# Fetal Surgery — GCMD Library living collection Also covered as: myelomeningocele · congenital diaphragmatic hernia · pulmonary hypoplasia · hydrops · hydrocephalus · spina bifida · hindbrain herniation · ascites Experts: Dr. Rod Gerardo, Dr. Alan Flake, Dr. Jack Langer, Dr. Steven Rothenberg Updated: n/a · 30 episodes · 724 cited statements ## Episodes ### Diagnosis & Workup - [Overview of Prenatal Diagnosis: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743) — video · 40:34 · [machine version](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743.md) - [Prenatal diagnosis of fetal lower urinary tract obstruction: Fetal...](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919) — video · 40:14 · [machine version](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919.md) - [Utility of Fluorescence In Situ Hybridization as a Fetal Surgery Eligibility Criterion for....](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688) — video · 0:52 · [machine version](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688.md) ### Surgical Management - [Controversies in Congenital Diaphragmatic Hernia: Update Course 2018](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338) — video · 41:42 · [machine version](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338.md) - [Urologic Fetal Intervention: Cincinnati Fetal Center](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745) — video · 61:40 · [machine version](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745.md) - [Fetal Interventions Part II: Lung Lesions](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884) — video · 16:30 · [machine version](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884.md) - [Pediatric Hernia: Update Course 2013](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885) — video · 52:50 · [machine version](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885.md) - [Fetal urological aspect: Fetal Genitourinary Disease 2015](https://library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917) — video · 59:23 · [machine version](https://library.globalcastmd.com/watch/fetal-urological-aspect-fetal-genitourinary-disease-2015-917.md) - [Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025) — video · 149:16 · [machine version](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025.md) - [Open Fetal Surgery Overview: Fetal Surgery 2012](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027) — video · 37:55 · [machine version](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027.md) - [Lung Lesions: Fetal Interventions Parts I+II](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088) — video · 30:56 · [machine version](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088.md) - [Fetal Interventions Part I: Lung Lesions](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087) — video · 14:27 · [machine version](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087.md) - [Prenatal Management of CPAMs: Lung Lesions](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089) — video · 18:16 · [machine version](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089.md) - [Neonatal Lung Lesions with Dr. Steven Rothenberg](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307) — podcast · 66:58 · [machine version](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307.md) - [Fetoscopic Endoluminal Tracheal Occlusion (FETO)](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330) — podcast · 5:54 · [machine version](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330.md) - [Fetoscopic Repair of Myelomeningocele (MMC)](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391) — podcast · 5:52 · [machine version](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391.md) - [Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791) — podcast · 10:56 · [machine version](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791.md) - [Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326) — video · 3:41 · [machine version](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326.md) - [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569) — video · 4:30 · [machine version](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569.md) - [Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570) — video · 4:30 · [machine version](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570.md) ### Evidence & Research - [Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026) — video · 165:47 · [machine version](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026.md) - [Journal of Pediatric Surgery Article Review: January 2022 APSA Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103) — podcast · 13:09 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103.md) - [Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404) — video · 22:13 · [machine version](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404.md) - [Journal of Pediatric Surgery Article Highlights: April 2022](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md) - [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 64:30 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.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://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://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 Ep 19](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465) — video · 4:27 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465.md) ### In-Depth Reviews - [The Full Story on CPAMs](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463) — podcast · 56:08 · [machine version](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463.md) - [Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333) — video · 10:23 · [machine version](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333.md) ### Emerging & Future Directions - [The fetal frontier: A review of current and emerging fetal therapies for genetic diseases](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057) — video · 0:44 · [machine version](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=0) FISH Testing Utility in Fetal Surgery Screening (Ep 28) - [0:01](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=1) Introduction and FETO Overview (Ep 29) - [0:59](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=59) Anatomical Navigation (Ep 29) - [2:34](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=154) Balloon Deployment and Positioning (Ep 29) - [3:56](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=236) Summary and Conclusion (Ep 29) - [0:01](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=1) Introduction and Procedure Overview (Ep 30) - [1:03](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=63) Anatomical Navigation (Ep 30) - [2:36](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=156) Balloon Positioning and Deployment (Ep 30) - [3:48](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=228) Summary and Conclusion (Ep 30) - [0:00](https://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=0) Introduction and Study Design (Ep 24) - [0:22](https://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=22) Key Findings (Ep 24) - [0:46](https://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) Conclusion (Ep 24) - [0:09](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=9) Rationale for Fetal Surgery and Prenatal Diagnosis (Ep 23) - [2:11](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=131) Fetal Lung Lesions and CPAM Management (Ep 23) - [5:13](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=313) Sacrococcygeal Teratoma (Ep 23) - [5:45](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=345) Spina Bifida: Pathophysiology and Fetal Repair (Ep 23) - [8:58](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=538) EXIT Procedure (Ep 23) - [0:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=0) Introduction and Myelomeningocele Overview (Ep 26) - [0:47](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=47) Initial Surgical Access and Preparation (Ep 26) - [1:32](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=92) Myelomeningocele Dissection and Neural Reconstruction (Ep 26) - [2:37](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=157) Skin Closure and Grafting (Ep 26) - [3:12](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=192) Closure and Summary (Ep 26) - [0:00](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=0) Introduction and Context (Ep 15) - [1:18](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=78) CDH Severity Classification and Imaging (Ep 15) - [2:41](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=161) FETO Procedure Technique (Ep 15) - [4:12](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=252) Balloon Removal and Delivery (Ep 15) - [5:13](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=313) Closing (Ep 15) - [0:00](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=0) Introduction (Ep 16) - [1:13](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=73) Myelomeningocele Overview and Timing (Ep 16) - [1:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=111) Surgical Access and Port Placement (Ep 16) - [2:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=171) Fetal Anesthesia and Placode Untethering (Ep 16) - [3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224) Defect Closure (Ep 16) - [4:39](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=279) Completion and Postoperative Care (Ep 16) - [0:00](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=0) Fetal Thoracic Interventions: Techniques and Outcomes (Ep 4) - [3:43](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=223) Clinical Perspective on Intervention Indications (Ep 4) - [6:05](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=365) Disappearing Lesions and Diagnostic Challenges (Ep 4) - [9:19](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=559) Indications for Pleuro-Amniotic Shunting (Ep 4) - [12:07](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=727) Referral Criteria and Imaging Strategy (Ep 4) - [0:00](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=0) Introduction and FETO Technique Overview (Ep 9) - [23:20](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=1400) FETO Trial Design and Recruitment Challenges (Ep 9) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "Many centers require genetic testing to rule out chromosome abnormalities before fetal surgery, even when ultrasounds and blood tests already look reassuring" — Lizzie Lee (clinical) [Ep 28 · 0:09](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=9) - "A study reviewed nearly 1000 pregnancies evaluated