# Congenital Diaphragmatic Hernia — GCMD Library living collection Everything in the library about CDH — built automatically from dossiers that name it. Updated: n/a · 15 episodes · 351 cited statements ## Episodes ### Acute Management - [Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129) — video · 5:22 · [machine version](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129.md) ### Surgical Management - [Controversies in Congenital Diaphragmatic Hernia: Update Course 2018](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338) — video · 41:42 · [machine version](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338.md) - [Challenges in Diaphragmatic Hernia Repair: Update Course 2016](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559) — video · 44:15 · [machine version](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559.md) - [Fetoscopic Endoluminal Tracheal Occlusion (FETO)](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330) — podcast · 5:54 · [machine version](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330.md) - [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569) — video · 4:30 · [machine version](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569.md) ### Complications - [Neonatal Gastric Volvulus with Dr. Jason Frischer](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494) — podcast · 11:17 · [machine version](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494.md) ### Evidence & Research - [Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689) — podcast · 16:50 · [machine version](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689.md) - [EUPSA - MicroRNAs in amniotic fluid stem cellextracellular vesicles modulate lung development in experimental congenital diaphragmatic hernia - Kasra Khalaj](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430) — video · 10:03 · [machine version](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430.md) - [Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334.md) - [Quick Literature Updates Episode 20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554) — video · 4:03 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554.md) ### In-Depth Reviews - [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952) — podcast · 82:05 · [machine version](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952.md) - [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303) — podcast · 82:05 · [machine version](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303.md) - [Update Course Rewind: 2024 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md) ### Emerging & Future Directions - [Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025) — video · 149:16 · [machine version](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025.md) - [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570) — video · 4:30 · [machine version](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=0) Prenatal Counseling and Diagnosis (Ep 5) - [7:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=434) Initial Neonatal Management and Respiratory Strategy (Ep 5) - [17:48](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1068) ECMO Indications and Contraindications (Ep 5) - [29:21](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1761) ECMO Technical Considerations (Ep 5) - [36:24](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2184) Timing of Surgical Repair (Ep 5) - [46:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2800) Surgical Approach: Open vs Thoracoscopic (Ep 5) - [53:56](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3236) Technical Aspects of Repair (Ep 5) - [59:19](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3559) Postoperative Management and Chest Tubes (Ep 5) - [69:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4168) Long-term Complications and Follow-up (Ep 5) - [74:54](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4494) Recurrence and Right-sided Hernias (Ep 5) - [0:00](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=0) Introduction and Case 1: Timing of Repair in Stable CDH (Ep 1) - [4:31](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=271) Surgical Approach: MIS versus Open Repair (Ep 1) - [7:50](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=470) Technical Aspects of Thoracoscopic CDH Repair (Ep 1) - [17:47](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1067) Patch Materials and Recurrence Prevention (Ep 1) - [25:02](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1502) Case 2: ECMO Management and Repair Timing (Ep 1) - [30:27](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1827) ECMO Repair Strategies and David Kays' Results (Ep 1) - [36:14](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2174) Redo Repairs, Muscle Flaps, and Fetal Intervention (Ep 1) - [0:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=0) Indications and Technical Approach to MIS CDH Repair (Ep 2) - [12:39](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=759) Mesh Layering Technique and ECMO Considerations (Ep 2) - [16:32](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=992) Case 1: Timing of Repair in Stable Term Neonate (Ep 2) - [21:09](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1269) Case 2: ECMO Cannulation Strategy (Ep 2) - [25:42](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1542) Repair Timing Relative to ECMO Run (Ep 2) - [35:51](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2151) Case 3: Recurrent Right-Sided CDH with Sac (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=0) Prenatal Counseling and Diagnosis (Ep 3) - [7:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=434) Initial Stabilization and Respiratory Management (Ep 3) - [18:38](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1118) ECMO Indications, Cannulation, and Management (Ep 3) - [33:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2025) ECMO Complications and Futility (Ep 3) - [45:31](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2731) Surgical Repair Timing and Approach (Ep 3) - [53:56](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3236) Surgical Technique and Technical Pearls (Ep 3) - [59:19](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3559) Thoracoscopic Approach and Chest Tube Controversy (Ep 3) - [69:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4168) Postoperative Management and Long-term Complications (Ep 3) - [74:54](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4494) Recurrence and Right-sided Hernias (Ep 3) - [0:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=0) Introduction and FETO Technique for Congenital Diaphragmatic Hernia (Ep 4) - [23:20](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1400) FETO Trial Design and Outcomes (Ep 4) - [35:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=2100) Panel Discussion on FETO Trial Design and Challenges (Ep 4) - [62:30](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=3750) Laser Photocoagulation for Twin-Twin Transfusion Syndrome (Ep 4) - [105:50](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6350) Technical Aspects of Laser Photocoagulation (Ep 4) - [125:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7500) Selective Intrauterine Growth Restriction in Monochorionic Twins (Ep 4) - [0:00](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=0) Introduction and app promotion (Ep 6) - [2:21](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=141) Guest introductions (Ep 6) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies" — Charlie Stolar (epidemiological) [Ep 5 · 2:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=165) - "CDH diagnosis is typically made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart" — Charlie Stolar (clinical) [Ep 5 · 3:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=217) - "CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side" — Charlie Stolar (clinical) [Ep 5 · 4:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=254) - "At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation" — Charlie Stolar (clinical) [Ep 5 · 4:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=263) - "CDH is a field defect; the most common neonatal comorbidity is foregut motility difficulty" — Charlie Stolar (clinical) [Ep 5 · 4:39](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=279) - "CDH is a medical physiologic emergency but not a surgical emergency" — Charlie Stolar (clinical) [Ep 5 · 5:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=300) - "The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues" — Charlie Stolar (guideline) [Ep 5 · 5:24](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=324) - "Antenatal interventions for CDH are no better than investigational and experimental at best" — Charlie Stolar (opinion) [Ep 5 · 6:35](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=395) - "Babies with CDH should be born at a full-service children's facility with ECMO capability; maybe 10-15% will benefit from ECMO" — Charlie Stolar (guideline) [Ep 5 · 7:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=443) - "In single-center experiences, presence of liver in the chest or stomach in the chest is of no prognostic value" — Charlie Stolar (clinical) [Ep 5 · 8:31](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=511) - "Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8), where prognosis is concerning" — Charlie Stolar (clinical) [Ep 5 · 8:42](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=522) - "Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis" — Charlie Stolar (clinical) [Ep 5 · 9:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=547) - "If shown 100 children with CDH, 80-85% will survive to become teenagers" — Charlie Stolar (epidemiological) [Ep 5 · 10:13](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=613) - "Antenatal steroids have tremendous value for preterm labor under 35 weeks but most CDH babies are near-term (37-39 weeks) where steroid role is arguable" — Charlie Stolar (clinical) [Ep 5 · 10:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=637) - "Exit to ECMO for CDH is nonsense; it moves the goalposts on almost certainly non-viable babies" — Charlie Stolar (opinion) [Ep 5 · 12:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=726) - "We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth" — Charlie Stolar (clinical) [Ep 5 · 13:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=780) - "Initial evaluation of newborn with CDH includes looking for morphology, associated anomalies, respiratory distress, pre- and post-ductal oxygen gradients, and early cardiac echo for right heart function" — Charlie Stolar (clinical) [Ep 5 · 14:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=885) - "Not every baby with CDH needs or is a candidate for ECMO; approximately 5% have insufficient lung to support life based on inability to saturate preductal blood" — Charlie Stolar (clinical) [Ep 5 · 15:55](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=955) - "ECMO is a drug delivery system for oxygen; indication is when end organs aren't getting enough oxygen despite best care" — Charlie Stolar (clinical) [Ep 5 · 17:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1026) - "The best way to assess end-organ function is urine output" — Charlie Stolar (clinical) [Ep 5 · 17:44](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1064) - "ECMO indication is typically oxygenation index in excess of 40 for 4 hours or more" — Charlie Stolar (guideline) [Ep 5 · 18:21](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1101) - "All therapy is guided by preductal oximetry, not postductal; if preductal saturation is 90% (PaO2 ~65 torr), the brain is doing fine with fetal hemoglobin" — Charlie Stolar (clinical) [Ep 5 · 19:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1146) - "When managing dropping preductal saturation, first ensure adequate hemoglobin and circulating volume, then increase FiO2 or ventilator pressure, but avoid trying to control PCO2 as this will destroy the lungs" — Charlie Stolar (clinical) [Ep 5 · 20:25](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1225) - "Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today" — Charlie Stolar (opinion) [Ep 5 · 21:38](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1298) - "CDH babies are not paralyzed during ventilation; minimal sedation is used and babies should be awake and breathing spontaneously" — Charlie Stolar (clinical) [Ep 5 · 21:56](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1316) - "Initial conventional ventilator settings (IMV rate ~40, peak pressure 25-28, PEEP ~5) are not tolerated by most CDH babies" — Charlie Stolar (clinical) [Ep 5 · 22:15](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1335) - "Unconventional ventilation mode for CDH uses high rate (100 breaths/min), low peak pressure (turned down to zero due to stacking), and high gas flow rate with permissive hypercapnia" — Charlie Stolar (clinical) [Ep 5 · 22:53](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1373) - "High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO; when they get out the oscillator, it's time to prime an ECMO circuit" — Charlie Stolar (clinical) [Ep 5 · 24:30](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1470) - "Nitric oxide is a waste of money for CDH; it's terrific for premature babies with immature lung disease but of no value in CDH" — Charlie Stolar (opinion) [Ep 5 · 25:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1545) - "The best drug for CDH is oxygen" — Charlie Stolar (opinion) [Ep 5 · 26:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1567) - "ECMO gestational age limit has been pushed from 36 weeks down to 35, maybe 34 weeks; below 32 weeks the intracranial hemorrhage rate takes off and neurologic outcomes become poor" — Charlie Stolar (clinical) [Ep 5 · 26:22](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1582) - "The smallest ECMO arterial cannula is about 8 French; getting adequate flow out of small cannulas is problematic due to resistance related to both length and diameter" — Charlie Stolar (clinical) [Ep 5 · 27:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1660) - "For ECMO candidacy, it's the gestational age that matters for intracranial hemorrhage risk (germinal matrix), not the size; size becomes an issue only when cannulas don't fit" — Charlie Stolar (clinical) [Ep 5 · 28:15](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1695) - "The broad principle for ECMO candidacy is: do you have a reversible condition? Can you get out with reasonable confidence once you start?" — Charlie Stolar (clinical) [Ep 5 · 28:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1725) - "VV ECMO is terrific if the heart works but problematic in CDH because heart function is often depressed and it's hard to get the cannula in with the shifted mediastinum" — Charlie Stolar (clinical) [Ep 5 · 30:27](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1827) - "VV ECMO is for less sick patients who aren't in extremis; most CDH babies are sicker and do better on VA ECMO" — Charlie Stolar (clinical) [Ep 5 · 31:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1860) - "VA bypass is basically dialing in a PaO2; VV has mixing issues, cannula position concerns, and is more annoying to manage" — Charlie Stolar (clinical) [Ep 5 · 31:53](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1913) - "Echo guidance during ECMO cannulation is really helpful with the shifted mediastinum; the arterial cannula can go out the subclavian artery or the venous cannula into the innominate vein" — Charlie Stolar (clinical) [Ep 5 · 32:17](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1937) - "If the arterial cannula goes out the subclavian artery, you'll have a well-perfused hand and think preductal sats look good, but the baby isn't seeing the oxygen" — Charlie Stolar (clinical) [Ep 5 · 33:01](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1981) - "Using a guide wire to position the venous cannula into the right atrium is helpful when the mediastinum is distorted" — Charlie Stolar (clinical) [Ep 5 · 33:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2003) - "Use 3 stay sutures (5-0 Prolene, rubber-shod) to lift the venotomy and arteriotomy open to avoid shearing off the intima and creating a false passage" — Charlie Stolar (clinical) [Ep 5 · 33:55](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2035) - "In the first hours on ECMO, hyperkalemia can cause cardiac arrest if blood isn't washed; just perfuse through it and give calcium" — Charlie Stolar (clinical) [Ep 5 · 34:47](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2087) - "ECMO flow must be increased slowly over 45-90 minutes to reduce intracranial hemorrhage incidence" — Charlie Stolar (clinical) [Ep 5 · 34:55](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2095) - "Target VA ECMO flow is 100-125 cc/kg/min, which is about 80% of cardiac output assuming an open duct" — Charlie Stolar (clinical) [Ep 5 · 35:10](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2110) - "At target ECMO flow, preductal saturation will be good and mixed venous (from venous drainage) will come up to 65-70%" — Charlie Stolar (clinical) [Ep 5 · 35:29](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2129) - "Regular cardiac echos during ECMO weaning are important to assess right heart function, dilation, tricuspid regurgitation, and pulmonary outflow tract jet" — Charlie Stolar (clinical) [Ep 5 · 36:12](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2172) - "The hyperoxia test (turning ventilator FiO2 up to 1.0) demonstrates if the baby can use their lungs; if PaO2 rises, it gives courage to begin weaning ECMO" — Charlie Stolar (clinical) [Ep 5 · 36:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2194) - "For babies unweanable from ECMO after 2+ weeks at high flow, ensure they are maximally dried out (bone dry, eyes sucked into head), making good urine, with good labs and chest X-ray before considering on-ECMO repair" — Charlie Stolar (clinical) [Ep 5 · 38:18](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2298) - "Repairing the hernia on ECMO is unusual to get you out of trouble; the problem is lung growth arrest at 14-15 weeks gestation, not that bowel is in the chest" — Charlie Stolar (clinical) [Ep 5 · 39:05](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2345) - "Heparin inhibits conversion of fibrinogen to fibrin, so only platelets (beat-up ones) are making clot; platelet thrombus lifespan is 48-72 hours" — Charlie Stolar (clinical) [Ep 5 · 40:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2440) - "If operating on ECMO, you have about 48-72 hours to decannulate before bleeding starts; operate when nearly weanable (20 cc/kg/min), expect 1 day of post-op deterioration, then 2-3 days to get off" — Charlie Stolar (clinical) [Ep 5 · 41:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2467) - "Operating off ECMO means the baby will get stiff post-operatively, pulmonary hypertension may relapse, and you risk needing a second ECMO run" — Charlie Stolar (clinical) [Ep 5 · 41:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2511) - "When operating on ECMO, load with Amicar preoperatively, do abdominal approach, use low threshold for patch to avoid tension, place Jackson-Pratt drain under patch, and place chest tube" — Charlie Stolar (clinical) [Ep 5 · 42:39](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2559) - "Futility on ECMO begins to rear its head after 2-3 weeks; it becomes easier to discuss withdrawal if there's been a CNS event like intracranial hemorrhage" — Charlie Stolar (clinical) [Ep 5 · 44:11](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2651) - "For non-ECMO babies, repair timing is when they're on minimal ventilator settings (FiO2 0.4, conventional settings), which typically takes 3-4 days" — Charlie Stolar (clinical) [Ep 5 · 45:42](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2742) - "Use the infant ventilator instead of anesthesia machine intraoperatively; infant anesthesia machines have high dead space and aren't very compliant" — Charlie Stolar (clinical) [Ep 5 · 46:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2767) - "Anesthesia can be all intravenous (muscle relaxants and narcotics); you don't need an anesthesia machine" — Charlie Stolar (clinical) [Ep 5 · 46:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2788) - "Pre-repair assessment includes pre/post-ductal gradient, echo showing RV not dilated, RV pressure no more than systemic (not super-systemic), acceptable tricuspid regurgitation, and acceptable pulmonary outflow tract acceleration times" — Charlie Stolar (clinical) [Ep 5 · 46:47](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2807) - "Perioperative antibiotics (typically ampicillin-gentamicin) are given because a patch may be placed in a newborn" — Charlie Stolar (clinical) [Ep 5 · 47:57](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2877) - "The thoracoscopic approach provides a gorgeous view and often the bowel reduces with chest insufflation, but only rock-stable kids are candidates because you're creating a tension pneumothorax in a potentially hypercapnic baby" — Charlie Stolar (clinical) [Ep 5 · 48:32](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2912) - "In Dr. Stolar's series of 35 thoracoscopic CDH repairs in stable babies, recurrence rate was about 25% in under a year; APSA outcomes committee meta-analysis reached similar conclusions" — Charlie Stolar (clinical) [Ep 5 · 49:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2977) - "Laparoscopic CDH repair is problematic because the scaphoid abdomen has loss of abdominal domain; insufflating just puts air up in the chest" — Charlie Stolar (opinion) [Ep 5 · 50:21](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3021) - "For open repair, key is adequate subcostal incision (not a small two-finger incision); rotate liver out of chest and abdomen to see the defect" — Charlie Stolar (clinical) [Ep 5 · 54:58](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3298) - "Critical repair points are all medial where structures with names are located; mobilize posterior leaflet by unrolling it like a window shade down to the body wall until you feel rib" — Charlie Stolar (clinical) [Ep 5 · 55:31](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3331) - "The medial repair is hardest because sometimes the esophagus or aorta hangs out with nothing to sew to; use an upside-down U-shaped pericardial flap rotated down to where the diaphragm would be to begin the repair" — Charlie Stolar (clinical) [Ep 5 · 56:11](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3371) - "Favor monofilament suture (like PDS) because it doesn't saw through tissue when pulled, unlike braided suture like Vicryl" — Charlie Stolar (opinion) [Ep 5 · 57:16](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3436) - "For patches, favor non-biologic material like 1mm Gore-Tex; laterally, anchor the patch to the ribs by getting a needle around the rib and into the patch" — Charlie Stolar (clinical) [Ep 5 · 57:59](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3479) - "Make the patch somewhat balloon-shaped with redundancy so the baby doesn't rip sutures out with a deep breath; over time it gets incorporated into fibrous tissue" — Charlie Stolar (clinical) [Ep 5 · 58:43](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3523) - "For thoracoscopic repair, use 3 ports (4mm camera with 30-degree lens, 3mm neonatal instruments), insufflation peak pressure 5-7 cm (no more), and reduce spleen last as it obturates the hole and keeps bowel in the belly" — Charlie Stolar (clinical) [Ep 5 · 60:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3623) - "Thoracoscopically, mobilizing the posterior leaflet is difficult because it's rolled into the abdomen and hard to see around the corner" — Charlie Stolar (clinical) [Ep 5 · 61:35](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3695) - "For thoracoscopic patch placement, use extracorporeal-intracorporeal suture technique: come from outside through skin around rib into patch and back out, tie externally, and bury the knot under the skin" — Charlie Stolar (clinical) [Ep 5 · 62:03](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3723) - "If you can see through the diaphragm (it's just pleura and peritoneum with no muscle), resect it back to something that looks like muscle; plication of see-through tissue will fail" — Charlie Stolar (clinical) [Ep 5 · 64:16](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3856) - "The ipsilateral lung is small and not as big as the pleural space; that's how God made this lung. You won't inflate the lung to fill the chest" — Charlie Stolar (clinical) [Ep 5 · 66:47](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4007) - "The pleural space will be obliterated either slowly by lung growth over 3-4 years or by filling with fluid; it's not a pneumothorax under pressure, it's pneumothorax ex vacuo" — Charlie Stolar (clinical) [Ep 5 · 67:01](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4021) - "Chest tube on water-seal suction will distort the mediastinum and precipitate a pulmonary hypertensive crisis; there's no reason to put in a chest tube unless there's active air leak or bleeding" — Charlie Stolar (clinical) [Ep 5 · 67:18](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4038) - "Typical stable post-op CDH baby will be unstable for about a day with increased ventilator requirements, then improve and get extubated in 4-5 days" — Charlie Stolar (clinical) [Ep 5 · 68:53](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4133) - "CDH is a field defect affecting the entire foregut from pharynx to ligament of Treitz; these kids have disordered motility throughout" — Charlie Stolar (clinical) [Ep 5 · 69:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4174) - "All CDH patients should have a GI series showing dilated, ectatic, abnormal esophagus; manometry and impedance show abnormal esophageal and gastric motility and emptying" — Charlie Stolar (clinical) [Ep 5 · 69:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4191) - "The foregut problem is not really reflux; calling it reflux has suckered surgeons into doing fundoplications and pyloroplasties that are basically torture" — Charlie Stolar (opinion) [Ep 5 · 70:09](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4209) - "CDH babies do well with continuous feedings slowly condensed to bolus; surgical intervention for foregut issues is unusual and should be approached as palliation" — Charlie Stolar (clinical) [Ep 5 · 70:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4228) - "Nissen fundoplication is a poor operation for CDH kids (like for esophageal atresia) because their motility is abnormal; if surgery is needed, use a partial wrap with gastrostomy and real drainage procedure (Jaboulay-Finney type, not Heineke-Mikulicz)" — Charlie Stolar (opinion) [Ep 5 · 70:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4240) - "Dr. Stolar's multidisciplinary CDH clinic follows 450-500 patients for life, addressing heart, lung, foregut, nutrition, neurodevelopmental, and axial skeleton issues that emerge over time" — Charlie Stolar (clinical) [Ep 5 · 72:11](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4331) - "Dr. Stolar has 4 CDH teenagers with Barrett's esophagitis; he recommends lifelong proton pump inhibitors and regular endoscopic surveillance" — Charlie Stolar (clinical) [Ep 5 · 73:18](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4398) - "CDH patients have increased incidence of attention deficit disorders and autism; early intervention for