Abstract Objectives : The patients with arch obstruction and intracardiac defects have high probability of abnormal geometry of aortopulmonary space that may result in airway compression. We described our experiences of cardiac CT evaluation for airway problem and its management in these patients. Methods : We retrospectively reviewed the medical records of 90 patients with arch obstruction and intracardiac defects who were taken heart CT and corrective surgery in our institution between January 2000 and January 2007. Results: Seventy seven patients were taken heart CT preoperatively (Group I).Airway compression was detected in 20(20/77,25.9%).Seven patients underwent concomitant airway relieving procedures with arch reconstruction. Additional operations for airway problem were needed late after arch repair in 2 patients. For relieving airway compression, additional procedures were performed such as right pulmonary artery translocation anterior to aorta, aortopexy, extensive bronchus dissection and arch extension with homograft interposition between arch.In 13 patients, heart CT was done postoperatively only.(Group II). Among them, 6 patients underwent airway relieving procedures. Type of arch repair was as follows; end to side anastomosis(ESA) in 47, extended end to end anastomosis(EEEA) in 40 and end to end anastomosis(EEA) in 3. Airway compression requiring surgical intervention was most common in ESA (10/15, 66.6%) and EEEA (5/15, 33.3%). Conclusions : The patients with arch obstruction and intracardiac defect showed rather high incidence of airway compression. ESA type arch repair was more prone to this problem. Preoperative heart CT was very useful for detecting this potential airway problem and concomitant management.