for fetal surgery" — Lizzie Lee (epidemiological) [Ep 28 · 0:23](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=23) - "When imaging and cell-free DNA screening showed low risk for aneuploidy, the FISH test matched those results 100% of the time" — Lizzie Lee (clinical) [Ep 28 · 0:23](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=23) - "For low-risk pregnancies, FISH did not provide any new information that changed surgery candidacy" — Lizzie Lee (clinical) [Ep 28 · 0:36](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=36) - "In carefully selected low-risk cases, non-invasive screening may be enough, potentially avoiding the FISH procedure" — Lizzie Lee (opinion) [Ep 28 · 0:42](https://library.globalcastmd.com/watch/utility-of-fluorescence-in-situ-hybridization-as-a-fetal-surgery-eligibility-criterion-for-12688?t=42) - "FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus" — Beth Rymeski (clinical) [Ep 29 · 0:33](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=33) - "The procedure uses a standard fetoscope with a side channel through which the balloon is worked" — Beth Rymeski (clinical) [Ep 29 · 0:42](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=42) - "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow" — Jill Knepprath (clinical) [Ep 29 · 0:47](https://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 (clinical) [Ep 29 · 0:53](https://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 when doing FETO because it is bumpy" — Beth Rymeski (clinical) [Ep 29 · 1:21](https://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 29 · 1:29](https://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 29 · 1:38](https://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 identify when navigating to find the correct location" — Beth Rymeski (clinical) [Ep 29 · 1:58](https://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 29 · 2:23](https://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 tracheal (not esophageal) placement and indicates position within the trachea" — Beth Rymeski (clinical) [Ep 29 · 2:36](https://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 29 · 2:56](https://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 29 · 3:03](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=183) - "The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea" — Jill Knepprath (clinical) [Ep 29 · 3:08](https://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 29 · 3:29](https://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" — Beth Rymeski (clinical) [Ep 29 · 3:33](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13569?t=213) - "Final confirmation requires advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea" — Jill Knepprath (clinical) [Ep 29 · 3:40](https://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 abdominal wall into the uterus" — Beth Rymeski (clinical) [Ep 30 · 0:33](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=33) - "The procedure uses a standard fetoscope with a side channel through which the balloon is worked" — Beth Rymeski (clinical) [Ep 30 · 0:42](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=42) - "The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow" — Jill Knepprath (clinical) [Ep 30 · 0:47](https://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 (clinical) [Ep 30 · 0:53](https://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 during FETO because it is bumpy" — Beth Rymeski (clinical) [Ep 30 · 1:21](https://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 and allow easier advancement" — Beth Rymeski (clinical) [Ep 30 · 1:29](https://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 aligned with the scope, twisting and turning is required to navigate through the mouth" — Beth Rymeski (clinical) [Ep 30 · 1:38](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=98) - "The epiglottis is sought as a landmark to guide navigation" — Beth Rymeski (clinical) [Ep 30 · 1:58](https://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 scope goes through the abdominal and uterine walls and could cause membrane damage" — Beth Rymeski (clinical) [Ep 30 · 2:23](https://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 tracheal position and determine location within the trachea" — Beth Rymeski (clinical) [Ep 30 · 2:36](https://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 but should inflate in the main trachea" — Beth Rymeski (clinical) [Ep 30 · 2:56](https://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 to allow visualization of balloon inflation" — Beth Rymeski (clinical) [Ep 30 · 3:03](https://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 (clinical) [Ep 30 · 3:08](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=188) - "The balloon contains a small metal ball that can be visualized" — Beth Rymeski (clinical) [Ep 30 · 3:29](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=209) - "Final confirmation requires visualizing that the balloon is below the vocal cords and in the main trachea" — Beth Rymeski (clinical) [Ep 30 · 3:48](https://library.globalcastmd.com/watch/inside-a-feto-procedure-fetoscopic-balloon-tracheal-occlusion-with-dr-beth-rymeski-13570?t=228) - "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (clinical) [Ep 24 · 0:24](https://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 24 · 0:29](https://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 24 · 0:33](https://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 24 · 0:33](https://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 24 · 0:33](https://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 24 · 0:46](https://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 24 · 0:46](https://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 24 · 0:46](https://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) - "Prenatal ultrasound at mid-gestation around 20 weeks is the most important tool for prenatal diagnosis" — Jose Peiro (clinical) [Ep 23 · 0:47](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=47) - "The rate of detection of malformations is very high in developed countries at 20 weeks gestation" (epidemiological) [Ep 23 · 0:55](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=55) - "Doppler can analyze hemodynamic status by measuring flows in umbilical artery, ductus venosus, and middle cerebral artery" — Jose Peiro (clinical) [Ep 23 · 1:27](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=87) - "Fetal MRI contributes to defining diagnosis after ultrasound, mostly for findings in brain, chest, and abdomen" — Jose Peiro (clinical) [Ep 23 · 1:41](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=101) - "Open fetal surgery requires opening the uterus, which produces a scar and can activate uterine dynamics" (clinical) [Ep 23 · 2:37](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=157) - "Preterm delivery can happen a few days after fetal surgery even if the surgery was successful, despite tocolysis" (clinical) [Ep 23 · 2:45](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=165) - "Open fetal surgery is still used for large solid masses in the chest, sacrococcygeal teratomas, and spina bifida" — Jose Peiro (clinical) [Ep 23 · 3:12](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=192) - "CVR (congenital pulmonary airway malformation volume ratio) is calculated by mass volume (width × height × length × 0.523) divided by head circumference, with cutoff of 1.6" (clinical) [Ep 23 · 4:12](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=252) - "CVR less than 1.6 indicates very low risk of developing hydrops; more than 1.6 indicates high risk" — Jose Peiro (clinical) [Ep 23 · 4:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=265) - "Maternal intramuscular betamethasone is first-line therapy for CPAM, given in 1, 2, or 3 rounds weekly to decrease CVR" (clinical) [Ep 23 · 4:36](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=276) - "Steroids rescue more than half of CPAM cases; approximately 40% do not respond well" — Jose Peiro (clinical) [Ep 23 · 4:53](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=293) - "For solid CPAM before 30 weeks that does not respond to steroids, open fetal surgery with lobectomy is the only option" — Jose Peiro (clinical) [Ep 23 · 4:56](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=296) - "In spina bifida, the spinal cord malformation occurs at 4 weeks of embryonic time" — Jose Peiro (clinical) [Ep 23 · 6:04](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=364) - "Neural tissue in spina bifida is exposed to amniotic fluid rich in meconium and enzymes that progressively damage and destroy the spinal cord and nerves" — Jose Peiro (clinical) [Ep 23 · 6:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=385) - "At 24 weeks gestation, half of fetuses with spina bifida already have hydrocephalus" (epidemiological) [Ep 23 · 7:20](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440) - "95% of fetuses with spina bifida will develop hydrocephalus later in pregnancy if they do not have it at 24 weeks" (epidemiological) [Ep 23 · 7:20](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=440) - "The MOMS trial showed prenatal spina bifida surgery reduced the need for shunting by at least half" (clinical) [Ep 23 · 8:17](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=497) - "Prenatal spina bifida repair improved mental scores and motor outcomes" (clinical) [Ep 23 · 8:22](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=502) - "Prenatal spina bifida repair completely reversed hindbrain herniation in most cases" (clinical) [Ep 23 · 8:29](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=509) - "EXIT procedure can maintain oxygenation from mother through placenta for 1 to 3 hours" — Jose Peiro (clinical) [Ep 23 · 9:25](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=565) - "EXIT procedure uses inhalational anesthetics for uterine relaxation" (clinical) [Ep 23 · 9:41](https://library.globalcastmd.com/watch/open-fetal-surgery-exit-procedure-with-dr-jose-peiro-9333?t=581) - "Myelomeningocele is a neural tube defect where the spinal cord does not close and is exposed on surface through an opening in the spine" (clinical) [Ep 26 · 0:20](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=20) - "Myelomeningocele usually occurs in the low back region" (clinical) [Ep 26 · 0:31](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=31) - "The incidence of neural tube defects is around 0.2 per 1000 live births in the United States" (epidemiological) [Ep 26 · 0:33](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=33) - "When diagnosed prenatally, myelomeningoceles