neuropsychiatric issues is recommended" — Charlie Stolar (clinical) [Ep 5 · 73:57](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4437) - "As a field defect, CDH causes asymmetric chest growth leading to pectus-like distortion; some patients need Nuss-type operations to rebuild chest wall" — Charlie Stolar (clinical) [Ep 5 · 74:09](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4449) - "Some CDH girls have no breast development on the hernia side as teenagers; combined Nuss operation and breast implant procedures have been performed" — Charlie Stolar (clinical) [Ep 5 · 74:29](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4469) - "CDH patients develop thoracolumbar scoliosis (not idiopathic scoliosis, as it's mostly in boys); early bracing programs help minimize this" — Charlie Stolar (clinical) [Ep 5 · 74:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4474) - "CDH recurrence is related to tension on tissues and tissue quality; it's a tough problem whether tissue-to-tissue or prosthetic repair" — Charlie Stolar (clinical) [Ep 5 · 75:16](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4516) - "Recurrence is more common with left-sided CDH than right because the liver plugs up the hole on the right" — Charlie Stolar (clinical) [Ep 5 · 77:35](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4655) - "For right-sided CDH, the most important consideration is determining where hepatic veins drain; not infrequently they enter directly into the right atrium, not the suprahepatic IVC" — Charlie Stolar (clinical) [Ep 5 · 77:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4671) - "If hepatic veins enter the right atrium directly, attempting to reduce the liver into the abdomen will cause a troublesome moment; you should not try to put that liver in the abdomen" — Charlie Stolar (clinical) [Ep 5 · 78:09](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4689) - "Hepatopulmonary fusion actually exists in right-sided CDH; the liver and lung are fused and cannot be separated surgically" — Charlie Stolar (clinical) [Ep 5 · 78:29](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4709) - "Most patients with hepatopulmonary fusion don't survive; they often have associated severe congenital heart disease and IVC interruption with azygous continuation" — Charlie Stolar (clinical) [Ep 5 · 79:11](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4751) - "For right-sided CDH, prep the baby for both thoracic and abdominal incisions; often need to be on both sides to figure out what's going on because the liver is in the way" — Charlie Stolar (clinical) [Ep 5 · 79:48](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4788) - "For right-sided CDH, can put a scope through an open thoracotomy to see around corners where the liver might come up against the heart" — Charlie Stolar (clinical) [Ep 5 · 80:12](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4812) - "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (clinical) [Ep 10 · 0:24](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=24) - "Tracheomalacia symptoms typically receded within 55 months in FETO-treated infants" — Carlos Colunga (clinical) [Ep 10 · 0:29](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=29) - "FETO-treated infants showed a larger trachea, approximately 31% wider" — Carlos Colunga (clinical) [Ep 10 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "37% of tracheally occluded cases retained metallic balloon components" — Carlos Colunga (clinical) [Ep 10 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "No significant complications were reported from retained metallic balloon components" — Carlos Colunga (clinical) [Ep 10 · 0:33](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=33) - "Tracheal occlusion is effective in promoting lung growth" — Carlos Colunga (clinical) [Ep 10 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "FETO is associated with a higher risk of tracheomalacia" — Carlos Colunga (clinical) [Ep 10 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "Most cases of FETO-associated tracheomalacia resolve and do not appear to have long-term effects" — Carlos Colunga (clinical) [Ep 10 · 0:46](https://qa.library.globalcastmd.com/watch/tracheomalacia-and-tracheomegaly-in-infants-and-children-with-congenital-diaphragmatic-hernia-managed-with-and-without-fetoscopic-endoluminal-tracheal-occlusion-a-multicentre-retrospective-cohort-study-9334?t=46) - "A Columbia paper showed high recurrence rates with MIS CDH repair, creating resistance to the approach" — Wolfan (host_summary) [Ep 1 · 1:11](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=71) - "For stable CDH patients not on ECMO, waiting 24-48 hours allows transitional circulation to stabilize and provides ventilator reserve before repair" — Ron (clinical) [Ep 1 · 2:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=169) - "Bowel distention in unreduced CDH compromises pulmonary and cardiac function over time, favoring earlier repair" (clinical) [Ep 1 · 3:40](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=220) - "Echocardiography to assess pulmonary hypertension guides timing of CDH repair" — David (clinical) [Ep 1 · 3:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=233) - "Charlie Stoller showed approximately 30% recurrence rate with thoracoscopic CDH repair" — Ron (host_summary) [Ep 1 · 6:36](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=396) - "Recurrence rates improve with surgical experience and technique refinement in thoracoscopic CDH repair" — Ron (opinion) [Ep 1 · 6:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=409) - "Surgeons may unconsciously avoid placing adequate sutures in MIS repair if knot-tying is time-consuming, contributing to recurrence" — Wolfan (opinion) [Ep 1 · 9:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=589) - "Cauterizing the edge of the CDH defect promotes inflammation and healing, similar to unfolding the posterior leaflet in open repair" — Wolfan (clinical) [Ep 1 · 10:17](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=617) - "Excessive tension during thoracoscopic CDH closure can create an overly flat diaphragm, though Avi Schleger's work suggests post-op bowing may not significantly affect outcomes" — Wolfan (clinical) [Ep 1 · 10:49](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=649) - "Using buttress material reduces recurrence rates in CDH repair, per data from Rusty and Craig's institution" — Wolfan (host_summary) [Ep 1 · 12:31](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=751) - "Liberal use of absorbable mesh as underlay beneath primary repair reduces CDH recurrence" — Wolfan (clinical) [Ep 1 · 12:48](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=768) - "MIS approach to CDH repair greatly reduces small bowel obstruction compared to laparotomy" — Wolfan (clinical) [Ep 1 · 22:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1373) - "In the speaker's series, MIS and open CDH repairs showed similar recurrence rates, with patch use being a major factor" — Wolfan (epidemiological) [Ep 1 · 23:24](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1404) - "For CDH with agenesis or near-agenesis (type C or D defects), open repair is preferred due to complexity and proximity to esophagus" — Wolfan (clinical) [Ep 1 · 23:53](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1433) - "Severe CDH patients (O-to-E ratios 25% or below) often have small left ventricles causing hemodynamic problems in addition to pulmonary issues" — Ron (clinical) [Ep 1 · 25:35](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1535) - "VV ECMO may not work well in CDH patients with small left ventricles; VA ECMO is preferred in those cases" — Ron (clinical) [Ep 1 · 26:02](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1562) - "Inhaled nitric oxide (iNO) should not be trialed before ECMO in severe CDH; data show it does not work pre-ECMO" — Ron (clinical) [Ep 1 · 26:20](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1580) - "After birth, severe CDH patients may initially have high CO2 that falls over the first couple hours; this response guides ECMO cannulation timing" — Ron (clinical) [Ep 1 · 26:51](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1611) - "A recent Pediatric Surgery International paper showed low rates of return to ECMO and death following CDH repair, not justifying routine repair on ECMO" — Wolfan (host_summary) [Ep 1 · 29:43](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1783) - "Timing of CDH repair has no real influence on ultimate survival" — Wolfan (host_summary) [Ep 1 · 30:08](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1808) - "David Kays in Saint Petersburg achieves 100% survival in CDH (last 75 patients, all comers including preemies and heart disease), with 80% requiring ECMO and all repaired immediately on ECMO" (host_summary) [Ep 1 · 31:19](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1879) - "David Kays switched to using bivalirudin for ECMO anticoagulation and reports decreased bleeding rates with immediate CDH repair on ECMO" — Ron (host_summary) [Ep 1 · 32:34](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1954) - "When repairing CDH on ECMO, leaving the abdomen open or using a silo prevents compromised pulmonary compliance from increased intra-abdominal pressure" — Ron (clinical) [Ep 1 · 34:21](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2061) - "Transversalis muscle flap repair for CDH shows very low recurrence rates but results in abdominal wall bulge" — Wolfan (clinical) [Ep 1 · 36:41](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2201) - "Overall mortality for any CDH patient requiring ECMO is approximately 50%" — Ron (epidemiological) [Ep 1 · 37:34](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2254) - "Midgut volvulus after CDH repair is surprisingly low in incidence; routine Ladd's procedure is not performed" — Wolfan (epidemiological) [Ep 1 · 38:33](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2313) - "Indications for the FETO trial (fetal tracheal occlusion) are liver herniation and lung-to-head ratio (LHR) greater than 0.9" — Wolfan (guideline) [Ep 1 · 41:18](https://qa.library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2478) - "Gastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time." — Rod Gerardo (host_summary) [Ep 9 · 1:18](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78) - "Gastric volvulus is associated with eventration of the diaphragm about 25% of the time." — Rod Gerardo (host_summary) [Ep 9 · 1:18](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=78) - "60% of gastric volvulus cases in the pediatric population happen in the first year of life, with about 21% in the first month." — Jason Frischer (epidemiological) [Ep 9 · 1:33](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=93) - "In a 4-month-old child with gastric volvulus, acute presentation is more likely than chronic." — Jason Frischer (clinical) [Ep 9 · 1:58](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=118) - "Acute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia." — Rod Gerardo (host_summary) [Ep 9 · 2:13](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=133) - "Key presentation findings in gastric volvulus include a weird looking fixed bubble in the chest that cannot be decompressed and inability to advance the NG tube." — Beth Rymeski (clinical) [Ep 9 · 2:38](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=158) - "A little bit of bloody aspirate from the NG tube and a funny looking stomach bubble on X-ray are key findings in gastric volvulus." — Jason Frischer (clinical) [Ep 9 · 2:47](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=167) - "Chronic gastric volvulus is more related to laxity of the gastric ligaments including gastrophrenic, gastrosplenic, gastrocolic, and gastrohepatic ligaments." — Jason Frischer (clinical) [Ep 9 · 3:10](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=190) - "Without ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points." — Rod Gerardo (host_summary) [Ep 9 · 3:27](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=207) - "Organoaxial volvulus is the first and most common type of gastric volvulus." — Jason Frischer (clinical) [Ep 9 · 3:43](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=223) - "In organoaxial volvulus, the stomach spins around an axis drawn between the GE junction and the pylorus, with the greater curvature flipping up and over to become more superior than the lesser curvature." — Jason Frischer (clinical) [Ep 9 · 3:55](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=235) - "In mesenteroaxial volvulus, rotation occurs around a line through the middle of the stomach from lesser to greater curvature, with the stomach flipping behind and back over." — Jason Frischer (clinical) [Ep 9 · 4:18](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=258) - "In gastric volvulus, when filled with contrast, the pylorus appears right next to or near the GE junction and above the body of the stomach." — Jason Frischer (clinical) [Ep 9 · 4:46](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=286) - "Gastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube." — Rod Gerardo (host_summary) [Ep 9 · 4:58](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=298) - "On upper GI contrast study in gastric volvulus, contrast probably does not go past the stomach if it makes it into the stomach." — Ellen Encisco (clinical) [Ep 9 · 5:32](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=332) - "A classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus." — Rod Gerardo (host_summary) [Ep 9 · 5:41](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=341) - "In organoaxial volvulus, if contrast gets past the GE junction into the stomach, the greater curvature appears flipped up." — Ellen Encisco (clinical) [Ep 9 · 