Congenital H-type tracheo-esophageal Fistulas (TOF) or esophageal atresia type IV (Vogt classification 1929) are rare congenital malformations. 1:50 000-1:100 000 children are born with H-TOF [1]. Late diagnosis is typical and usually requires intensive diagnostics. The rareness of this malformation as well as the unspecific symptoms are the main reasons for late diagnosis. During the years 2009-2022, 11 patients with H-TOF were treated in our clinic.In this paper all cases will be presented, and diagnostics and treatment will be discussed. The aim of this study is to improve diagnosis and to minimize complications, such as paralysis of the recurrent laryngeal nerve.