Collection
CICU / Post-op CHD Care
Also covers: congenital heart disease · severe acute kidney injury · pulmonary hypoplasia
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Early Tricuspid Valve Surgery for Heart Failure in Congenital Heart Disease
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Rawan Amir, Magalie Ladouceur, David Danford, Jamil Aboulhosn, Petra Antonova, David Baker, Judith Bouchardy, Werner Budts, Luke J Burchill, David S Celermajer, Timothy Cotts, Jonathan Cramer, Payam Dehghani, Flavia Fusco, Mikael Dellborg,
video0:46 · May 2026
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in th
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Grant Chappell, Darren Turner, Amir Mehdizadeh-Shrifi, David Lehenbauer, Marco Ricci, Meghan M Chlebowski, Stuart L Goldstein, Awais Ashfaq, David L S Morales
Hemodialysis after infant congenital heart surgery (CHS) for acute kidney injury
video0:53 · May 2026
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
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This video highlights a recent PubMed article on hemodialysis outcomes in infants following congenital heart surgery (CHS). It reveals that approximately 1% of infants undergoing CHS develop severe acute kidney injury requiring dialysis, wi
video0:53 · Jun 2026
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
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This video discusses a PubMed article on dialysis outcomes for infants undergoing congenital heart surgery. It highlights that about 1% of these infants develop severe acute kidney injury requiring dialysis, with a one-year survival rate of
video0:53 · Jun 2026
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery...
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Lizzy Lee from Cincinnati Children's discusses a study on hemodialysis outcomes in infants after congenital heart surgery (CHS). Approximately 1% of infants undergoing CHS develop severe acute kidney injury (AKI) requiring dialysis, with a
video0:53 · Jun 2026
Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis
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Lizzie Lee from Cincinnati Children's discusses a study on pediatric pulmonary vein stenosis (PVS), a rare but serious condition. The research compares surgical and catheter-based interventions, revealing high recurrence rates for both appr
video0:57 · Jul 2026
The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues — Charlie Stolar, Congenital Diaphragmatic Hernia with Dr. Charlie Stolar · 5:24
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
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Dr Charlie Stolar discusses key points of CDH with Dr. Todd Ponsky. EDITED BY NICHOLAS BRUNS, MD and IAN GLENN, MD.In this episode, Dr. Charles Stolar from Columbia University College of Physicians and Surgeons and California Pediatric Sur
podcast1:22:05 · Dec 2020
Abdominal Wall Defects with Dr. Jacob Langer
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Dr Jacob Langer discusses abdominal wall defects with Dr. Todd Ponsky.Edited by Ian C. Glenn, MD and Sophia Abdulhai, MDAn interactive discussion about gastroschisis and omphalocele between Todd Ponsky, MD and Jacob "Jack" Langer, MD. Dr. L
podcast52:45 · Dec 2020
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Congenital diaphragmatic hernia (CDH) is a field defect causing bilateral pulmonary hypoplasia and altered pulmonary vascular resistance, not a surgical emergency but a physiologic one requiring birth at ECMO-capable centers.[e303-c2,e303-c3,e303-c4,e303-c7] Survival to adolescence is 80–85%. Respiratory management prioritizes spontaneous breathing with minimal sedation; preductal saturations of 90% are adequate given fetal hemoglobin.[e303-c14,e303-c17] Nitric oxide offers no benefit; oxygen is the primary therapy.[e303-c19,e303-c20] ECMO candidacy (OI >40 for ≥4 hours) requires reversible disease; VA bypass is preferred over VV given frequent cardiac dysfunction and mediastinal shift.[e303-c15,e303-c22,e303-c24] The foregut dysmotility—not reflux—causes esophageal and gastric ectasia; Nissen fundoplication is contraindicated.[e303-c28,e303-c30,e303-c32] Long-term sequelae include Barrett's esophagitis, neurodevelopmental disorders (ADHD, autism), asymmetric chest growth, and thoracolumbar scoliosis requiring multidisciplinary follow-up.[e303-c34,e303-c35,e303-c36,e303-c37] Pulmonary hypertension in CDH persists beyond 3 weeks in 50% of patients; endothelin upregulation predicts outcome, and chronic prostacyclin therapy (Remodulin) yields 50% survival.[e10205-c2,e10205-c5,e10205-c6] Combined pressure-flow forces drive endothelial dysfunction and vascular remodeling more than flow alone.[e10205-c21,e10205-c22] Post-cardiac surgery acute kidney injury requiring dialysis occurs in 1% of infants, with 1-year survival of 46% versus 94% without dialysis; high-volume centers achieve threefold better hospital survival.[e12114-c1,e12114-c2,e12114-c3,e12114-c5]
- CDH is a bilateral lung field defect, not a surgical emergency; manage with spontaneous ventilation, preductal O₂ monitoring, and avoid nitric oxide.
- Foregut dysmotility in CDH mimics reflux but is not; Nissen fundoplication worsens outcomes. Continuous feeds and PPIs are preferred.
- ECMO for CDH requires reversible disease (OI >40 ×4h); VA bypass preferred over VV given cardiac dysfunction and mediastinal shift.
- Post-cardiac surgery AKI requiring dialysis (1% incidence) has 46% 1-year survival; high-volume dialysis centers triple hospital survival.
Expert statements from the recordings in this collection.
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies
Charlie Stolar2:45
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 Stolar3:37
CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side
Charlie Stolar4:14
At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation
Charlie Stolar4:23
CDH is a field defect; the most common neonatal comorbidity is foregut motility difficulty
Charlie Stolar4:39
CDH is a medical physiologic emergency but not a surgical emergency
Charlie Stolar5:00
The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues
Antenatal interventions for CDH are no better than investigational and experimental at best
Babies with CDH should be born at a full-service children's facility with ECMO capability; maybe 10-15% will benefit from ECMO
In single-center experiences, presence of liver in the chest or stomach in the chest is of no prognostic value
Charlie Stolar8:31
Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8), where prognosis is concerning
Charlie Stolar8:42
Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis
Charlie Stolar9:07
If shown 100 children with CDH, 80-85% will survive to become teenagers
Charlie Stolar10:13
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 Stolar10:37
Exit to ECMO for CDH is nonsense; it moves the goalposts on almost certainly non-viable babies
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 Stolar13:00
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 Stolar14:45
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 Stolar15:55
ECMO is a drug delivery system for oxygen; indication is when end organs aren't getting enough oxygen despite best care
Charlie Stolar17:06
The best way to assess end-organ function is urine output
Charlie Stolar17:44
ECMO indication is typically oxygenation index in excess of 40 for 4 hours or more
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 Stolar19:06
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 Stolar20:25
Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today
CDH babies are not paralyzed during ventilation; minimal sedation is used and babies should be awake and breathing spontaneously
Charlie Stolar21:56
Initial conventional ventilator settings (IMV rate ~40, peak pressure 25-28, PEEP ~5) are not tolerated by most CDH babies
Charlie Stolar22:15
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 Stolar22:53
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 Stolar24:30
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
The best drug for CDH is oxygen