5:53](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=353) - "In mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction because the pylorus has flipped up and over or behind and over the top of the stomach." — Jason Frischer (clinical) [Ep 9 · 6:08](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=368) - "Surgical management of gastric volvulus should be attempted laparoscopically, with the first step being to bring the stomach down from the chest if herniated." — Carolina Pinzon Guzman (clinical) [Ep 9 · 7:09](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=429) - "G-tube placement is used to pexy the stomach to the abdominal wall to prevent recurrent twisting in gastric volvulus." — Carolina Pinzon Guzman (clinical) [Ep 9 · 7:26](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=446) - "Gastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization." — Rod Gerardo (host_summary) [Ep 9 · 7:34](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=454) - "Fundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases." — Rod Gerardo (host_summary) [Ep 9 · 7:47](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=467) - "When managing gastric volvulus found during CDH repair, viability of the stomach must always be checked, especially if chronically volvulized or volvulized for a couple of days, by looking at the serosa and blood flow." — Jason Frischer (clinical) [Ep 9 · 8:40](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=520) - "In acute gastric volvulus with sudden onset of symptoms, initial management includes securing two good points of IV access and managing the ABCs before proceeding to imaging or surgery." — Chris Pastor (clinical) [Ep 9 · 9:38](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=578) - "In an acutely ill infant with suspected gastric volvulus, an urgent upper GI should be obtained while resuscitating, as malrotation is more common and must be differentiated from gastric volvulus." — Chris Pastor (clinical) [Ep 9 · 10:08](https://qa.library.globalcastmd.com/watch/neonatal-gastric-volvulus-with-dr-jason-frischer-5494?t=608) - "CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies managed by community obstetricians." — Charlie Stolar (epidemiological) [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=165) - "CDH diagnosis is usually made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart." — Charlie Stolar (clinical) [Ep 3 · 3:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=217) - "CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side." — Charlie Stolar (clinical) [Ep 3 · 4:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=254) - "At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation." — Charlie Stolar (clinical) [Ep 3 · 4:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=263) - "CDH is a medical physiologic emergency, not a surgical emergency." — Charlie Stolar (clinical) [Ep 3 · 5:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=300) - "The diagnosis of CDH alone is not an indication for cesarean section." — Charlie Stolar (guideline) [Ep 3 · 5:24](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=324) - "Antenatal interventions for CDH are no better than investigational and experimental at best." — Charlie Stolar (opinion) [Ep 3 · 6:35](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=395) - "Babies with CDH should be born at a full-service children's facility with ECMO capability." — Charlie Stolar (guideline) [Ep 3 · 7:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=443) - "Maybe 10-15% of babies diagnosed with CDH will benefit from ECMO." — Charlie Stolar (epidemiological) [Ep 3 · 7:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=454) - "In single-center experiences, presence of liver in the chest is of no prognostic value for CDH." — Charlie Stolar (clinical) [Ep 3 · 8:31](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=511) - "Lung-to-head ratio (LHR) is of limited prognostic value except when very low (less than 0.8)." — Charlie Stolar (clinical) [Ep 3 · 8:42](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=522) - "Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis in CDH." — Charlie Stolar (clinical) [Ep 3 · 9:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=547) - "If shown 100 children with CDH, 80-85% will survive to become teenagers." — Charlie Stolar (epidemiological) [Ep 3 · 10:13](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=613) - "Steroids have tremendous value for preterm labor under 35 weeks but their role in near-term CDH babies (37-39 weeks) is arguable." — Charlie Stolar (clinical) [Ep 3 · 10:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=637) - "Exit-to-ECMO for CDH is essentially moving the goalposts and deck chairs around on the Titanic for non-viable babies." — Charlie Stolar (opinion) [Ep 3 · 12:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=726) - "We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth." — Charlie Stolar (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=780) - "All therapy for CDH should be guided by preductal oximetry, not postductal, because all babies have some degree of pulmonary hypertension with shunting." — Charlie Stolar (guideline) [Ep 3 · 19:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1146) - "If preductal saturation is 90% (PaO2 of 65 torr), the brain is doing fine because this is fetal hemoglobin." — Charlie Stolar (clinical) [Ep 3 · 19:32](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1172) - "Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today because they trash lungs in a heartbeat." — Charlie Stolar (opinion) [Ep 3 · 21:38](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1298) - "CDH babies should not be paralyzed and should have minimal sedation to maintain spontaneous breathing." — Charlie Stolar (guideline) [Ep 3 · 21:56](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1316) - "Most CDH babies don't tolerate conventional ventilator settings (rate 40, peak pressure 25-28, PEEP 5) and require unconventional high-rate (100 breaths/min) low-pressure ventilation." — Charlie Stolar (clinical) [Ep 3 · 22:15](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1335) - "High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO." — Charlie Stolar (clinical) [Ep 3 · 24:38](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1478) - "Nitric oxide is a waste of money for CDH babies; meta-analyses show it's terrific for premature babies with immature lung disease but of no value in CDH." — Charlie Stolar (clinical) [Ep 3 · 25:45](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1545) - "The best drug for CDH is oxygen." — Charlie Stolar (opinion) [Ep 3 · 26:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1567) - "ECMO should not be used in babies under 36 weeks gestational age initially, though this has been pushed down to 35 weeks, maybe 34 weeks, with intracranial hemorrhage rates taking off below 32 weeks." — Charlie Stolar (guideline) [Ep 3 · 26:22](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1582) - "The smallest ECMO arterial perfusion cannula available is about 8 French, and resistance is related to both length and diameter, making adequate flow difficult in very small babies." — Charlie Stolar (clinical) [Ep 3 · 27:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1660) - "For ECMO candidacy, the real risk for intracranial hemorrhage is the germinal matrix, which is usually OK by 35-36 weeks gestation, so it's gestational age that matters, not size." — Charlie Stolar (clinical) [Ep 3 · 28:15](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1695) - "The broad principle for ECMO candidacy is whether you can get out of ECMO with reasonable confidence if you get in—don't start something you can't finish." — Charlie Stolar (guideline) [Ep 3 · 29:10](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1750) - "VV ECMO is terrific if the heart works, but in CDH the heart function is often depressed and it's hard to get the cannula in with the shifted mediastinum." — Charlie Stolar (clinical) [Ep 3 · 30:27](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1827) - "VA bypass is essentially dialing in a PaO2, while VV ECMO is much more annoying with mixing, cannula position issues, and CDH babies are generally too unstable for VV." — Charlie Stolar (opinion) [Ep 3 · 31:53](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1913) - "Echo guidance during ECMO cannulation is really helpful to prevent driving the arterial cannula out the subclavian artery or the venous cannula into the innominate vein." — Charlie Stolar (clinical) [Ep 3 · 32:17](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1937) - "If the arterial cannula goes out the subclavian artery, you'll have a very well-perfused hand and think preductal sats look good, but the baby isn't seeing the oxygen." — Charlie Stolar (clinical) [Ep 3 · 33:01](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1981) - "The first few hours on ECMO can be unstable; hyperkalemia cardiac arrest can occur if blood isn't washed, but you just perfuse through it and give calcium." — Charlie Stolar (clinical) [Ep 3 · 34:19](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2059) - "ECMO flow should be slowly increased over 45 minutes to 1.5 hours to about 100-125 cc/kg/min (about 80% of cardiac output) to reduce intracranial hemorrhage incidence." — Charlie Stolar (guideline) [Ep 3 · 34:55](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2095) - "The hyperoxia test—turning FIO2 up to 1.0 on the ventilator while on ECMO—gives courage to begin weaning if the PaO2 rises, showing the baby can use their lungs." — Charlie Stolar (clinical) [Ep 3 · 36:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2194) - "For babies stuck on ECMO at 2 weeks, ensure they are maximally dried out (bone dry, eyes sucked into back of head, turned into a prune) before considering on-ECMO repair." — Charlie Stolar (guideline) [Ep 3 · 38:18](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2298) - "The problem in CDH is not that bowel is in the chest; the problem is growth arrest of the lungs that happened at 14-15 weeks gestation. Getting bowel out of the chest is not miraculous." — Charlie Stolar (clinical) [Ep 3 · 39:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2354) - "Heparin inhibits conversion of fibrinogen to fibrin, so only platelets (beat-up ones) make clot on ECMO. A platelet thrombus lasts 48-72 hours, giving a window to operate and get off ECMO before bleeding starts." — Charlie Stolar (clinical) [Ep 3 · 40:37](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2437) - "Preferred approach is to wean ECMO down to 20 cc/kg/min, do the operation, accept 1 day of post-op edema, then have 2-3 days to get off ECMO before bleeding starts." — Charlie Stolar (guideline) [Ep 3 · 41:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2474) - "If you take a baby off ECMO then operate, every patient gets stiff after surgery, pulmonary hypertension relapses, and you're talking about a second ECMO run." — Charlie Stolar (clinical) [Ep 3 · 41:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2511) - "When operating on ECMO, load with Amicar preoperatively, do it as an abdominal operation, use a patch with low threshold to avoid tension, place a Jackson-Pratt drain under the patch, and place a chest tube." — Charlie Stolar (guideline) [Ep 3 · 42:39](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2559) - "Futility on ECMO starts to rear its head after about 2-3 weeks." — Charlie Stolar (opinion) [Ep 3 · 44:14](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2654) - "The typical stable CDH baby not requiring ECMO takes 3-4 days to wean to minimal ventilator settings (FIO2 0.4, conventional settings) before repair." — Charlie Stolar (clinical) [Ep 3 · 45:42](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2742) - "Use the infant ventilator instead of an anesthesia machine intraoperatively because infant anesthesia machines have high dead space and are not very compliant." — Charlie Stolar (guideline) [Ep 3 · 46:07](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2767) - "For repair timing, three variables matter: pre/post-ductal gradient on pulse ox, right ventricle dilation on echo, and RV pressure versus LV pressure (RV should be no more than systemic)." — Charlie Stolar (guideline) [Ep 3 · 46:47](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2807) - "The thoracoscopic approach for CDH is gorgeous with a sparkling view, but the recurrence rate is really high—about 25% in under a year in Dr. Stolar's series of 35 stable kids." — Charlie Stolar (clinical) [Ep 3 · 48:32](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2912) - "The APSA outcomes committee meta-analysis came to a very similar conclusion about high thoracoscopic CDH recurrence rates." — Charlie Stolar (clinical) [Ep 3 · 50:02](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3002) - "For open CDH repair, need a real subcostal incision (not a small two-finger incision), rotate the liver out of chest and abdomen, eviscerate bowel, and mobilize the posterior leaflet like unrolling a window shade down to rib." — Charlie Stolar (guideline) [Ep 3 · 55:02](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3302) - "The medial part of CDH repair is hardest because sometimes the esophagus or aorta is hanging out with nothing to sew to." — Charlie Stolar (clinical) [Ep 3 · 56:06](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3366) - "When there's no diaphragm to sew to medially, make an upside-down U-shaped incision on the pericardium and rotate that down to where the diaphragm would be to begin the repair." — Charlie Stolar (guideline) [Ep 3 · 56:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3388) - "Favor monofilament suture (like PDS) because it doesn't saw through tissue when pulled, unlike