Purpose: The present study is aimed to investigate the relation between cardiovascular structures and airway in complex congenital heart disease using three-dimensional composite volume rendered(VR) images Material and method: In 18 patients who have congenital heart disease and respiratory symptoms, 4-slice or 16-slice multidetector computed tomography with volume rendered reconstruction was performed. All patients were sedated with chloral hydrate. Contrast medium was administered through a pedal venous route and then CT scanning was done during breathing. The CT volume data were transferred to the commercially available software (voxelplus2, Seoul, Korea). After respective reconstruction of cardiovascular structures and airway using VR technique, both images were composed using the soft ware. The image was reviewed whether it was correlated with the clinical symptoms of each patient by congenital cardiac surgeon, pediatric cardiologist, and cardiac radiologist. And then management strategies were decided. Results: Significant bronchial stenotic lesions were detected in 7 patients. As the congenital lesions, huge dilatation of pulmonary arteries in the absent pulmonary valve syndrome in 1, aberrant origin of left pulmonary artery in 2 (pulmonary artery sling in 1, with Tetralogy of Fallot in 1), abnormal course of pulmonary artery with Tetralogy of Fallot in 1, bronchial wall thickening due to bronchopulmonary dysplasia with ventricular septal defect in 1. As the postoperative complications, posterior displacement of ascending aorta after the repair of interruption of aorta and aortopexy in 1, multifocal dilatation of pulmonary arteries after pulmonary artery banding for the management of single ventricle in 1. These all patients were surgically repaired successfully. The other 11 patients did not have significant airway lesions. Conclusions: Composition of both volume rendered images can provide more exact airway images in relation to surrounding cardiovascular structures and promise optimal management strategies in congenital heart disease.