# CICU / Post-op CHD Care — GCMD Library living collection

Also covered as: congenital heart disease · severe acute kidney injury · pulmonary hypoplasia

Experts: Dr. Lizzie Lee, Dr. Todd Ponsky, Dr. Charlie Stolar, Dr. Avi Schlager

Updated: n/a · 8 episodes · 225 cited statements

## Episodes
### Evidence & Research
- [Early Tricuspid Valve Surgery for Heart Failure in Congenital Heart Disease](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050) — video · 0:46 · [machine version](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in th](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery...](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128.md)
- [Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566) — video · 0:57 · [machine version](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566.md)

### In-Depth Reviews
- [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)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821) — podcast · 52:45 · [machine version](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821.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 1)
- [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 1)
- [17:48](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1068) ECMO Indications and Contraindications (Ep 1)
- [29:21](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1761) ECMO Technical Considerations (Ep 1)
- [36:24](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2184) Timing of Surgical Repair (Ep 1)
- [46:40](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2800) Surgical Approach: Open vs Thoracoscopic (Ep 1)
- [53:56](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3236) Technical Aspects of Repair (Ep 1)
- [59:19](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=3559) Postoperative Management and Chest Tubes (Ep 1)
- [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 1)
- [74:54](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4494) Recurrence and Right-sided Hernias (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0) Introduction and Background (Ep 2)
- [4:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=243) Gastroschisis: Prenatal Counseling and Delivery Planning (Ep 2)
- [8:34](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=514) Gastroschisis: Initial Management and Closure Techniques (Ep 2)
- [17:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1024) Gastroschisis: Intestinal Atresia Management (Ep 2)
- [22:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1337) Gastroschisis: Prolonged Ileus and Complications (Ep 2)
- [28:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1707) Omphalocele: Prenatal Counseling and Associated Anomalies (Ep 2)
- [32:22](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1942) Omphalocele: Surgical Management and Reduction Techniques (Ep 2)
- [40:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2417) Omphalocele: Delayed Closure and Patch Repair (Ep 2)
- [45:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2754) Omphalocele: Feeding Issues and Associated Problems (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=0) Timing of Tricuspid Valve Surgery in TGA (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 5)
- [0:00](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 6)
- [0:00](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 7)
- [0:00](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=0) Surgical vs Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis (Ep 8)

## 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 80:12](https://qa.library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4812)
- "Pulmonary vein stenosis is a rare but serious condition where the veins from the lungs to the heart become narrowed" — Lizzie Lee (clinical) [Ep 8 · 0:06](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=6)
- "A study from Cincinnati Children's examined 56 children comparing surgery versus catheter-based interventions for pulmonary vein stenosis" — Lizzie Lee (epidemiological) [Ep 8 · 0:12](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=12)
- "Over time, catheter-based treatments became the preferred first option for pulmonary vein stenosis" — Lizzie Lee (clinical) [Ep 8 · 0:23](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=23)
- "Surgery was reserved for complex cases involving multiple severely affected veins or other heart defects" — Lizzie Lee (clinical) [Ep 8 · 0:28](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=28)
- "92% of children with pulmonary vein stenosis needed another intervention after initial treatment" — Lizzie Lee (epidemiological) [Ep 8 · 0:34](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Most reinterventions for pulmonary vein stenosis occurred within the first year after initial treatment" — Lizzie Lee (epidemiological) [Ep 8 · 0:34](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Recurrence of pulmonary vein stenosis remained common regardless of the initial intervention type" — Lizzie Lee (clinical) [Ep 8 · 0:34](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Pulmonary vein stenosis requires ongoing surveillance, repeated interventions, and a long-term multidisciplinary approach" — Lizzie Lee (clinical) [Ep 8 · 0:48](https://qa.library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=48)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (host_summary) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0)
- "With gastroschisis, the main issue is that the bowel gets damaged through fetal life" — Jack Langer (clinical) [Ep 2 · 4:36](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=276)
- "Most gastroschisis patients don't have any other associated anomalies, and it's pretty rare to have abnormal chromosomes" — Jack Langer (clinical) [Ep 2 · 4:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "Early papers showed a benefit to cesarean section in gastroschisis, but cesarean sections were usually done early at 36 or 37 weeks, raising the question of whether timing rather than cesarean section itself gave the benefit" — Jack Langer (clinical) [Ep 2 · 5:46](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=346)