Vicryl which saws tissue." — Charlie Stolar (opinion) [Ep 3 · 57:16](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3436) - "Favor non-biologic material like 1mm Gore-Tex for patches, and anchor the patch to the ribs laterally by getting a needle around the rib." — Charlie Stolar (guideline) [Ep 3 · 57:59](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3479) - "Make the patch somewhat balloon-shaped with redundancy so the baby doesn't rip sutures out taking a deep breath; over time it gets incorporated into fibrous tissue." — Charlie Stolar (guideline) [Ep 3 · 58:43](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3523) - "For thoracoscopic CDH repair, use 3 ports (4mm camera with 30-degree lens, 3mm neonatal instruments), insufflation peak pressure 5-7 cm (no more), and put solid organs (spleen or left liver lobe) in last to plug the hole and keep bowel down." — Charlie Stolar (guideline) [Ep 3 · 60:23](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3623) - "There is no indication for a chest tube in CDH except for active air leak or anticipated/active bleeding. The ipsilateral lung is small and won't fill the pleural space—that's how God made this lung." — Charlie Stolar (guideline) [Ep 3 · 66:47](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4007) - "A pneumothorax in CDH is a pneumothorax ex vacuo, not air under pressure. Putting in a chest tube on water seal suction will just distort the mediastinum and precipitate a pulmonary hypertensive crisis." — Charlie Stolar (clinical) [Ep 3 · 67:13](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4033) - "The typical stable CDH baby will be crummy for about a day postoperatively, then get better and be extubated in 4-5 days and go home." — Charlie Stolar (clinical) [Ep 3 · 68:54](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4134) - "CDH is a field defect affecting the whole foregut from pharynx to ligament of Treitz. Everything—esophagus, stomach, gastric emptying—has abnormal motility." — Charlie Stolar (clinical) [Ep 3 · 69:39](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4179) - "If you do a GI series on CDH kids, the esophagus will be very dilated, ectatic, and abnormal-looking. Manometry and impedance manometry are abnormal." — Charlie Stolar (clinical) [Ep 3 · 69:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4191) - "It's not really reflux in CDH—calling it reflux has suckered surgeons into doing fundoplications and pyloroplasties that are basically torture." — Charlie Stolar (opinion) [Ep 3 · 70:09](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4209) - "CDH kids generally do well with continuous feedings slowly condensed to bolus. It's unusual to need surgical intervention for foregut dysmotility." — Charlie Stolar (clinical) [Ep 3 · 70:28](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4228) - "When surgery is needed for CDH foregut dysmotility, approach it as palliation: some sort of fundoplication (not Nissen—it's fully competent on an abnormal-motility esophagus), combined with gastrostomy and a real drainage procedure like Jaboulay-Finney, not Heineke-Mikulicz." — Charlie Stolar (guideline) [Ep 3 · 70:36](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4236) - "Dr. Stolar has 4 CDH teenagers with Barrett's esophagitis and now recommends lifelong proton pump inhibitors and regular scoping for all CDH patients." — Charlie Stolar (clinical) [Ep 3 · 73:18](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4398) - "Dr. Stolar's 1989-1990 paper showed most CDH kids turn out OK unless the mother had an 8th grade education and the child is a boy." — Charlie Stolar (clinical) [Ep 3 · 73:46](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4426) - "There is an incidence of attention deficit disorders and autism in CDH survivors, prompting early intervention for neuropsychiatric issues." — Charlie Stolar (clinical) [Ep 3 · 73:58](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4438) - "Because CDH is a field defect, there's asymmetric chest growth leading to pectus-like distorted chest wall growth requiring Nuss-type operations in some patients." — Charlie Stolar (clinical) [Ep 3 · 74:09](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4449) - "Some CDH girls as teenagers have no breast development on the side of the hernia, requiring Nuss operation and breast implant." — Charlie Stolar (clinical) [Ep 3 · 74:20](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4460) - "CDH patients can develop non-idiopathic scoliosis (mostly in boys, not the typical idiopathic scoliosis in girls), requiring early bracing to minimize thoracolumbar scoliosis." — Charlie Stolar (clinical) [Ep 3 · 74:34](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4474) - "If you can see through the diaphragm tissue (it's nothing but pleura and peritoneum), resect it back to muscle for a fresh edge to sew together, or the plication will fail." — Charlie Stolar (guideline) [Ep 3 · 64:16](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3856) - "For right-sided CDH, the most important consideration is to ask echocardiographers where the hepatic veins drain, because they often enter directly into the right atrium, not the suprahepatic cava." — Charlie Stolar (guideline) [Ep 3 · 77:51](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4671) - "Hepatopulmonary fusion actually exists in right-sided CDH. The liver and lung are fused and cannot be separated surgically. Most of these patients don't survive and often have severe congenital heart disease and IVC discontinuation." — Charlie Stolar (clinical) [Ep 3 · 78:36](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4716) - "For right-sided CDH, prep the baby for both thoracic and abdominal incisions because you often need to be on both sides. Start in the abdomen, but if the liver is in the way, make a counter-incision in the chest." — Charlie Stolar (guideline) [Ep 3 · 79:48](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4788) - "Even with an open thoracotomy, you can put a scope in to see around a corner without ugly retractors." — Charlie Stolar (guideline) [Ep 3 · 80:12](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4812) - "Congenital diaphragmatic hernia occurs in 10-20% of monochorionic twin pregnancies and is responsible for large amounts of perinatal mortality and morbidity, with 80-100% mortality if untreated in the past." — Jan Deprest (epidemiological) [Ep 4 · 0:45](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=45) - "Patient selection for FETO is based on lung-to-head ratio (LHR) corrected for gestational age (observed/expected) and presence of liver herniation, with severe hypoplasia defined as maximum 20% survival, moderate 50%, and mild 85% survival." — Jan Deprest (clinical) [Ep 4 · 1:20](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=80) - "External validation from Children's Hospital Philadelphia (2006-2010 cohort) and Toronto confirmed that outcomes remain dependent on lung-to-head ratio and these selection criteria are still valid." — Jan Deprest (host_summary) [Ep 4 · 2:36](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=156) - "The FETO procedure is done at 26-28 weeks (now 29 weeks in updated protocol) under local anesthesia with fetal analgesia and immobilization, lasting 6-10 minutes on average when fetal position is favorable." — Jan Deprest (clinical) [Ep 4 · 3:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=199) - "The median gestational age at birth after FETO was 35 weeks, similar to open fetal surgery, with 20-22% experiencing ruptured membranes by 34 weeks." — Jan Deprest (clinical) [Ep 4 · 8:32](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=512) - "Balloon removal in utero at least 24 hours prior to birth is associated with better survival and early morbidity compared to removal at delivery." — Jan Deprest (clinical) [Ep 4 · 11:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=679) - "FETO increased survival from around 0% to 20% in the smallest lung group and by 30-35% on average in the severe hypoplasia group compared to historical controls." — Jan Deprest (clinical) [Ep 4 · 12:42](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=762) - "Independent predictors of survival after FETO are initial lung size prior to operation, gestational age at delivery, and ability to remove balloon in utero at least 24 hours before birth." — Jan Deprest (clinical) [Ep 4 · 13:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=824) - "Even with delivery prior to 32 weeks after FETO, survival rate is as high as predicted at term without fetal therapy; for delivery at 32 weeks or later, survival is 60%, which doesn't increase beyond 34 weeks." — Jan Deprest (clinical) [Ep 4 · 14:37](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=877) - "There is an apparent decrease in bronchopulmonary dysplasia after FETO, with no evidence of substituting mortality by morbidity based on oxygen need, ventilator days, time to full enteral feeding, and NICU days." — Jan Deprest (clinical) [Ep 4 · 15:50](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=950) - "The TOTAL trial in Europe compares tracheal occlusion at 27-29 weeks to expectant management, with survival as primary outcome in severe cases and survival without BPD in moderate cases." — Jan Deprest (clinical) [Ep 4 · 16:41](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1001) - "Centers offering FETO must have an active fetoscopy program (minimum 36 interventions per year or 3 per month), experience with 15 balloon occlusion cases (at least 5 done locally), and 24-hour balloon removal capability." — Jan Deprest (guideline) [Ep 4 · 19:45](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1185) - "In the moderate TTTS trial, 54 cases have been recruited beyond the first interim analysis, with all participating centers agreeing not to offer fetal therapy outside the trial." — Jan Deprest (clinical) [Ep 4 · 25:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1505) - "The severe FETO trial has been hampered by too long offering the procedure outside trial settings while trying to optimize technique, though the last 100 cases showed no improvement in outcomes." — Jan Deprest (opinion) [Ep 4 · 25:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1544) - "Ruben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient." — Todd Ponsky (clinical) [Ep 4 · 86:57](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5217) - "Only 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve." — Todd Ponsky (epidemiological) [Ep 4 · 89:21](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5361) - "Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow." — Todd Ponsky (host_summary) [Ep 4 · 90:22](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5422) - "The recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues." — Todd Ponsky (clinical) [Ep 4 · 92:14](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5534) - "Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction." — Todd Ponsky (host_summary) [Ep 4 · 102:07](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6127) - "High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks." — Todd Ponsky (host_summary) [Ep 4 · 103:26](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6206) - "Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser." — Todd Ponsky (host_summary) [Ep 4 · 104:15](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6255) - "CHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal." — Todd Ponsky (clinical) [Ep 4 · 105:01](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6301) - "CHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature." — Todd Ponsky (clinical) [Ep 4 · 110:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6600) - "Diode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP." — Todd Ponsky (clinical) [Ep 4 · 107:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6425) - "Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin)." — Todd Ponsky (host_summary) [Ep 4 · 128:56](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7736) - "Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions." — Todd Ponsky (host_summary) [Ep 4 · 131:00](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7860) - "With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin." — Todd Ponsky (host_summary) [Ep 4 · 136:04](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8164) - "Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups." — Todd Ponsky (host_summary) [Ep 4 · 136:36](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8196) - "CHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion." — Todd Ponsky (clinical) [Ep 4 · 141:19](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8479) - "In Type 3 sIUGR, after laser photocoagulation to separate circulations, the smaller twin dies in 75% of cases within 48 hours because it was surviving on blood from the normal twin." — Eduardo Gratacos (clinical) [Ep 4 · 146:21](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8781) - "The CDH study group collected patient data from 2015 to 2018 in a retrospective review of prospectively collected data examining cardiac dysfunction within the first 48 hours of life." — Vic (host_summary) [Ep 6 · 4:31](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=271) - "Among all CDH patients in the study period, 39% had some evidence of cardiac dysfunction on their first echocardiogram in the first 48 hours of life." — Vic (host_summary) [Ep 6 · 5:19](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=319) - "Patients with normal cardiac function had a survival of over 80% on adjusted analysis." — Vic (host_summary) [Ep 6 · 5:36](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=336) - "Patients with right ventricular dysfunction only had a survival of 74%." — Vic (host_summary) [Ep 6 · 