheomalasia was found in one patient. Three patients wit h ventilation difficulties died postoperatively. Special attention was give n to the care of the diseased airways perioperatively, and the remaining 11 patients had a smooth course of hospitalization and discharge. Conclusions: Our results show that EBCT provides good delineation of both c ardiac and tracheobronchial anomalies and suggest that it should be used pe rioperatively to detect associated airway anomalies in TF, to facilitate th e design of an appropriate ventilation care strategy.