- "Many studies have failed to show an advantage to cesarean section, and most people nowadays would not do routine cesarean section for gastroschisis" — Jack Langer (clinical) [Ep 2 · 6:13](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery in gastroschisis" — Jack Langer (clinical) [Ep 2 · 6:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto's approach is to deliver gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jack Langer (clinical) [Ep 2 · 6:58](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=418)
- "The mean gestational age of onset of labor is a lot earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by the inflamed bowel" — Jack Langer (clinical) [Ep 2 · 7:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor can usually be successfully induced at 37 weeks, unlike regular pregnancies" — Jack Langer (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=450)
- "Most evidence, including from the CapsNet database, suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jack Langer (clinical) [Ep 2 · 8:36](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport of gastroschisis patients, it's important for the baby to be nursed on his or her side, usually right side down, to prevent kinking of the mesentery and ischemia of the bowel" — Jack Langer (clinical) [Ep 2 · 10:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "For gastroschisis, bedside closure is the first choice if the bowel is not too thickened and there's not too much peel" — Jack Langer (clinical) [Ep 2 · 10:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jack Langer (clinical) [Ep 2 · 11:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jack Langer (clinical) [Ep 2 · 11:29](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "The current approach uses pre-formed silos, slowly pushing on them with fentanyl or morphine sedation in an awake baby, aiming to keep intraabdominal pressure below 20" — Jack Langer (clinical) [Ep 2 · 11:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=707)
- "If reduction is successful with good pressure and perfusion, the silo can be removed immediately and the umbilical cord stump used to cover the hole with a Duoderm dressing left for about 5 days" — Jack Langer (clinical) [Ep 2 · 12:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=747)
- "The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord" — Todd Ponsky (host_summary) [Ep 2 · 13:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=795)
- "A study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (host_summary) [Ep 2 · 14:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=859)
- "Umbilical hernias from plastic closure generally close by age 2 or 3 years, just like any umbilical hernia" — Jack Langer (clinical) [Ep 2 · 14:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=896)
- "Some gastroschisis patients become tachypneic with bluish legs after reduction and require intubation by neonatologists an hour or two later" — Jack Langer (clinical) [Ep 2 · 16:12](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=972)
- "The disadvantage of leaving a silo on for 24-48 hours is that the abdominal wall defect gets stretched out and bigger, taking longer to close with plastic closure" — Jack Langer (clinical) [Ep 2 · 17:25](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1045)
- "Spring-loaded silos apply pressure outward as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 2 · 18:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jack Langer (epidemiological) [Ep 2 · 18:51](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia where bowel gets very dilated but not thick-walled, and late atresia where the abdominal wall defect becomes very small causing ischemia and potentially vanishing gastroschisis" — Jack Langer (clinical) [Ep 2 · 19:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years because of intestinal failure centers, better TPN that doesn't damage the liver as much, and control of sepsis" — Jack Langer (clinical) [Ep 2 · 20:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "For atresia in gastroschisis, there are three management choices: repair at time of closure, bring out stomas, or drop everything back in and repair the atresia later" — Jack Langer (clinical) [Ep 2 · 20:54](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1254)
- "There's no good evidence for optimal management of atresia in gastroschisis because it's such a rare occurrence" — Jack Langer (opinion) [Ep 2 · 21:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "If bowel looks good without much peel, primary repair of atresia at initial closure is appropriate; if there's concern, drop it back in and repair later" — Jack Langer (clinical) [Ep 2 · 21:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1295)
- "Stomas are brought out only when there's necrotic bowel requiring resection and the bowel is not healthy enough to anastomose" — Jack Langer (clinical) [Ep 2 · 22:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1321)
- "The umbilicus is the preferred site for neonatal stomas because it results in a scar that would have been there anyway and is convenient for appliance placement" — Jack Langer (clinical) [Ep 2 · 22:50](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jack Langer (clinical) [Ep 2 · 23:00](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jack Langer (clinical) [Ep 2 · 24:27](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1467)
- "Metoclopramide (Reglan) can be given intravenously for gastroschisis hypomotility, unlike oral prokinetics where absorption is uncertain" — Jack Langer (clinical) [Ep 2 · 25:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A UK study showed cisapride helped gastroschisis patients achieve bowel function more quickly, but cisapride is no longer available" — Jack Langer (clinical) [Ep 2 · 25:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "A randomized prospective trial is currently underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jack Langer (clinical) [Ep 2 · 25:37](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1537)