5:42](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342) - "Patients with left ventricular dysfunction had a survival of 57%." — Vic (host_summary) [Ep 6 · 5:46](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=346) - "Patients with biventricular dysfunction had a survival of 50%, the worst risk profile." — Vic (host_summary) [Ep 6 · 5:50](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=350) - "Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality in CDH." — Vic (host_summary) [Ep 6 · 6:01](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=361) - "The CDH study group does not prescribe standardized management protocols; they allow institutions to report cardiac dysfunction as yes/no and specify whether it is systolic or diastolic." — Vic (clinical) [Ep 6 · 7:01](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=421) - "Pulmonary hypertension is a predictor of mortality for CDH infants." — Vic (clinical) [Ep 6 · 7:30](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=450) - "In CDH with pulmonary hypertension, you can see decreased right ventricular ejection, which can lead to bowing of the septum into the left ventricle, resulting in decreased ventricular volumes and decreased ejection." — Vic (clinical) [Ep 6 · 7:35](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=455) - "The standardized post-operative protocol for Nuss pectus repair included scheduled anti-emetics, epidural pain control discontinued on post-op day 2, early Foley removal, and encouraged ambulation." — Joe La Hillier (host_summary) [Ep 6 · 11:31](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=691) - "The standardized protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days." — Joe La Hillier (host_summary) [Ep 6 · 12:06](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=726) - "There were zero readmissions out of 164 patients in the Nuss pectus repair standardization study." — Joe La Hillier (host_summary) [Ep 6 · 12:15](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=735) - "The Cincinnati Children's pectus protocol did not use cryotherapy for pain control in any patients." — Joe La Hillier (host_summary) [Ep 6 · 13:57](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=837) - "The Cincinnati authors acknowledged studies showing cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy, yet expressed reservations due to lack of long-term outcomes data." — Joe La Hillier (host_summary) [Ep 6 · 14:29](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=869) - "Cryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results." — Todd Ponsky (opinion) [Ep 6 · 14:53](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=893) - "Protocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study." — Todd Ponsky (opinion) [Ep 6 · 15:06](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=906) - "It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH." — Fung Lim (clinical) [Ep 7 · 1:29](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=89) - "Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus." — Rod Gerardo (host_summary) [Ep 7 · 1:40](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=100) - "MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH." — Rod Gerardo (host_summary) [Ep 7 · 1:48](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=108) - "In mild diaphragmatic hernia, the left lung starts to shrink in size." — Fung Lim (clinical) [Ep 7 · 2:05](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=125) - "In moderate diaphragmatic hernia, the left lung gets smaller as the intestines and part of the liver push upwards." — Fung Lim (clinical) [Ep 7 · 2:11](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=131) - "In the most severe CDH cases, the liver occupies a good portion of the chest, the left lung is very small, and even the right lung is shrinking." — Fung Lim (clinical) [Ep 7 · 2:24](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=144) - "Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO." — Rod Gerardo (host_summary) [Ep 7 · 2:35](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=155) - "The tracheal occlusion procedure is commonly performed at gestational age between 27 weeks and 29 weeks 6 days." — Fung Lim (guideline) [Ep 7 · 2:44](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=164) - "Anesthesia for FETO is induced by ultrasound guidance with local anesthetic and numbing medication injected into the mother." — Fung Lim (clinical) [Ep 7 · 2:53](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=173) - "An introducer is inserted into the amniotic space to allow placement of a fetoscope (small camera) through the introducer into the amniotic space." — Fung Lim (clinical) [Ep 7 · 3:04](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=184) - "The fetoscope is advanced carefully into the fetal trachea once the baby's mouth is located." — Fung Lim (clinical) [Ep 7 · 3:16](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=196) - "The ideal position for the fetoscope in FETO is in the main trachea below the vocal cords but above the carina, before the trachea splits into the two main bronchi." — Fung Lim (clinical) [Ep 7 · 3:27](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=207) - "A balloon is inserted into the fetal airway, inflated to completely occlude the trachea, then detached and left in place." — Fung Lim (clinical) [Ep 7 · 3:38](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=218) - "Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop." — Rod Gerardo (host_summary) [Ep 7 · 3:48](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=228) - "The balloon is left in place for a few weeks to accelerate lung growth." — Fung Lim (clinical) [Ep 7 · 4:12](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=252) - "The balloon is typically removed at about 34 weeks gestation." — Rod Gerardo (host_summary) [Ep 7 · 4:18](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=258) - "If the baby is in proper position, the balloon can be punctured under ultrasound guidance." — Fung Lim (clinical) [Ep 7 · 4:26](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=266) - "The deflated balloon is pushed out of the baby's trachea by lung fluids and poses no risk to the baby's health." — Fung Lim (clinical) [Ep 7 · 4:33](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=273) - "If the baby's position does not allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, and the deflated balloon is then removed from the airway using the grasper." — Fung Lim (clinical) [Ep 7 · 4:40](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=280) - "After balloon removal, the mother and fetus are monitored carefully for the remainder of the pregnancy." — Fung Lim (guideline) [Ep 7 · 4:56](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=296) - "Ideally, the baby is delivered vaginally at term, with cesarean section reserved for the usual obstetrical reasons." — Fung Lim (guideline) [Ep 7 · 5:02](https://qa.library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=302) - "Meta-analysis by Shibuya et al. included 709 patients from 15 research studies across multiple international centers comparing thoracoscopic versus open repair for congenital diaphragmatic hernia." — Lizzie Lee (host_summary) [Ep 12 · 1:03](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=63) - "Thoracoscopic repair for congenital diaphragmatic hernia has higher recurrence rates compared to open repair." — Lizzie Lee (host_summary) [Ep 12 · 1:18](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78) - "Thoracoscopic repair for congenital diaphragmatic hernia has longer operative times compared to open repair." — Lizzie Lee (host_summary) [Ep 12 · 1:18](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=78) - "Thoracoscopic repair for congenital diaphragmatic hernia has a lower incidence of postoperative bowel obstruction compared to open repair." — Lizzie Lee (host_summary) [Ep 12 · 1:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=85) - "Ziegler et al. prospective study included 10 patients with giant omphalocele and 6 with complicated gastroschisis using a traction-assisted abdominal wall closure device (Fascia Tense Pediatric)." — Alex Halpern (host_summary) [Ep 12 · 1:58](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=118) - "Complete fascial closure was achieved after a median of 7 days in children with giant omphalocele using the Fascia Tense Pediatric device." — Alex Halpern (host_summary) [Ep 12 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133) - "Complete fascial closure was achieved after a median of 5 days in children with complicated gastroschisis using the Fascia Tense Pediatric device." — Alex Halpern (host_summary) [Ep 12 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=133) - "No patients developed abdominal compartment syndrome after traction-assisted closure with Fascia Tense Pediatric." — Alex Halpern (host_summary) [Ep 12 · 2:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143) - "No ventral hernias occurred after a median follow-up of 12 months in patients who underwent traction-assisted closure with Fascia Tense Pediatric." — Alex Halpern (host_summary) [Ep 12 · 2:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=143) - "Esposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two)." — Cecilia Gigena (host_summary) [Ep 12 · 3:01](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=181) - "Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG." — Cecilia Gigena (host_summary) [Ep 12 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203) - "Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG." — Cecilia Gigena (host_summary) [Ep 12 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203) - "Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG." — Cecilia Gigena (host_summary) [Ep 12 · 3:23](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=203) - "Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice." — Cecilia Gigena (host_summary) [Ep 12 · 3:38](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-20-10554?t=218) - "At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access." (host_summary) [Ep 11 · 0:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53) - "You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine." (host_summary) [Ep 11 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62) - "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT." (clinical) [Ep 11 · 1:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85) - "ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets and screening included articles based on title and abstract." (host_summary) [Ep 11 · 2:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140) - "In cryoanalgesia for pectus procedures, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of cryoablation." (host_summary) [Ep 11 · 4:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275) - "Cryoanalgesia targets nerves from T3 to T8 with a 2-minute freeze cycle starting at the third rib and working down." (host_summary) [Ep 11 · 4:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286) - "Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with cryo nerve block." (host_summary) [Ep 11 · 4:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296) - "Cryoanalgesia blocks fail when surgeons use a single lumen tube and perform the block too far anteriorly." (host_summary) [Ep 11 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313) - "The SER Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups." (host_summary) [Ep 11 · 6:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403) - "Every unilateral isolated CDH should be pursued with ECMO if there was good prenatal counseling with the parents." (host_summary) [Ep 11 · 6:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=418) - "With bivalrudin, you can operate after 8 hours of putting patients on ECMO as long as levels are stable, and it's a much easier surgical repair." (host_summary) [Ep 11 · 7:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446) - "Early repair while on ECMO is safe and can offer physiological benefits, with the optimal window between 8 to 24 hours." (host_summary) [Ep 11 · 7:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=461) - "CO2 laser emits infrared light in the spectrum of 920 to 1400 nanometers, which is well absorbed by water." (host_summary) [Ep 11 · 8:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494) - "In 56 circumcision cases using CO2 laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%." (host_summary) [Ep 11 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510) - "CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required." (host_summary) [Ep 11 · 8:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520) - "Autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy in a randomized controlled trial from France." (host_summary) [Ep 11 · 9:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577) - "With autofluorescence, parathyroids naturally autofluoresce at a specific wavelength without injecting anything." (clinical) [Ep 11 · 9:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593) - "Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it." (epidemiological) [Ep 11 · 10:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607) - "A surgery-first pathway for pediatric biliary stones reduces resource utilization, including MRCP, according to recently published work." (epidemiological) [Ep 11 · 11:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=692) - "With ERCP, you're going to get pancreatitis 10% of the time no matter how good you are." (epidemiological) [Ep 11 · 12:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722) - "With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%." (host_summary) [Ep 11 · 12:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734) - "If