title: Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival.
abstract: BACKGROUND
  Infants with tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) frequently have other associated congenital anomalies which can have a significant impact on their anesthetic care and survival to discharge.
  
  
  METHODS
  A medical record review and retrospective data analysis were performed in a university affiliated children's hospital of all infants undergoing TEF/EA repair between January 1998 and July 2004. The incidence of intraoperative complications during the TEF repair and overall survival to hospital discharge was compared in two groups of infants: 26 patients with TEF/EA and coexisting congenital heart disease (CHD), and 27 patients with TEF/EA and no CHD.
  
  
  RESULTS
  The overall incidence of intraoperative critical events during repair of TEF/EA was significantly higher in infants with associated cardiac pathology (P = 0.003). Six of 53 infants died during hospitalization (overall mortality, 11.3%) and all had associated cardiac pathology. In comparison with nonductal-dependent lesions, the presence of a ductal-dependent cardiac lesion appeared to significantly increase patient mortality (57% vs. 10%, P = 0.028).
  
  
  CONCLUSIONS
  Low birth weight (<1500 g) and associated cardiac pathology were found to be independent predictors of mortality in infants undergoing surgery for TEF/EA repair. The presence of a ductal-dependent cardiac lesion further increased the risk of morbidity and mortality, in addition to necessitating special anesthesia considerations.
authors.affiliation: Division of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, TX 77030, USA. lkdiaz@bcm.tmc.edu
authors.forename: Laura K
authors.initials: LK
authors.lastname: Diaz
authors.forename: Elif A
authors.initials: EA
authors.lastname: Akpek
authors.forename: Radhika
authors.initials: R
authors.lastname: Dinavahi
authors.forename: Dean B
authors.initials: DB
authors.lastname: Andropoulos
mesh_terms: D000768:Anesthesia, General; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D008499:Medical Records; D011379:Prognosis; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*