can be repaired during the fetal stage of life while in utero" (clinical) [Ep 26 · 0:39](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=39) - "The pregnant patient is placed under general anesthesia and the uterus is approached by a midline laparotomy" (clinical) [Ep 26 · 0:47](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=47) - "An ultrasound is used to map the location of the placenta and major vessels on the uterine surface" (clinical) [Ep 26 · 0:55](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=55) - "Four full thickness sutures are placed through the uterine wall to delineate a 1 centimeter square area through which a 10 French trochar is inserted using Seldinger technique" (clinical) [Ep 26 · 1:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=60) - "After removing a portion of the amniotic fluid, the uterus is insufflated with warm, humidified carbon dioxide" (clinical) [Ep 26 · 1:14](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=74) - "Two subsequent trocars are placed under endoscopic visualization" (clinical) [Ep 26 · 1:22](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=82) - "Prior to surgical intervention, the fetus is administered a sedative cocktail of rocuronium, fentanyl, and atropine" (clinical) [Ep 26 · 1:26](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=86) - "Dissection of the myelomeningocele begins lateral to the exposed spinal cord, detaching it from the arachnoid and skin" (clinical) [Ep 26 · 1:32](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=92) - "The spinal cord is circumferentially released, taking care not to injure the ascending spinal cord, lateral dorsal roots, or segmental vasculature" (clinical) [Ep 26 · 1:41](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=101) - "Tenotomy scissors and right-angled hook electrocautery are used to sharply dissect through the tissue to completely free the placode" (clinical) [Ep 26 · 1:51](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=111) - "The neural placode is reconstructed with interrupted 6-0 sutures after it is completely untethered from the skin" (clinical) [Ep 26 · 1:59](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=119) - "The dura attaches laterally and ventrally to the open skin edge at the junctional zone" (clinical) [Ep 26 · 2:06](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=126) - "Lateral fascia and muscle may be freed to allow medialization and primary closure of the dura under less tension" (clinical) [Ep 26 · 2:16](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=136) - "A running, non-absorbable 6-0 suture is utilized to re-approximate the dura, which will persist long term and act as a useful guide if subsequent untethering is required" (clinical) [Ep 26 · 2:24](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=144) - "Skin closure should be performed in the mid-sagittal plane when possible" (clinical) [Ep 26 · 2:37](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=157) - "Skin mobilization may require including the subcutaneous fat layer, as the skin's vascular supply comes through this layer" (clinical) [Ep 26 · 2:43](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=163) - "Blunt dissection in the plane between the muscle and subcutaneous fat is the best method to preserve the blood supply" (clinical) [Ep 26 · 2:49](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=169) - "In some cases, the size of the skin defect may prevent primary skin closure" (clinical) [Ep 26 · 2:55](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=175) - "A synthetic skin graft may be utilized and sutured to the edges of the healthy skin when primary closure is not possible" (clinical) [Ep 26 · 3:00](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=180) - "The synthetic skin graft will promote eventual epithelialization of the open defect" (clinical) [Ep 26 · 3:07](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=187) - "After completing the fetal back closure, the amniotic fluid is replaced in the uterus with warmed, lactated Ringer solution" (clinical) [Ep 26 · 3:12](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=192) - "The ports are removed and the insertion sites are closed, the uterus is returned to the abdominal cavity and the abdominal incision is closed in the standard fashion" (clinical) [Ep 26 · 3:19](https://library.globalcastmd.com/watch/myelomeningoceles-fetoscopic-intrauterine-myelomeningocele-closure-11326?t=199) - "It is difficult to determine with imaging exactly how large the hole in the diaphragm is in CDH" — Fung Lim (clinical) [Ep 15 · 1:29](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=89) - "Ultrasound is usually the screening tool used to find congenital diaphragmatic hernia in the fetus" — Rod Gerardo (clinical) [Ep 15 · 1:40](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=100) - "MRI provides higher resolution imaging than ultrasound for fetal CDH and can provide information about the pulmonary status of the fetus" — Rod Gerardo (clinical) [Ep 15 · 1:48](https://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 15 · 2:05](https://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 15 · 2:11](https://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 15 · 2:24](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=144) - "Fetuses with severe CDH are good candidates for FETO" — Rod Gerardo (clinical) [Ep 15 · 2:35](https://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 and 6 days" — Fung Lim (clinical) [Ep 15 · 2:44](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=164) - "Local anesthetic with numbing medication is injected into the mother for the FETO procedure" — Fung Lim (clinical) [Ep 15 · 2:58](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=178) - "An introducer is inserted into the amniotic space to allow placement of a fetoscope" — Fung Lim (clinical) [Ep 15 · 3:04](https://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 15 · 3:16](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=196) - "The ideal position for the fetoscope 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 15 · 3:27](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=207) - "A balloon is inserted into the airway, inflated to completely occlude the trachea, then detached and left in place" — Fung Lim (clinical) [Ep 15 · 3:38](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=218) - "Fetal lung tissue constantly creates fluid that normally escapes through the trachea" — Rod Gerardo (clinical) [Ep 15 · 3:48](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=228) - "When the trachea is occluded, fluid continues to build up and pressure builds in the trachea, which helps the lungs develop" — Rod Gerardo (clinical) [Ep 15 · 3:52](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=232) - "The balloon is left in place for a few weeks to accelerate lung growth" — Fung Lim (clinical) [Ep 15 · 4:12](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=252) - "Balloon removal is typically attempted at about 34 weeks gestation" — Rod Gerardo (clinical) [Ep 15 · 4:18](https://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 15 · 4:26](https://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 15 · 4:33](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=273) - "If the baby's position doesn't allow for needle puncture, a grasper is used to hold the balloon while a needle punctures it, then the deflated balloon is removed using the grasper" — Fung Lim (clinical) [Ep 15 · 4:40](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=280) - "The mother and fetus are monitored carefully for the remainder of the pregnancy after balloon removal" — Fung Lim (clinical) [Ep 15 · 4:56](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=296) - "Ideally, the baby is delivered vaginally at term with C-section reserved for the usual obstetrical reasons" — Fung Lim (clinical) [Ep 15 · 5:02](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-4330?t=302) - "Neural tube defects are the most common congenital central nervous system anomaly" — Rod Gerardo (epidemiological) [Ep 16 · 0:42](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=42) - "Myelomeningocele or spina bifida is the most common neural tube defect" — Rod Gerardo (epidemiological) [Ep 16 · 1:20](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=80) - "In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin so the meninges and spinal cord are exposed" — Rod Gerardo (clinical) [Ep 16 · 1:25](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=85) - "The patient may be left with neural defects based on the level of the spinal cord where the lesion is" — Rod Gerardo (clinical) [Ep 16 · 1:33](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=93) - "Prenatal repair is most commonly done between 22 and 26 weeks gestation" — Fung Lim (guideline) [Ep 16 · 1:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=104) - "For maternal access, either a transverse incision or a midline incision may be used" — Fung Lim (clinical) [Ep 16 · 1:54](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=114) - "The amniotic cavity is expanded using humidified and heated carbon dioxide to create more space for the repair" — Fung Lim (clinical) [Ep 16 · 2:22](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=142) - "Three ports total are placed: one first port under ultrasound guidance, then two additional ports under direct vision" — Fung Lim (clinical) [Ep 16 · 2:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=137) - "Fetal anesthesia is induced via an intragluteal injection" — Rod Gerardo (clinical) [Ep 16 · 2:51](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=171) - "A stabilization stitch is placed in the baby's upper back above the spina bifida" — Fung Lim (clinical) [Ep 16 · 2:56](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=176) - "The sack is opened and dissection is performed circumferentially around it" — Rod Gerardo (clinical) [Ep 16 · 3:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=188) - "The placode is freed in a procedure called untethering, which allows it to fall back down into the spinal canal" — Fung Lim (clinical) [Ep 16 · 3:25](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=205) - "Skin flaps are created to loosen the skin and help form a watertight closure of the spinal defect" — Fung Lim (clinical) [Ep 16 · 3:44](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=224) - "A patch is placed into the defect to protect the placode and anchored with dissolvable sutures" — Fung Lim (clinical) [Ep 16 · 3:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=237) - "A second patch is