you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, the success rate was in the 90s." (epidemiological) [Ep 11 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745) - "MMP-7 was identified about 10 years ago by Georgia Bezarra as a diagnostic biomarker for biliary atresia." (host_summary) [Ep 11 · 13:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=787) - "Data from a recent Midwest study shows that every 10-day delay in biliary atresia treatment worsens outcomes by 20%." (host_summary) [Ep 11 · 13:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821) - "MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, and the sensitivity is pretty good, but cutoffs vary because the assay is still evolving." (host_summary) [Ep 11 · 13:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838) - "The institutional commitment is to perform Kasai procedure within 7 days of patients showing up if they have biliary atresia." (host_summary) [Ep 11 · 14:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=855) - "REBOA can be used in children if you have it at your center and you're good at it, though it's not done a lot in pediatric hospitals." (host_summary) [Ep 11 · 15:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=908) - "REBOA seems to take longer than opening the abdomen or chest if you're just needing to cross-clamp the aorta." (host_summary) [Ep 11 · 15:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948) - "Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach." (host_summary) [Ep 11 · 16:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983) - "John Armstrong, while serving in the US Army, ran a clinic where patients were shaved weekly, and they observed a dramatic improvement, significantly reducing the need for surgical intervention in pilonidal disease." (host_summary) [Ep 11 · 16:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000) - "If you're not pushing hair removal and meticulous hygiene, you're probably going to end up operating on some people that might not need an operation for pilonidal disease." (host_summary) [Ep 11 · 16:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1015) - "For pilonidal disease hair removal, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once-a-week recommended." (host_summary) [Ep 11 · 17:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037) - "FETO is a percutaneous intervention on the mother using one trocar placed through the abdominal wall into the uterus." — Beth Rymeski (clinical) [Ep 14 · 0:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=33) - "A standard fetoscope with a side channel is used, and the balloon is worked through the side channel." — Beth Rymeski (clinical) [Ep 14 · 0:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=36) - "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow." — Jill Knepprath (host_summary) [Ep 14 · 0:47](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=47) - "FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies." — Jill Knepprath (host_summary) [Ep 14 · 0:53](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=53) - "The tongue is an easy landmark to identify during FETO because it is bumpy in appearance." — Beth Rymeski (clinical) [Ep 14 · 1:21](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=81) - "Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement." — Beth Rymeski (clinical) [Ep 14 · 1:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=89) - "If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth." — Beth Rymeski (clinical) [Ep 14 · 1:38](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=98) - "The epiglottis is a key landmark to locate when navigating to the trachea." — Beth Rymeski (clinical) [Ep 14 · 1:58](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=118) - "Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage." — Beth Rymeski (clinical) [Ep 14 · 2:23](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=143) - "The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus." — Beth Rymeski (clinical) [Ep 14 · 2:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=156) - "The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea." — Beth Rymeski (clinical) [Ep 14 · 2:56](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=176) - "The scope is backed up as the balloon is inflated so that balloon inflation can be watched." — Beth Rymeski (clinical) [Ep 14 · 3:03](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=183) - "The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea." — Jill Knepprath (host_summary) [Ep 14 · 3:08](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=188) - "The balloon contains a little metal ball that can be visualized." — Beth Rymeski (clinical) [Ep 14 · 3:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=209) - "Sometimes the trocar advances into the mouth during the procedure and needs to be backed out." — Jill Knepprath (host_summary) [Ep 14 · 3:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=213) - "Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea." — Jill Knepprath (host_summary) [Ep 14 · 3:40](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=220) - "FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus." — Beth Rymeski (clinical) [Ep 15 · 0:33](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=33) - "A standard fetoscope with a side channel is used, and the balloon is worked through the side channel." — Beth Rymeski (clinical) [Ep 15 · 0:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=36) - "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow." — Jill Knepprath (host_summary) [Ep 15 · 0:47](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=47) - "FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies." — Jill Knepprath (host_summary) [Ep 15 · 0:53](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=53) - "The tongue is an easy landmark to identify during FETO because it is bumpy in appearance." — Beth Rymeski (clinical) [Ep 15 · 1:21](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=81) - "Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement." — Beth Rymeski (clinical) [Ep 15 · 1:29](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=89) - "If the baby's head is not perfectly in alignment with the scope, twisting and turning is required to navigate through the mouth." — Beth Rymeski (clinical) [Ep 15 · 1:38](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=98) - "The epiglottis is a key landmark to identify when navigating toward the trachea." — Beth Rymeski (clinical) [Ep 15 · 1:58](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=118) - "Excessive torquing of the membranes should be avoided because the trocar goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage." — Beth Rymeski (clinical) [Ep 15 · 2:23](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=143) - "The scope should always be advanced until the carina is visualized to confirm position in the trachea and determine location within the trachea." — Beth Rymeski (clinical) [Ep 15 · 2:36](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=156) - "The balloon should not be driven into one side of the trachea or the other; it should inflate in the main trachea." — Beth Rymeski (clinical) [Ep 15 · 2:56](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=176) - "The scope is backed up as the balloon is inflated so that balloon inflation can be watched." — Beth Rymeski (clinical) [Ep 15 · 3:03](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=183) - "The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea." — Jill Knepprath (host_summary) [Ep 15 · 3:08](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=188) - "After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea." — Jill Knepprath (host_summary) [Ep 15 · 3:40](https://qa.library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=220) - "Indication for minimally invasive CDH repair is any patient stable enough to transport to OR, with pulmonary pressures lower than systemic." (guideline) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=0) - "Most centers wait to repair CDH until right-sided (pulmonary) pressures are lower than systemic pressures." (host_summary) [Ep 2 · 1:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=60) - "Contraindications to MIS CDH repair include repair on ECMO; liver-up, stomach-up, oscillator use, and redo repair are NOT contraindications." (guideline) [Ep 2 · 1:30](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90) - "A laparotomy for CDH repair carries significant lifelong risk of small bowel obstruction, which may be underestimated and is a major advantage of MIS approach." (opinion) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=180) - "Early studies from Babies Hospital showed relatively high recurrence rate for primary MIS CDH repair, but this may be related to technique." (host_summary) [Ep 2 · 2:30](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=150) - "Technical pearls for MIS CDH repair include pericostal sutures, mesh reinforcement, and avoiding tension; agenesis or near-agenesis should prompt conversion to open." (clinical) [Ep 2 · 3:30](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=210) - "All CDH patients have obligate pneumothorax post-repair due to pulmonary hypoplasia; chest tube use is debated." (clinical) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=420) - "Biologic mesh alone to bridge a CDH defect is associated with higher recurrence rates; biologics dissolve in the middle due to lack of tissue ingrowth on the chest side." (clinical) [Ep 2 · 10:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=600) - "PTFE-biologic sandwich technique (PTFE on lung side, biologic on abdominal side) reduces recurrence compared to biologic alone, particularly for dome recurrences." (clinical) [Ep 2 · 10:40](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=640) - "Pericostal 'seesaw' suture technique involves bringing suture through small stab incision, around rib, and tying externally; scars fade over time." (clinical) [Ep 2 · 8:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=480) - "Biologic underlay should extend beyond the primary repair edge by 1-2 cm, with sutures taking bites of diaphragm and mesh away from the edge to create overlap." (clinical) [Ep 2 · 12:39](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=759) - "In multivariate analysis of institutional experience, use of biologic mesh alone was a major risk factor for CDH recurrence." (epidemiological) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=720) - "Recent study suggests waiting until after ECMO decannulation for CDH repair may improve survival rates." (host_summary) [Ep 2 · 1:30](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90) - "VV ECMO overall outcomes may favor VV over VA ECMO for CDH; VA ECMO associated with more neurologic events, VV with more renal complications." (host_summary) [Ep 2 · 25:42](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1542) - "Propensity analysis showed VV ECMO survival 60% versus VA ECMO 46% for CDH." (host_summary) [Ep 2 · 26:20](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1580) - "Institutional comfort and experience with VV ECMO management affects outcomes; some centers routinely convert VV to VA due to instability." (clinical) [Ep 2 · 27:02](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1622) - "Oxygen is an incredible inotrope; oxygenated blood via VV ECMO often allows weaning of pressors." (host_summary) [Ep 2 · 28:32](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1712) - "VV ECMO cannulation technique uses open cut-down with cephalad cannula to smooth out first 24 hours and improve flows." (clinical) [Ep 2 · 29:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1740) - "ELSO registry study of matched patients showed higher survival for CDH repair after ECMO versus on ECMO." (host_summary) [Ep 2 · 35:51](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2151) - "Some institutions repair very sick CDH patients early in ECMO run (first 24-48 hours) with reported decreased bleeding risk, though this is debated." — Jason (clinical) [Ep 2 · 37:16](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236) - "Patients who linger then have acute hypertensive crisis and go on ECMO may be repaired off ECMO after short run; long-riders may be repaired early if stable." — Jason (clinical) [Ep 2 · 37:16](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236) - "Muscle flap repair (transversus abdominis) has dramatically lower recurrence rate than patch repair for large CDH defects, particularly in ECMO population." (host_summary) [Ep 2 · 33:10](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1990) - "Transversus abdominis flap technique involves transverse abdominal incision at umbilicus level, developing transversus plane, maintaining blood supply; half the flap remains naturally attached to lateral wall." (clinical) [Ep 2 · 43:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580) - "Muscle flap reconstruction carries risk of abdominal wall deformity; patient selection is important." (clinical) [Ep 2 · 43:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580) - "In recurrent-recurrent CDH, latissimus flaps or large chest wall muscle flaps may be used as salvage." (clinical) [Ep 2 · 42:20](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540) - "Sewing to good tissue is critical; recurrences may occur when suturing to scar tissue rather than viable diaphragm." (clinical) [Ep 2 · 42:20](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540) - "Consensus among audience: wait 2-4 days before repairing stable term CDH neonate to ensure pulmonary hypertension does not develop." (host_summary) [Ep 2 · 16:32](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=992) - "Days to repair are less important than change in pulmonary pressure over time; goal