- "At 4 weeks without bowel function, contrast enema is performed to look for mechanical obstruction, sometimes followed by upper GI if enema is inconclusive" — Jack Langer (clinical) [Ep 2 · 25:57](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1557)
- "If still no bowel function at 6 weeks, laparotomy is typically performed, often finding adhesions which are taken down" — Jack Langer (clinical) [Ep 2 · 26:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1604)
- "Going in too early on gastroschisis patients with prolonged ileus is a mistake" — Jack Langer (opinion) [Ep 2 · 27:21](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, it's usually the right testis that is extruded, and in about half the cases it finds its way down into the scrotum after being reduced" — Jack Langer (clinical) [Ep 2 · 28:03](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jack Langer (clinical) [Ep 2 · 28:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Karyotype analysis and testing for Beckwith-Wiedemann syndrome are routinely performed for omphalocele patients" — Jack Langer (clinical) [Ep 2 · 28:59](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1739)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jack Langer (clinical) [Ep 2 · 29:47](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "For small omphaloceles, there's no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery" — Jack Langer (clinical) [Ep 2 · 30:05](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair surgically" — Jack Langer (clinical) [Ep 2 · 30:23](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1823)
- "For giant omphaloceles (defined as any omphalocele with a lot of liver out), most surgeons recommend cesarean section, though this is not evidence-based" — Jack Langer (clinical) [Ep 2 · 31:04](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1864)
- "Giant omphaloceles should be delivered at a perinatal center because they need a pediatric surgeon and experienced neonatologists" — Jack Langer (clinical) [Ep 2 · 31:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1902)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jack Langer (clinical) [Ep 2 · 31:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "Some giant omphalocele patients have severe pulmonary hypoplasia requiring early intubation and respiratory support" — Jack Langer (clinical) [Ep 2 · 32:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1929)
- "The goal in omphalocele management is to reduce viscera without injury from direct trauma or increased intraabdominal pressure" — Jack Langer (clinical) [Ep 2 · 32:38](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1958)
- "Intraabdominal pressure monitoring is very helpful in omphalocele management" — Jack Langer (clinical) [Ep 2 · 33:14](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1994)
- "Stuart Lacy established the guideline of keeping intraabdominal pressure below 20 mmHg based on rabbit studies in the 1980s, which showed improved outcomes in a prospective study in children" — Jack Langer (clinical) [Ep 2 · 33:28](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Lacy also described an increase in central venous pressure of more than 4 as a concerning threshold" — Jack Langer (clinical) [Ep 2 · 33:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2036)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jack Langer (clinical) [Ep 2 · 34:02](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of pressure is more important than the absolute number during reduction" — Jack Langer (clinical) [Ep 2 · 34:17](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "Primary closure is attempted for full-term omphalocele patients without significant cardiac disease, respiratory issues, or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 2 · 34:43](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2083)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days to allow abdominal wall stretching" — Jack Langer (clinical) [Ep 2 · 35:07](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Sequential sac ligation requires a thick enough sac and umbilical cord insertion at the top rather than the side" — Jack Langer (clinical) [Ep 2 · 35:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2144)
- "Using Duoderm to gradually reduce omphaloceles appears to achieve reduction more quickly than sac ligation" — Jack Langer (clinical) [Ep 2 · 37:34](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or giant omphaloceles where reduction is not feasible" — Jack Langer (clinical) [Ep 2 · 38:12](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles have a small abdominal wall defect but large external contents, making reduction impossible" — Jack Langer (clinical) [Ep 2 · 38:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2329)
- "Sigy Ein had long experience using silver sulfadiazine (Silvadene) for escharotic therapy in omphaloceles" — Jack Langer (clinical) [Ep 2 · 39:26](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2366)
- "With escharotic therapy, the omphalocele is painted with the agent, forms an eschar, eventually epithelializes, and is later repaired like a large ventral hernia" — Jack Langer (clinical) [Ep 2 · 39:45](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2385)
- "Timing of definitive omphalocele repair after escharotic therapy depends on the individual child, ranging from 6-8 months to 3-4 years depending on defect size and medical comorbidities" — Jack Langer (clinical) [Ep 2 · 40:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2419)