placed to give additional protection and secured with dissolvable sutures" — Fung Lim (clinical) [Ep 16 · 4:08](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=248) - "The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin" — Fung Lim (clinical) [Ep 16 · 4:17](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=257) - "If the defect is too big and the skin edges cannot be approximated, a skin patch is used to form a watertight closure" — Fung Lim (clinical) [Ep 16 · 4:26](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=266) - "Port sites are closed with dissolvable sutures" — Fung Lim (clinical) [Ep 16 · 4:49](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=289) - "Removed amniotic fluid is replaced with warm fluid and antibiotics are placed into the amniotic cavity" — Fung Lim (clinical) [Ep 16 · 4:57](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=297) - "If able, the baby is delivered vaginally at term" — Rod Gerardo (clinical) [Ep 16 · 5:14](https://library.globalcastmd.com/watch/fetoscopic-repair-of-myelomeningocele-4391?t=314) - "Shunts for macrocystic CCAMs have been performed with pretty good success, with similar test numbers to published series" — Jack (clinical) [Ep 4 · 0:29](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=29) - "Vessel occlusion in bronchopulmonary sequestrations or hybrid lesions using various techniques has had mixed success" — Jack (clinical) [Ep 4 · 0:49](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=49) - "Radiofrequency ablation for vessel occlusion was a disaster and is not recommended" — Jack (clinical) [Ep 4 · 1:27](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=87) - "Coil embolization was initially successful but the fetus died about a week later for unclear reasons" — Jack (clinical) [Ep 4 · 1:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=93) - "Alcohol injection for vessel occlusion carries risk of systemic circulation through shunts, potentially causing thrombosis in cardiac chambers and other sites" — Alan (clinical) [Ep 4 · 1:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=112) - "The effects of alcohol injection on fetal neural development and organ development have not been studied experimentally, even in sheep models" — Alan (opinion) [Ep 4 · 2:29](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=149) - "Radiofrequency ablation cannot be controlled in the fetus due to 90% water content, with energy dispersing unpredictably and causing collateral damage" — Alan (clinical) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=180) - "Probably 95% of CCAMs are now prenatally diagnosed" (epidemiological) [Ep 4 · 3:46](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=226) - "Almost none of prenatally diagnosed CCAMs require prenatal intervention and very few require intervention the day the child is born" (clinical) [Ep 4 · 3:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=232) - "Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions due to the small number of cases requiring such treatment" (opinion) [Ep 4 · 4:09](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=249) - "The majority of children with prenatally diagnosed lung lesions can be delivered without fetal distress" (clinical) [Ep 4 · 4:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=273) - "Some cases with hydrops have regressed spontaneously, with the CCAM not even detectable on CT scan a year after birth" (clinical) [Ep 4 · 4:57](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=297) - "Many lung lesions have been referred after recommendation for termination by practitioners who don't understand the natural history" — Alan (clinical) [Ep 4 · 5:20](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=320) - "Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions" — Alan (clinical) [Ep 4 · 5:31](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=331) - "Garden variety postnatal CCAM is very different than some prenatal CCAMs" — Alan (clinical) [Ep 4 · 5:44](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=344) - "True cystic CCAMs do not disappear, though they often regress and become isoechogenic in third trimester" — Alan (clinical) [Ep 4 · 6:05](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=365) - "All cystic CCAMs seen prenatally and followed with postnatal CT scan at one month remain present and prominent" — Alan (clinical) [Ep 4 · 6:30](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=390) - "Some lesions that look like CCAMs in utero are actually bronchial stenosis or atresia, which can be minimally apparent or non-apparent after birth" — Alan (clinical) [Ep 4 · 6:13](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=373) - "Congenital lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring specimen examination" — Jean Martin (opinion) [Ep 4 · 7:45](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=465) - "Many tertiary centers have the capacity to perform EXIT procedures with appropriate team approach and leadership" — Jean Martin (clinical) [Ep 4 · 8:17](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=497) - "Indications for EXIT procedure are more important than technical capability, as inappropriate use can lead to unnecessary intervention" — Jean Martin (opinion) [Ep 4 · 8:28](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=508) - "Good prenatal diagnosis is essential and not equivalent across all centers or practitioners" — Alan (opinion) [Ep 4 · 9:19](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=559) - "Lung agenesis is frequently misdiagnosed as microcystic CCAM at other centers" — Alan (clinical) [Ep 4 · 9:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=573) - "EXIT procedure is more invasive than regular cesarean section" — Jean Martin (clinical) [Ep 4 · 9:56](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=596) - "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops" — Alan (clinical) [Ep 4 · 11:08](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=668) - "Hydrops is defined as requiring more than just ascites: must include pleural effusion, pericardial effusion, and skin or scalp edema" — Alan (clinical) [Ep 4 · 11:18](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=678) - "Pure ascites is not necessarily hydrops and can be related to mediastinal shift and hepatic venous return" — Alan (clinical) [Ep 4 · 11:27](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=687) - "Pleuro-amniotic shunts are avoided prophylactically" — Alan (clinical) [Ep 4 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=708) - "Large macrocystic lesions may be tapped just prior to delivery to improve ventilation, but shunts are not placed unless there is hydrops" — Alan (clinical) [Ep 4 · 11:52](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=712) - "CVR cutoff of 1.6 is used for prediction of adverse physiology" — Alan (clinical) [Ep 4 · 13:33](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=813) - "CVR less than 1.6 on presentation of a CCAM predicts likelihood of hydrops evolution at about 3% or less than 5%" — Alan (clinical) [Ep 4 · 13:36](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=816) - "It is very unusual for a CVR less than 1.6 with microcystic lesion to evolve into hydrops" — Alan (clinical) [Ep 4 · 14:04](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=844) - "CVR greater than 1.6 requires close watching with much higher likelihood of hydrops evolution" — Alan (clinical) [Ep 4 · 14:11](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=851) - "Macrocystic lesions are a wild card because cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6" — Alan (clinical) [Ep 4 · 14:18](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=858) - "MRI is often helpful in defining anatomy and general size of lesions" — Alan (clinical) [Ep 4 · 14:40](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=880) - "MRI can clarify abnormalities when there is ambiguity on ultrasound or confusion about diagnosis" — Alan (clinical) [Ep 4 · 15:07](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=907) - "In centers not geared toward fetal aspects, most patients are followed with fetal ultrasound alone and evaluated after birth, with MRI reserved for unusual cases" (clinical) [Ep 4 · 15:25](https://library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=925) - "FETO for severe CDH (LHR <25%, liver up) increases survival from approximately 20% to 50-60%" — Jan Deprest (clinical) [Ep 9 · 12:42](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=762) - "Premature rupture of membranes occurs in 20-25% of FETO cases before 34 weeks" — Jan Deprest (clinical) [Ep 9 · 8:32](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=512) - "Balloon removal in utero at least 24 hours before birth improves both survival and early morbidity" — Jan Deprest (clinical) [Ep 9 · 11:32](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=692) - "The median gestational age at birth after FETO is 35 weeks, similar to open fetal surgery" — Jan Deprest (clinical) [Ep 9 · 8:32](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=512) - "FETO does not appear to substitute mortality for morbidity - there is an apparent decrease in bronchopulmonary dysplasia" — Jan Deprest (clinical) [Ep 9 · 15:50](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=950) - "Twin-twin transfusion syndrome occurs in 10-20% of monochorionic twin pregnancies" — Steven Rothenberg (epidemiological) [Ep 9 · 79:24](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=4764) - "Arterio-arterial anastomoses act as bidirectional connections that equilibrate unidirectional AV anastomoses and prevent TTTS" — Steven Rothenberg (clinical) [Ep 9 · 83:37](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5017) - "Amnio-reduction improves fetal oxygenation by decreasing placental compression from polyhydramnios" — Steven Rothenberg (clinical) [Ep 9 · 90:22](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=5422) - "High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, and 78% dual twin survival" — Steven Rothenberg (clinical) [Ep 9 · 103:50](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6230) - "Major neurodevelopmental delays after laser photocoagulation occur in 5-6% of cases, minor delays in 7-8%" — Steven Rothenberg (clinical) [Ep 9 · 104:33](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6273) - "Missed vascular connections occur in approximately 0.8% of cases with careful mapping and placental injection studies" — Steven Rothenberg (clinical) [Ep 9 · 110:11](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6611) - "Type 3 sIUGR is characterized by intermittent