is to avoid repairing during physiologic instability." (clinical) [Ep 2 · 17:45](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1065) - "Historical 'honeymoon period' where stable CDH neonates suddenly crash to ECMO is seen less often now but remains a concern." (clinical) [Ep 2 · 18:10](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1090) - "Physiologic defect in CDH is pulmonary, not the intestines in the chest ('not the chits in the chest')." (clinical) [Ep 2 · 19:10](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1150) - "Audience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall." — Todd Ponsky (host_summary) [Ep 2 · 20:03](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1203) - "Decision to place CDH patient on ECMO is joint between pediatric surgeon and neonatologist; institutional variability exists." (clinical) [Ep 2 · 22:00](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1320) - "Standard ECMO criteria require repeated evidence of elevated OI over several hours, not single measurement." (host_summary) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1350) - "Institutional practice: if CDH patient cannot be weaned from ECMO, transition to comfort measures rather than last-ditch repair on ECMO." (clinical) [Ep 2 · 35:20](https://qa.library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2120) - "Hypoplastic lungs of babies with pulmonary hypoplasia secondary to CDH have impaired fetal lung growth and maturation" — Kasra Khalaj (clinical) [Ep 8 · 0:31](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=31) - "Several treatment agents have been administered prenatally for CDH, but none have been shown to fully rescue lung development" — Kasra Khalaj (clinical) [Ep 8 · 0:39](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=39) - "Extracellular vesicles are nanoparticles known to be the mediators of stem cell paracrine signaling" — Kasra Khalaj (clinical) [Ep 8 · 0:45](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=45) - "AFSCEV administration rescued the number of lung branches back to normal in CDH models" — Kasra Khalaj (clinical) [Ep 8 · 0:56](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=56) - "AFSCEVs improve fetal lung maturation as shown by rescuing the expression of surfactant protein C" — Kasra Khalaj (clinical) [Ep 8 · 1:07](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=67) - "AFSCEVs contain microRNA 17-92 cluster, which has been reported in the literature to modulate fetal lung development" — Kasra Khalaj (clinical) [Ep 8 · 1:17](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=77) - "Knockout of the microRNA 17-92 cluster can recapitulate pulmonary hypoplasia" — Kasra Khalaj (clinical) [Ep 8 · 1:31](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=91) - "Autophagy has been shown to be critical for lung branching morphogenesis" — Kasra Khalaj (clinical) [Ep 8 · 1:46](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=106) - "Autophagy is a recycling mechanism of cellular trash and is one of the key ways that cell survival is promoted" — Kasra Khalaj (clinical) [Ep 8 · 1:55](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=115) - "Autophagy is most impaired at the pseudoglandular and canalicular stages in the nitrofen model of CDH" — Kasra Khalaj (clinical) [Ep 8 · 2:04](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=124) - "CDH fetal lungs show reduced levels of Beclin 1 and ATG5 (autophagy activators) and higher levels of sequestosome (autophagy adapter) at pseudoglandular and canalicular stages" — Kasra Khalaj (clinical) [Ep 8 · 2:18](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=138) - "High levels of sequestosome indicate autophagy impairment" — Kasra Khalaj (clinical) [Ep 8 · 2:18](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=138) - "Treatment with AFSCEVs restores autophagy key genes (Beclin 1, ATG5, sequestosome) at the pseudoglandular and canalicular stage" — Kasra Khalaj (clinical) [Ep 8 · 2:32](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=152) - "AFSCEVs are taken up by virtually all cells in fetal lung explants, including the fetal lung epithelium" — Kasra Khalaj (clinical) [Ep 8 · 2:56](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=176) - "Activation of autophagy by AFSCEVs is localized in the lung epithelial compartment of the fetal lung microenvironment" — Kasra Khalaj (clinical) [Ep 8 · 3:19](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=199) - "Knockdown of microRNAs 17 and 20 in AFSCEVs results in increased sequestosome and down regulation of Beclin mRNA, indicating impaired autophagy" — Kasra Khalaj (clinical) [Ep 8 · 3:27](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=207) - "Knockdown of microRNAs 17 and 20 results in lower levels of LC3B2 protein, which is the active isoform of the autophagy cascade" — Kasra Khalaj (clinical) [Ep 8 · 3:53](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=233) - "Human fetal lung explant model of pulmonary hypoplasia was established using fetal lungs from healthy terminated fetuses from 15 to 19 weeks of gestation, corresponding to late pseudoglandular and canalicular stages" — Kasra Khalaj (clinical) [Ep 8 · 4:10](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=250) - "In human hypoplastic fetal lung explants, there is a reduction of Beclin 1 and ATG5 at the mRNA level" — Kasra Khalaj (clinical) [Ep 8 · 4:37](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=277) - "Treatment with human AFSCEVs results in restoration of Beclin 1 and ATG5 in human hypoplastic fetal lung explants" — Kasra Khalaj (clinical) [Ep 8 · 4:58](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=298) - "At the protein level in human tissue, all three autophagy markers (Beclin 1, ATG5, sequestosome) were dysregulated in the hypoplastic group, and human AFSCEVs restored all three markers back to control" — Kasra Khalaj (clinical) [Ep 8 · 5:04](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=304) - "This is the first study discovering autophagy impairment as an important mechanism in CDH pathophysiology" — Kasra Khalaj (opinion) [Ep 8 · 5:17](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=317) - "Autophagy levels are restored with administration of AFSCEVs, thus partially explaining their effect on branching morphogenesis" — Kasra Khalaj (clinical) [Ep 8 · 5:24](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=324) - "Autophagy can be targeted with microRNAs 17 and 20" — Kasra Khalaj (clinical) [Ep 8 · 5:31](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=331) - "The study evaluated autophagy in hypoplastic lungs throughout gestation and established whether extracellular vesicles from rat and human amniotic fluid stem cells can improve branching morphogenesis through autophagy-mediated mechanisms including microRNA cargo transfer" (host_summary) [Ep 8 · 5:56](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=356) - "The study demonstrated that autophagy levels are deregulated in fetal hypoplastic lungs from rats and humans" (host_summary) [Ep 8 · 6:47](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=407) - "Future work includes looking at ER stress, which is very closely interrelated with autophagy pathway, to see if AFSCEVs can exert an effect on this related mechanism" — Kasra Khalaj (opinion) [Ep 8 · 7:39](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=459) - "Studies in oncology have shown that the quantity of extracellular vesicles released when autophagy is impaired is different" — Kasra Khalaj (clinical) [Ep 8 · 8:07](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=487) - "Future functional studies will examine endogenous extracellular vesicle production in hypoplastic fetal lungs" — Kasra Khalaj (opinion) [Ep 8 · 8:37](https://qa.library.globalcastmd.com/watch/eupsa-micrornas-in-amniotic-fluid-stem-cellextracellular-vesicles-modulate-lung-development-in-experimental-congenital-diaphragmatic-hernia-kasra-khalaj-5430?t=517) - "Protocol changes began in August 2023 and were implemented in spring of 2024" — Jill Knepprath (host_summary) [Ep 13 · 0:20](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=20) - "Initial protocol focus was on delivery room, ECMO utilization, and ventilator management, then progressed system by system through GI, cardiac, and neuro" — Paul Kingma (clinical) [Ep 13 · 0:27](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=27) - "Previously, for non-ECMO patients, surgical repair was performed when echocardiography demonstrated improved pulmonary hypertension, ranging from a few days to as late as 56 days" — Paul Kingma (clinical) [Ep 13 · 0:46](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=46) - "Under the new protocol, all ECMO patients are repaired within the first 12 to 24 hours of ECMO cannulation" — Paul Kingma (clinical) [Ep 13 · 1:09](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=69) - "All non-ECMO patients are repaired between day 4 and 8, provided they are stable, which applies to the vast majority" — Paul Kingma (clinical) [Ep 13 · 1:16](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=76) - "Previously, peak pressures were limited to 25 to 26 cmH2O and mean airway pressures to less than 16 to 17 cmH2O" — Jill Knepprath (host_summary) [Ep 13 · 1:26](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=86) - "The new protocol never exceeds a peak pressure of 22 cmH2O" — Paul Kingma (clinical) [Ep 13 · 1:39](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=99) - "A standardized escalation and weaning protocol is followed approximately 100% of the time" — Paul Kingma (clinical) [Ep 13 · 1:42](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=102) - "The clinical philosophy is that if you protect the lungs, all the rest will fall in line and improve" — Paul Kingma (opinion) [Ep 13 · 1:35](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=95) - "Every baby now gets started on hydrocortisone for blood pressure support" — Paul Kingma (clinical) [Ep 13 · 1:51](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=111) - "There is a standardized protocol for which pressors are used" — Paul Kingma (clinical) [Ep 13 · 2:01](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=121) - "Inhaled nitric oxide is only started if there is evidence of a need" — Paul Kingma (clinical) [Ep 13 · 2:05](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=125) - "Previously, babies were fed once they had return of bowel function after repair" — Jill Knepprath (host_summary) [Ep 13 · 2:12](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=132) - "The All Children's philosophy is that starting NG feeds before oral feeding capability causes babies to lose the developmental connection between oral feeding and satiety" — Paul Kingma (opinion) [Ep 13 · 2:20](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=140) - "Babies are not fed enterally until they can feed by mouth; prior to that they receive TPN" — Paul Kingma (clinical) [Ep 13 · 2:33](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=153) - "Previously, babies received as-needed sedation" — Jill Knepprath (host_summary) [Ep 13 · 2:44](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=164) - "Every baby now gets started automatically on a continuous sedation drip" — Paul Kingma (clinical) [Ep 13 · 2:47](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=167) - "Overall use of sedation has plummeted since starting universal continuous drips despite starting at a higher baseline level" — Paul Kingma (clinical) [Ep 13 · 2:56](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=176) - "The new cohort had 36 babies compared to 99 in the previous cohort" — Jill Knepprath (host_summary) [Ep 13 · 3:31](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=211) - "After protocol implementation, the patient population appears to be skewed to the extremes with slightly more severe and slightly more mild cases" — Paul Kingma (epidemiological) [Ep 13 · 3:18](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=198) - "ECMO use increased from 14% to 22% in the new cohort" — Jill Knepprath (host_summary) [Ep 13 · 3:31](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=211) - "Survival increased from around 70% to around 80% after implementing protocol changes" — Paul Kingma (epidemiological) [Ep 13 · 3:41](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=221) - "Median time on mechanical ventilation dropped from 19 days to 9 days, almost a 50% decline" — Paul Kingma (epidemiological) [Ep 13 · 3:55](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=235) - "Survival for ECMO patients increased from 39% to 55%" — Jill Knepprath (host_summary) [Ep 13 · 4:09](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=249) - "The philosophy of getting babies on ECMO sooner has not caused an increase in the number of ECMO babies" — Paul Kingma (epidemiological) [Ep 13 · 4:19](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=259) - "ECMO use was around 41% in the old cohort versus 45% in the new cohort" — Jill Knepprath (host_summary) [Ep 13 · 4:29](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=269) - "There are many problems that CDH babies have beyond survival that need improvement" — Paul Kingma (opinion) [Ep 13 · 4:40](https://qa.library.globalcastmd.com/watch/improving-outcomes-for-congenital-diaphragmatic-hernia-protocol-changes-at-cincinnati-children-s-12129?t=280) ## Changelog - Sep 15: 3 items added automatically - Sep 10: 2 items no longer name congenital diaphragmatic hernia - Sep 7: Published again automatically — condition is back above threshold - Sep 7: 2 items no longer name congenital diaphragmatic hernia - Sep 7: 8 items added automatically - Sep 7: Unpublished automatically — folded or below threshold - Sep 7: 9 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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