- "Mushroom-shaped omphaloceles never reduce spontaneously and stay large" — Jack Langer (clinical) [Ep 2 · 41:10](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "For mushroom-shaped omphaloceles, the abdominal wall defect can be enlarged surgically as a first step to allow more spontaneous reduction before definitive repair" — Jack Langer (clinical) [Ep 2 · 41:20](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "The 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure" — Todd Ponsky (clinical) [Ep 2 · 42:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2526)
- "Formal adult-style component separation in small children carries risk of devascularization and can leave patients in worse condition if complications occur" — Jack Langer (clinical) [Ep 2 · 43:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2586)
- "In omphalocele closure, the defect often extends to the costal margin, making the upper portion impossible to close primarily, requiring patch placement" — Jack Langer (clinical) [Ep 2 · 43:35](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails in approximately 50% of omphalocele repairs, requiring reoperation with non-absorbable mesh like Prolene" — Jack Langer (clinical) [Ep 2 · 44:01](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2641)
- "Omphaloceles can be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jack Langer (clinical) [Ep 2 · 44:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Pentalogy of Cantrell omphaloceles tend to be more superiorly placed" — Jack Langer (clinical) [Ep 2 · 45:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2708)
- "Most pentalogy of Cantrell patients have cardiac problems requiring escharotic therapy for the omphalocele" — Jack Langer (clinical) [Ep 2 · 45:19](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2719)
- "In pentalogy of Cantrell, the diaphragmatic patch can be placed from above through sternotomy during cardiac surgery, with abdominal wall repair performed later" — Jack Langer (clinical) [Ep 2 · 45:31](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2731)
- "Reflux is very common in omphalocele patients, and many don't eat normally, especially with cardiac disease or pulmonary hypoplasia" — Jack Langer (clinical) [Ep 2 · 46:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiologists can place G-tubes under fluoroscopy in giant omphalocele patients by finding a window lateral to the defect" — Jack Langer (clinical) [Ep 2 · 46:30](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "After G-tube maturation, a GJ tube can be placed to allow feeding despite severe reflux" — Jack Langer (clinical) [Ep 2 · 46:55](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2815)
- "Fundoplication in a child with unrepaired giant omphalocele is extremely difficult because the liver is midline and access to the hiatus is nearly impossible, especially with cardiac disease and congested liver" — Jack Langer (clinical) [Ep 2 · 47:15](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "GJ tube is a better short-term solution than fundoplication for reflux in unrepaired omphalocele, with fundoplication performed at the time of definitive abdominal wall repair" — Jack Langer (clinical) [Ep 2 · 47:42](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2862)
- "In giant omphaloceles with midline liver, the liver can put pressure on the duodenum or pylorus causing mechanical gastric outlet obstruction that worsens reflux" — Jack Langer (clinical) [Ep 2 · 48:08](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus, so Ladd's procedure is not necessary" — Jack Langer (clinical) [Ep 2 · 48:49](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if the surgeon performs appendectomies during Ladd's procedures" — Jack Langer (opinion) [Ep 2 · 49:06](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2946)
- "Children with repaired omphaloceles can develop perforated appendicitis with delayed diagnosis due to abnormal appendix location" — Jack Langer (clinical) [Ep 2 · 49:18](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2958)
- "If a child with omphalocele has renal abnormalities requiring potential Mitrofanoff procedure, the appendix should be preserved" — Jack Langer (clinical) [Ep 2 · 49:44](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2984)
- "During omphalocele reduction with liver, hepatic veins are very superficial and can be injured during fascial dissection if not careful" — Jack Langer (clinical) [Ep 2 · 50:16](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "Kinking of hepatic veins during omphalocele reduction is prevented by using intraabdominal pressure monitoring and not being too aggressive with reduction when pressures exceed 20" — Jack Langer (clinical) [Ep 2 · 50:38](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3038)
- "In immediate omphalocele reduction, fascial edges can usually be approximated at the bottom but often not at the top, requiring patch placement" — Jack Langer (clinical) [Ep 2 · 50:56](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3056)
- "For partial omphalocele reduction with liver still protruding at the top, a temporary Gore-Tex or silastic patch can be sewn on with skin closed over it, then removed in 1-2 weeks for definitive fascial closure" — Jack Langer (clinical) [Ep 2 · 51:09](https://qa.library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3069)
- "1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 4 · 0:07](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=7)
- "For infants that needed hemodialysis after congenital heart surgery, one-year survival was 46%" — Lizzie Lee (epidemiological) [Ep 4 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=14)
- "For infants that did not need hemodialysis after congenital heart surgery, one-year survival was 94%" — Lizzie Lee (epidemiological) [Ep 4 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=14)
- "Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis" — Lizzie Lee (clinical) [Ep 4 · 0:23](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=23)
- "Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 4 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=33)
- "Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 4 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=33)