absent/reversed end-diastolic flow due to large AA anastomoses causing acute fetal-to-fetal transfusions" — Steven Rothenberg (clinical) [Ep 9 · 129:43](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=7783) - "Type 3 sIUGR has 20-25% risk of periventricular leukomalacia in the normal twin due to recurrent hypovolemic episodes" — Steven Rothenberg (clinical) [Ep 9 · 135:40](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8140) - "With expectant management of Type 3 sIUGR, there is 48% loss in the smaller twin and 33% loss in the normal twin" — Steven Rothenberg (clinical) [Ep 9 · 136:04](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8164) - "Bipolar cord cauterization achieves 86% singleton survival; radiofrequency ablation achieves 83% singleton survival" — Steven Rothenberg (clinical) [Ep 9 · 141:22](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8482) - "Earlier tracheal occlusion produces better lung growth response than later occlusion" — Jan Deprest (clinical) [Ep 9 · 33:44](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=2024) - "Delivery after 32 weeks following FETO results in 60% survival, which does not increase further beyond 34 weeks" — Jan Deprest (clinical) [Ep 9 · 14:53](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=893) - "The diode laser is much safer than argon laser for vessel photocoagulation, with lower penetration depth and less risk of vessel rupture" — Steven Rothenberg (clinical) [Ep 9 · 107:05](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6425) - "Completing laser ablation in under 5 minutes from first to last vessel minimizes vascular shifts and improves donor survival" — Michael Harrison / Hanmin Lee / Tim Crombleholme (clinical) [Ep 9 · 111:36](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=6696) - "In Type 3 sIUGR, 75% of smaller twins die within 48 hours after laser photocoagulation because they are dependent on the larger twin for survival" — Eduardo Gratacos (clinical) [Ep 9 · 146:21](https://library.globalcastmd.com/watch/fetoscopic-endoluminal-tracheal-occlusion-and-twin-twin-transfusion-fetal-1025?t=8781) - "Steroids are effective for treating large predominantly macrocystic CCAMs that aren't hydrops" — Todd (moderator) (clinical) [Ep 8 · 0:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=0) - "There have been only 1-3 fetal surgical resections for CCAs in most places in the last 5 years because steroids are effective" — Scott Adzik (clinical) [Ep 8 · 0:12](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=12) - "CCAM tumors tend to plateau and stop growing between 24 and 26 weeks gestation" — Todd (moderator) (clinical) [Ep 8 · 2:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=120) - "If you give steroids after 26 weeks, it's difficult to differentiate steroid effect from natural tumor plateau" — Todd (moderator) (clinical) [Ep 8 · 2:39](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=159) - "By the time patients reach referral centers, they've often already received steroids because the word is out" — Todd (moderator) (clinical) [Ep 8 · 3:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=200) - "If tumor continues to grow one week after betamethasone course, that's reason to try a second dose" — Todd (moderator) (clinical) [Ep 8 · 3:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=223) - "If you've given two courses of steroids and tumor continues to grow, it's a non-responsive tumor requiring more definitive intervention" — Todd (moderator) (clinical) [Ep 8 · 4:44](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=284) - "A patient with CVR almost 4 didn't respond to 2 rounds and a third round of steroids, delivered at 31 weeks" — Scott Adzik (clinical) [Ep 8 · 4:59](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=299) - "It's very hard to predict which kids will benefit from an EXIT procedure based on CVR criteria alone" — Todd (moderator) (clinical) [Ep 8 · 8:02](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=482) - "Some CPAM tumors are firm and noncompressible, requiring emergency decompression if there's massive mediastinal shift" — Todd (moderator) (clinical) [Ep 8 · 8:15](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=495) - "EXIT procedures have probably been overutilized in the past" — Todd (moderator) (opinion) [Ep 8 · 9:08](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=548) - "Type 1 SCTs can be expected to have good anorectal function; type 2 and 3 SCTs risk pelvic outlet compression and urogenital anomalies" — Todd (moderator) (clinical) [Ep 8 · 11:03](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=663) - "Type 2 and type 3 SCTs are at risk for acute renal injury and chronic renal insufficiency from bladder outlet obstruction" — Todd (moderator) (clinical) [Ep 8 · 11:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=717) - "Late recurrences with malignancy in SCT cases have been seen in the teen years" — Todd (moderator) (clinical) [Ep 8 · 13:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=780) - "RFA technology is problematic in the fetus because of the fluid content (80-90% water) making heat energy uncontrollable" — Todd (moderator) (clinical) [Ep 8 · 15:20](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=920) - "Ethanolamine doesn't stay in SCT tumors due to large arteriovenous communications, resulting in immediate thrombosis and emboli" — Todd (moderator) (clinical) [Ep 8 · 15:47](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=947) - "MR-guided high frequency ultrasound (HIFU) can pinpoint within 1 millimeter and coagulate vessels" — Todd (moderator) (clinical) [Ep 8 · 20:36](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=1236) - "Only about 5 HIFU devices are available in the US, approved by FDA to treat uterine fibroids" — Todd (moderator) (clinical) [Ep 8 · 21:04](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=1264) - "Fetoscopic repair with 3-4 ports leads to membrane fixation and tearing with uterine growth, causing premature birth 3-6 weeks after surgery" — Todd (moderator) (clinical) [Ep 8 · 22:37](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=1357) - "Spina bifida affects about 1500 babies born per year in the US (30 per week, 5-6 per day)" — Scott Adzik (epidemiological) [Ep 8 · 82:06](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4926) - "With standard postnatal care, roughly 14% of MMC patients die by age 5, mostly due to symptomatic brainstem compression" — Scott Adzik (epidemiological) [Ep 8 · 83:14](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=4994) - "About 85% of MMC patients require shunts with standard postnatal care, with half developing complications within one year" — Scott Adzik (epidemiological) [Ep 8 · 83:25](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5005) - "Mid-gestational spinal cord exposure in fetal sheep leads to a human-like myelomeningocele at birth with paralysis and loss of sensation" — Scott Adzik (clinical) [Ep 8 · 86:09](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5169) - "In utero coverage of myelomeningocele in sheep rescues neurologic function at birth" — Scott Adzik (clinical) [Ep 8 · 86:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5203) - "Hindbrain herniation reverses after in utero MMC repair, as shown on MRI at birth" — Scott Adzik (clinical) [Ep 8 · 89:45](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5385) - "When MMC is repaired before birth, CSF is prevented from leaking out, reestablishing pressure column and allowing hindbrain to ascend" — Scott Adzik (clinical) [Ep 8 · 90:23](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5423) - "In CHOP's pre-MOMS experience with 50 cases, shunt rate by one year was 40%" — Scott Adzik (clinical) [Ep 8 · 93:10](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5590) - "Two-thirds of prenatal MMC repair patients were two or more levels better functionally than the anatomic level" — Scott Adzik (clinical) [Ep 8 · 93:41](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5621) - "Postnatal MMC repair has approximately 85% shunt rate versus 40% for prenatal repair" — Scott Adzik (clinical) [Ep 8 · 94:08](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5648) - "In CHOP's pre-MOMS series, 44% delivered before planned 36-week C-section, with mean GA at delivery 32 weeks for that group" — Scott Adzik (clinical) [Ep 8 · 94:44](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=5684) - "13% of prenatal MMC surgery patients in MOMS trial were born at less than 30 weeks gestation" — Scott Adzik (clinical) [Ep 8 · 104:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6297) - "At age 5, 83% of prenatally repaired MMC children were in average or high average range on neurodevelopmental tests" — Scott Adzik (clinical) [Ep 8 · 112:26](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6746) - "MOMS trial was stopped December 7, 2010 by Data Safety Monitoring Board due to efficacy of prenatal surgery" — Scott Adzik (clinical) [Ep 8 · 102:18](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6138) - "MOMS trial: shunts placed in 40% of prenatal surgery group versus 82% of postnatal surgery group" — Scott Adzik (clinical) [Ep 8 · 102:55](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6175) - "MOMS trial: 42% of prenatal surgery group could walk independently versus 21% of postnatal group" — Scott Adzik (clinical) [Ep 8 · 103:31](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6211) - "MOMS trial: prenatal surgery group had anatomically higher lesions (68% L3 or lower) versus postnatal (84% L3 or lower)" — Scott Adzik (clinical) [Ep 8 · 103:40](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6220) - "MOMS trial: gestational age at birth was just beyond 34 weeks in prenatal group versus beyond 37 weeks in postnatal group" — Scott Adzik (clinical) [Ep 8 · 104:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6297) - "MOMS trial: respiratory distress syndrome was significantly higher in prenatal surgery group" — Scott Adzik (clinical) [Ep 8 · 105:21](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6321) - "Post-MOMS at CHOP: 359 referrals, 202 evaluated on-site, only 60 (30%) underwent fetal surgery" — Scott Adzik (clinical) [Ep 8 · 107:57](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6477) - "Absence of hindbrain herniation on MRI (signifying closed defect) is an exclusion criterion for fetal MMC surgery" — Scott Adzik (guideline) [Ep 8 · 108:58](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6538) - "Fetoscopic MMC repair with 3-4 ports has higher rates of fetal death, PROM, chorioamnionitis, oligohydramnios, premature delivery, and persistent