- "Dialysis after infant heart surgery is rare" — Lizzie Lee (epidemiological) [Ep 4 · 0:39](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=39)
- "Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis" — Lizzie Lee (opinion) [Ep 4 · 0:44](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-th-12114?t=44)
- "1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 5 · 0:07](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=7)
- "For infants needing hemodialysis after congenital heart surgery, one-year survival was 46%" — Lizzie Lee (clinical) [Ep 5 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=14)
- "For infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%" — Lizzie Lee (clinical) [Ep 5 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=14)
- "Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis" — Lizzie Lee (clinical) [Ep 5 · 0:23](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=23)
- "Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery" — Lizzie Lee (clinical) [Ep 5 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=33)
- "Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery" — Lizzie Lee (clinical) [Ep 5 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=33)
- "Dialysis after infant heart surgery is rare" — Lizzie Lee (epidemiological) [Ep 5 · 0:39](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=39)
- "Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis" — Lizzie Lee (opinion) [Ep 5 · 0:44](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12117?t=44)
- "1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 6 · 0:07](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=7)
- "For infants needing hemodialysis after congenital heart surgery, one-year survival was 46%" — Lizzie Lee (clinical) [Ep 6 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=14)
- "For infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%" — Lizzie Lee (clinical) [Ep 6 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=14)
- "Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis" — Lizzie Lee (clinical) [Ep 6 · 0:23](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=23)
- "Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery" — Lizzie Lee (clinical) [Ep 6 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=33)
- "Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery" — Lizzie Lee (clinical) [Ep 6 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=33)
- "Dialysis after infant heart surgery is rare" — Lizzie Lee (epidemiological) [Ep 6 · 0:39](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=39)
- "Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis" — Lizzie Lee (opinion) [Ep 6 · 0:44](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-in-the-12127?t=44)
- "1% of infants develop severe acute kidney injury requiring dialysis after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 7 · 0:07](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=7)
- "One-year survival for infants requiring hemodialysis after congenital heart surgery is 46%" — Lizzie Lee (epidemiological) [Ep 7 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=14)
- "One-year survival for infants not requiring hemodialysis after congenital heart surgery is 94%" — Lizzie Lee (epidemiological) [Ep 7 · 0:14](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=14)
- "Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis" — Lizzie Lee (clinical) [Ep 7 · 0:23](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=23)
- "Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 7 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=33)
- "Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery" — Lizzie Lee (epidemiological) [Ep 7 · 0:33](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=33)
- "Dialysis after infant heart surgery is rare" — Lizzie Lee (epidemiological) [Ep 7 · 0:39](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=39)
- "Outcomes for infants requiring dialysis after heart surgery may improve when treated at centers with more experience in using dialysis" — Lizzie Lee (clinical) [Ep 7 · 0:44](https://qa.library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-heart-surgery-12128?t=44)
- "In adults with transposition of the great arteries, the right ventricle sometimes has to pump blood to the whole body." — Lizzie Lee (clinical) [Ep 3 · 0:08](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=8)
- "The right ventricle was not built to pump blood to the whole body." — Lizzie Lee (clinical) [Ep 3 · 0:08](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=8)
- "Over time, many patients with transposition of the great arteries develop severe tricuspid regurgitation and worsening heart function." — Lizzie Lee (clinical) [Ep 3 · 0:16](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=16)
- "Patients with moderate to severe tricuspid valve leakage but only mild to moderate ventricular dysfunction had better outcomes after surgery." — Lizzie Lee (clinical) [Ep 3 · 0:25](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=25)
- "If the right ventricle was already severely weak, tricuspid valve surgery did not make a difference in outcomes." — Lizzie Lee (clinical) [Ep 3 · 0:33](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=33)
- "In patients with transposition of the great arteries, earlier tricuspid valve surgery can improve outcomes." — Lizzie Lee (clinical) [Ep 3 · 0:37](https://qa.library.globalcastmd.com/watch/early-tricuspid-valve-surgery-for-heart-failure-in-congenital-heart-disease-12050?t=37)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Aug 31: 5 doctors auto-found from episode dossiers
- Aug 30: 5 doctors auto-found from episode dossiers
- Aug 30: 5 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 13 doctors auto-found from episode dossiers
- Aug 29: 13 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 12 items, 12 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 12 items, 12 dossiers, summaries for 4 audience(s)

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