hindbrain herniation compared to open repair" — Scott Adzik (clinical) [Ep 8 · 110:00](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=6600) - "There have been 3 maternal deaths from open fetal surgery in South America" — Todd (moderator) (clinical) [Ep 8 · 132:16](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=7936) - "In the US experience with open fetal surgery, there have been no maternal deaths and no serious maternal complications in recent years" — Todd (moderator) (clinical) [Ep 8 · 133:43](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8023) - "One out of three mothers in European MMC program declines open surgery, representing missed opportunities" — Todd (moderator) (clinical) [Ep 8 · 146:39](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8799) - "In classical cystic myelomeningocele, it is essential to remove the cyst and excise tissues that don't belong, not just cover the lesion" — Todd (moderator) (clinical) [Ep 8 · 147:34](https://library.globalcastmd.com/watch/fetal-surgical-intervention-for-myelomeningocele-fetal-surgery-2012-1026?t=8854) - "Most congenital defects are still treated by waiting and treating the neonate, with fetal intervention reserved for a very few appropriately selected cases" — Alan Flake (clinical) [Ep 10 · 1:08](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=68) - "Accepted indications for fetal surgery include pulmonary airway malformations, bronchial atresia, CHAOS, sacrococcygeal teratoma, and myelomeningocele" — Alan Flake (clinical) [Ep 10 · 1:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=101) - "The majority of CPAM lesions regress late in gestation and do not require any fetal intervention" — Alan Flake (clinical) [Ep 10 · 2:53](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=173) - "Bronchial atresia can masquerade as microcystic CPAM but is distinguished by a dilated central bronchus or mucocele and requires documentation of contralateral lung presence" — Alan Flake (clinical) [Ep 10 · 3:31](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=211) - "Hydrops is the sole indication for consideration of open fetal surgery in CPAM" — Alan Flake (clinical) [Ep 10 · 5:13](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=313) - "CVR (CPAM volume ratio) greater than 1.6 indicates high risk for evolution to hydrops" — Alan Flake (clinical) [Ep 10 · 6:01](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=361) - "The majority of high-risk CPAMs respond to a trial of maternal steroids" — Alan Flake (clinical) [Ep 10 · 6:15](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=375) - "Open fetal surgery for CPAM is now extremely rare, with CHOP and UCSF reporting approximately one case in five years combined" (epidemiological) [Ep 10 · 28:44](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1724) - "Steroids have had a dramatic impact on reducing the number of open fetal surgeries for microcystic CPAM" — Alan Flake (clinical) [Ep 10 · 29:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1751) - "Macrocystic CPAMs and bronchial atresia do not respond as well to steroids as microcystic CPAMs" — Alan Flake (clinical) [Ep 10 · 29:23](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1763) - "Open fetal surgery for CPAM has approximately 60% survival" — Alan Flake (epidemiological) [Ep 10 · 10:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634) - "Thoracoamniotic shunts for macrocystic CPAM have 70-75% survival" — Alan Flake (epidemiological) [Ep 10 · 10:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=634) - "CHOP has treated three bronchial atresia cases by fetal intervention with one intraoperative fetal death, one hepatic necrosis death, and one ongoing NICU case" — Alan Flake (epidemiological) [Ep 10 · 10:52](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=652) - "Bronchial atresia is a much more difficult lesion to treat than CPAMs" — Alan Flake (opinion) [Ep 10 · 11:46](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=706) - "SCT fetal pathophysiology includes tumor vascular steal leading to high output cardiac failure" — Alan Flake (clinical) [Ep 10 · 12:18](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=738) - "Fetal SCT resection aims to interrupt arteriovenous steal from the low resistance tumor to prevent progression of high output failure" — Alan Flake (clinical) [Ep 10 · 12:28](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=748) - "Fetal SCT surgery is a quick debulking procedure to remove arteriovenous steal without coccyxectomy" — Alan Flake (clinical) [Ep 10 · 13:16](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=796) - "Watchful waiting in SCT can be hazardous, with majority of deaths occurring between 27-32 weeks gestation" — Alan Flake (clinical) [Ep 10 · 15:51](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=951) - "CHOP now uses a preemptive approach for SCT, delivering patients after 27 weeks at the slightest hint of fetal or maternal decompensation" — Alan Flake (clinical) [Ep 10 · 16:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=993) - "Five recent SCT cases managed with early delivery protocol had good outcomes with surprisingly little prematurity morbidity" — Alan Flake (epidemiological) [Ep 10 · 16:59](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1019) - "No safe ablative technology has been identified for SCT that does not induce significant collateral injury" — Alan Flake (clinical) [Ep 10 · 17:36](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1056) - "Essential components of EXIT procedure include maintenance of uteroplacental blood flow, complete uterine relaxation, maintenance of intrauterine volume, maternal homeostasis and hemostasis, control of membranes, and avoiding placenta and cord" — Alan Flake (clinical) [Ep 10 · 18:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1121) - "EXIT procedure requires a multidisciplinary team with specific roles for each member" — Alan Flake (clinical) [Ep 10 · 19:10](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1150) - "CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities" — Alan Flake (clinical) [Ep 10 · 21:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1265) - "CHAOS patients have to grow into their ventilatory mechanics and can have significant morbidity when treated at birth" — Alan Flake (clinical) [Ep 10 · 21:33](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1293) - "CVR is calculated by measuring CPAM in 3 dimensions, applying ellipse formula, and dividing by head circumference to standardize for gestational age" — Alan Flake (clinical) [Ep 10 · 26:38](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1598) - "CVR has been reliable for predicting hydrops risk, determining surveillance frequency, and counseling families" — Alan Flake (clinical) [Ep 10 · 27:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1625) - "Failure of steroid therapy is defined as progression of hydrops" — Alan Flake (clinical) [Ep 10 · 27:48](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1668) - "Patients on steroids for CPAM should be monitored with ultrasound every other day or 2-3 times per week because changes can occur rapidly" — Alan Flake (clinical) [Ep 10 · 28:05](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1685) - "One theory is that steroids drive lung development and make microcystic CPAM tissue mature more completely" (opinion) [Ep 10 · 29:41](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1781) - "Steroids may ameliorate maternal immune response against the fetus in hydropic patients" (opinion) [Ep 10 · 30:19](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1819) - "The evolution of fetal intervention for CPAM is a very happy story, demonstrating that solving one problem is not a reason to stop investigation" — Farmer (opinion) [Ep 10 · 30:49](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1849) - "Some fetuses with massive ascites and mild pleural effusion can be observed if cardiac function remains intact, rather than immediately intervening" (clinical) [Ep 10 · 31:25](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=1885) - "CVR has been useful for counseling families and determining follow-up tempo, with high CVR patients followed 2-3 times per week" — Adzik (clinical) [Ep 10 · 33:34](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2014) - "CPAM growth rate can be quite abrupt between 18 and 26-28 weeks gestation, then tends to plateau" — Adzik (clinical) [Ep 10 · 34:11](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2051) - "Steroids are most effective in microcystic/solid CPAM forms but are used even in type 1 and type 2 cases to arrest growth of solid components" (clinical) [Ep 10 · 35:52](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2152) - "In Cincinnati experience with 56 CPAM cases, prophylactic treatment for CVR above 1.6 resulted in literally 100% survival" (epidemiological) [Ep 10 · 36:28](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2188) - "Once hydrops is established in CPAM, steroids achieve 49% survival" (epidemiological) [Ep 10 · 36:42](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2202) - "If first course of steroids fails in CPAM, second course salvages about 2 out of 6 patients, with others proceeding to fetal surgery" (epidemiological) [Ep 10 · 36:51](https://library.globalcastmd.com/watch/open-fetal-surgery-overview-fetal-surgery-2012-1027?t=2211) - "EXIT procedures have been performed with lobectomy at time of delivery" — Jack (clinical) [Ep 12 · 0:00](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=0) - "Average CVR for EXIT cases has been over 2, representing large lesions" — Alan (clinical) [Ep 12 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "EXIT procedures are reserved for cases with evidence of compression including diaphragmatic aversion, marked mediastinal shift, often ascites" — Alan (clinical) [Ep 12 · 0:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=46) - "ECMO is very rare in CCAM patients" — Alan (clinical) [Ep 12 · 1:41](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=101) - "EXIT to ECMO has not been used; conventional ventilation is always tried first" — Alan (clinical) [Ep 12 · 1:39](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=99) - "Complex cases are referred to specialized centers while simple cases stay local, skewing reported percentages of EXIT and fetal surgery" — Jean-Martin (opinion) [Ep 12 · 2:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=124) - "No clear reduction in ability to have subsequent pregnancy after fetal surgery, studied and published approximately 4 times" — Alan (clinical) [Ep 12 · 2:46](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=166) - "Patients are not allowed to labor after fetal surgery incision, equivalent to classical cesarean section in upper uterus" — Alan (guideline) [Ep 12 · 2:59](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=179) - "Patients should never labor with future pregnancies after fetal surgery" — Alan (guideline) [Ep 12 · 3:08](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=188) - "No placenta accreta at hysterotomy site has been observed thus far" — Alan (clinical) [Ep 12 · 3:22](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=202) - "EXIT procedure is different from cesarean section and requires anesthetic team tuned into uterine relaxation and maternal issues" — Alan (clinical) [Ep 12 · 4:03](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=243) - "EXIT procedure requires expertise with hysterotomy and a whole team of people" — Alan (clinical) [Ep 12 · 4:15](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=255) - "EXIT can be more widely disseminated than fetal surgery programs" — Alan (opinion) [Ep 12 · 4:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=263) - "Close to 100 EXIT procedures performed at CHOP in past 10 years" — Alan (epidemiological) [Ep 12 · 4:49](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=289) - "Maternal expertise must be available at the hospital; bringing mother to freestanding children's hospital without maternal expertise is a bad idea" (guideline) [Ep 12 · 5:13](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=313) - "Approximately 4 or 5 centers in the US clearly have qualifications and background to do good EXIT procedures" — Alan (epidemiological) [Ep 12 · 6:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=364) - "EXIT procedure requires weeks of planning and discussions involving 15 to 20 people" (clinical) [Ep 12 · 6:44](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=404) - "One EXIT case per year is probably not enough to justify doing EXIT procedures; 3 to 5 per year is reasonable threshold" — Alan (opinion) [Ep 12 · 7:15](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=435) - "Very few if any cases of hydrops from sequestrations are due to high output failure mechanism" — Alan (clinical) [Ep 12 · 8:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=503) - "Most BPS causing hydrops have associated pleural effusions, mediastinal shift, or mass effect" — Alan (clinical) [Ep 12 · 8:34](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=514) - "Injecting alcohol or embolic substances into fetal vessels has potential hazard including neurologic effects, not adequately studied" — Alan (opinion) [Ep 12 · 9:13](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=553) - "Basic operation is the same for fetal lobectomy; difference is consistency of tissues and size" — Alan (clinical) [Ep 12 · 10:28](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=628) - "At 23 weeks and especially at 20 weeks, fetal tissues become very gelatinous and friable" — Alan (clinical) [Ep 12 · 10:49](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=649) - "Mishaps in fetal surgery usually related to traction causing tissue tears" — Alan (clinical) [Ep 12 · 11:04](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=664) - "Fetus is anesthetized from mother and receives additional anesthetic and paralytic shot" — Alan (clinical) [Ep 12 · 11:48](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=708) - "Fetus is positioned before opening uterus in amniotic fluid space" — Alan (clinical) [Ep 12 · 11:59](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=719) - "For thoracotomy, arm on operative side is brought out of hysterotomy to expose chest" — Alan (clinical) [Ep 12 · 12:09](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=729) - "Fetus is buoyed by amniotic infusion and comes up to almost seal the hysterotomy" — Alan (clinical) [Ep 12 · 12:23](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=743) - "No successful complete pneumonectomy has been performed" — Alan (clinical) [Ep 12 · 12:58](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=778) - "Bilobar lobectomies have been performed successfully" — Alan (clinical) [Ep 12 · 13:21](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=801) - "Many CCAM cases have abnormal fissure formation making anatomic separation difficult" — Alan (clinical) [Ep 12 · 13:24](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=804) - "Small fragments of lung left behind grow dramatically if airway and vasculature preserved" — Alan (clinical) [Ep 12 · 13:37](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=817) - "Fetal surgery can still be performed after prior cesarean sections" — Alan (clinical) [Ep 12 · 14:07](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=847) - "Most C-sections are done through lower uterine segment and do not interfere with fetal surgery incision" — Alan (clinical) [Ep 12 · 14:12](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=852) - "If prior classical cesarean section, fetal surgery incision is placed elsewhere" — Alan (clinical) [Ep 12 · 14:20](https://library.globalcastmd.com/watch/fetal-interventions-part-i-lung-lesions-1087?t=860) - "CPAM is abnormally developed lung which doesn't participate in gas exchange" — Pam Choi (clinical) [Ep 17 · 3:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=227) - "CPAMs have overgrowth of bronchioles without good development of alveoli" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 4:48](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=288) - "Type 1 CPAM (distal bronchi/proximal bronchioles) is most common, seen in 60-70% of cases" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 17 · 5:31](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=331) - "CPAMs typically grow in first 20-25 weeks and plateau around week 28" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 6:57](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=417) - "Hydrops is the strongest prognostic indicator of mortality in CPAM patients" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 8:02](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=482) - "CVR (CPAM volume ratio) is calculated as length × width × height × 0.52 divided by head circumference" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 8:41](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=521) - "CVR greater than 1.6 indicates increased risk of developing hydrops; 75% of patients with CVR >1.6 develop hydrops" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 9:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=554) - "Microcystic CPAMs are less than 5 millimeters; macrocystic are larger than 5 millimeters" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 10:14](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=614) - "Prenatal steroids (betamethasone 12 mg twice, 24 hours apart) can resolve hydrops and reduce CPAM size/CVR" — Pam Choi (clinical) [Ep 17 · 10:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=642) - "Thoracoamniotic shunt is placed for macrocystic lesions with high CVR or hydrops, with half in fetal chest and half in amniotic space" — Pam Choi (clinical) [Ep 17 · 13:29](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=809) - "Fetal resection involves partial delivery, thoracotomy, lung resection, and replacement of fetus in uterus, performed between 24-27 weeks as last resort" — Pam Choi (clinical) [Ep 17 · 15:11](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=911) - "Mirror syndrome occurs when mother develops edema, pleural effusion, and other symptoms mirroring fetal hydrops" — Pam Choi (clinical) [Ep 17 · 16:15](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=975) - "EXIT to resection involves partial delivery while maintaining umbilical cord attachment, allowing thoracotomy and resection before full delivery" — Pam Choi (clinical) [Ep 17 · 17:00](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1020) - "EXIT procedures have time constraints of typically 15 minutes to 1 hour before placental separation occurs" — Pam Choi (clinical) [Ep 17 · 17:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1073) - "Air trapping can occur postnatally where air enters CPAM but doesn't exit easily, causing progressive hyperinflation and rapid respiratory distress" — Pam Choi (clinical) [Ep 17 · 19:42](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1182) - "Incidence of CPAMs is estimated at 1 in 8,000 to 35,000 births" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 17 · 52:39](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3159) - "60% of prenatally diagnosed lung lesions are CPAMs" — Rod Gerardo and Ellen Ancisco (epidemiological) [Ep 17 · 52:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3173) - "Pleuropulmonary blastoma (PPB) is the malignancy associated with CPAM" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 27:47](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1667) - "Features suggesting higher PPB risk include multi-lobar involvement, bilateral disease, pneumothorax, and DICER1 mutation" — Jack Langer (clinical) [Ep 17 · 28:25](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1705) - "Features suggesting low PPB risk include feeding vessel and prenatal diagnosis" — Jack Langer (clinical) [Ep 17 · 28:59](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1739) - "Recent study found 0% malignancy in prenatally diagnosed lesions but 10% in postnatally diagnosed lesions" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 30:17](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1817) - "Infected CPAMs result in more difficult surgery with increased blood loss and complications" — Jack Langer (clinical) [Ep 17 · 32:26](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1946) - "Lobectomy risks include bleeding, pneumothorax, air leak, infection, prolonged ventilation, nerve injury, and death" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 26:13](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=1573) - "Single-lung ventilation is preferable for thoracoscopic lobectomy, achieved by main stem intubation of contralateral bronchus" — Steven Rothenberg (clinical) [Ep 17 · 36:37](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2197) - "For thoracoscopic lobectomy, scope port should be anterior to scapula tip in mid-axillary line over major fissure to allow front-to-back working approach" — Steven Rothenberg (clinical) [Ep 17 · 38:55](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2335) - "Vascular control technique involves making two seals on vessel with space between, then cutting partway to visualize lumen before complete division" — Steven Rothenberg (clinical) [Ep 17 · 43:09](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2589) - "Critical safety point: do not take pulmonary vein trunk near pericardium; if device fails, vessel will retract into pericardium causing fatal hemorrhage" — Steven Rothenberg (clinical) [Ep 17 · 48:53](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=2933) - "Typical postoperative course includes chest tube removal at 24 hours and discharge on postoperative day 2" — Pam Choi (clinical) [Ep 17 · 51:27](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3087) - "Follow-up occurs at 3-4 weeks post-surgery with chest X-ray" — Rod Gerardo and Ellen Ancisco (clinical) [Ep 17 · 51:40](https://library.globalcastmd.com/watch/the-full-story-on-cpams-4463?t=3100) - "Surgeons have historically been incentivized based on work RVUs, which is important for clinical productivity but does not capture other academic strengths" — Gail Besner (opinion) [Ep 19 · 1:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=101) - "The concept of academic RVUs was first described 12-13 years ago but without a clear incentivization framework" — Gail Besner (clinical) [Ep 19 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=175) - "Nationwide Children's Hospital implemented a point-based academic RVU system for publications, presentations, and other academic pursuits" — Gail Besner (clinical) [Ep 19 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=187) - "External federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system" — Rod Gerardo (clinical) [Ep 19 · 3:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=238) - "The academic RVU system at Nationwide resulted in increased presentations, peer-reviewed publications, and external federal research funding" (clinical) [Ep 19 · 3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=224) - "At Akron, the bonus structure required the entire group to reach a certain RVU threshold for 50% of bonus, eliminating competition for individual cases" — Todd (clinical) [Ep 19 · 5:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=303) - "The BC Children's Hospital gastroschisis study compared outcomes before and after implementation of a protocol in 2012, using data from 2008-2019" (clinical) [Ep 19 · 5:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=351) - "At Saint Justine, gastroschisis treatment differed from other institutions with very low silo use and attempts at immediate bedside sutureless closure for nearly every patient" — Charza Jaharifard (clinical) [Ep 19 · 7:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=432) - "Approximately 75% of gastroschisis babies can be closed immediately, either in the OR with fascial closure pre-protocol or at bedside post-protocol" — Charza Jaharifard (clinical) [Ep 19 · 7:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=477) - "With silo reduction, parents cannot hold their baby for 5-6 days while looking at intestines through the silo" — Charza Jaharifard (clinical) [Ep 19 · 8:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=507) - "With immediate closure, parents can hold their baby within 48 hours if intubated, or immediately if managed without intubation" — Charza Jaharifard (clinical) [Ep 19 · 8:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=523) - "Prior myelomeningocele studies used two separate in utero surgeries: one to create the defect and one to repair it with PMSCs" (clinical) [Ep 19 · 10:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=626) - "The current study performed a single operation at approximately 100 days gestational age, creating and repairing the defect simultaneously with PMSCs placed directly on the spinal cord" (clinical) [Ep 19 · 10:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=643) - "PMSCs did not persist in placentas, uteri, or lambs at 3 months post-treatment" (clinical) [Ep 19 · 11:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=683) - "There was no histological evidence of abnormal growth or tumor development from PMSC treatment" (clinical) [Ep 19 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=690) - "Human trials using PMSCs for myelomeningocele repair have begun with the first two patients" (clinical) [Ep 19 · 11:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-january-2022-apsa-issue-5103?t=712) - "The curation process reviews 33 journals including top pediatric, surgical, and clinical journals (NEJM, Lancet, JAMA), averaging 1200 articles monthly" — Todd (clinical) [Ep 20 · 1:53](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113) - "Upper GI contrast study is very dependent on the person who performs it and availability varies by institution" (opinion) [Ep 20 · 8:08](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=488) - "Reversal of vessels at the root of the mesentery on ultrasound is not a very reliable way to make the diagnosis of malrotation" (clinical) [Ep 20 · 8:35](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=515) - "Presence of an appendicolith has about a 50% failure rate with non-operative management of appendicitis" — Todd (clinical) [Ep 20 · 10:22](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=622) - "Most surgeons use the presence of appendicolith as a contraindication for non-operative management" — Todd (clinical) [Ep 20 · 10:43](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=643) - "In the non-surgical appendicitis management group, 46% of patients required appendectomy during 5-year follow-up" — Todd (clinical) [Ep 20 · 11:52](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=712) - "The surgical appendicitis group had no readmissions while half of the non-surgical group presented to the emergency room" — Todd (clinical) [Ep 20 · 12:04](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=724) - "Complete resection of intermediate risk neuroblastoma doesn't provide any surgical benefit" (clinical) [Ep 20 · 13:59](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=839) - "In stage 4 high-risk neuroblastoma, 5-year event-free survival and overall survival were significantly higher with complete resection" (clinical) [Ep 20 · 14:29](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=869) - "Local progression in stage 4 neuroblastoma was lower with complete resection compared with incomplete resection" (clinical) [Ep 20 · 14:36](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=876) - "Fetal endoscopic tracheal occlusion (FETO) resulted in 40% survival to discharge versus 15% with expectant care for severe left CDH" (clinical) [Ep 20 · 16:36](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=996) - "FETO was associated with increased risk of preterm pre-labor rupture of membranes and preterm labor" (clinical) [Ep 20 · 16:44](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1004) - "Whole blood transfusion as adjunct to component therapy resulted in decreased transfusion volume at 24 hours" — Todd (clinical) [Ep 20 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113) - "The whole blood group required fewer ventilation days compared to component therapy alone" — Todd (clinical) [Ep 20 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113) - "Mortality, length of stay, and major complications were the same between whole blood and component therapy groups" — Todd (clinical) [Ep 20 · 18:33](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1113) - "Ambulance rigs nationwide in adults are starting to travel with whole blood capabilities and use it earlier" — Todd (clinical) [Ep 20 · 19:40](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180) - "Current ATLS guidelines suggest initial bolus with normal saline or crystalloid solution before moving to blood products" — Todd (guideline) [Ep 20 · 19:51](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1191) - "Some centers are limiting whole blood use to males and children older than 15 years" — Todd (clinical) [Ep 20 · 21:10](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1270) - "Pediatric centers don't use massive transfusion protocols as frequently as adult centers" — Todd (clinical) [Ep 20 · 20:49](https://library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1249) - "The SIOP study examined children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection was successful or unsuccessful" — Brittany Levy (clinical) [Ep 21 · 0:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58) - "Wilms tumor has been a great success story for pediatric surgery and pediatric oncology" — Brittany Levy (opinion) [Ep 21 · 1:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74) - "If half of Wilms tumor patients get complete tumor removal and half don't, and there is an outcome difference, then surgeons should still try hard to remove all of it" — Brittany Levy (clinical) [Ep 21 · 1:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114) - "The UC Davis study is a pivotal study in obtaining FDA approval for use of clinical grade stem cells in fetal myelomeningocele repair" — Christina Theodoro (guideline) [Ep 21 · 2:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174) - "The study represents being one step closer to first in human clinical trial for stem cell use in myelomeningocele repair" — Brittany Levy (clinical) [Ep 21 · 3:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=183) - "In the ovine model, the extracellular matrix patch with placental stem cells is placed with cells facing the spinal cord in direct contact, then skin is closed and the fetus continues gestation until term" — Christina Theodoro (clinical) [Ep 21 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207) - "Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive stem cells" — Christina Theodoro (clinical) [Ep 21 · 3:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234) - "There is already shown benefit of repairing myelomeningocele in utero, and adding mesenchymal stromal cells provides even larger benefit in chance of ambulation" — Todd Ponsky (clinical) [Ep 21 · 4:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248) - "The fetal surgery survey was of non-trainee surgeons within the American Pediatric Surgical Association to gauge practice patterns in fetal surgery across the country" — Rod Gerardo (clinical) [Ep 21 · 4:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=298) - "Only 4% of self-identified fetal surgery specialists reported receiving formal training in fetal surgery" — Natalie Lopian (epidemiological) [Ep 21 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313) - "Many survey respondents reported receiving fetal training during pediatric surgery fellowship, yet when asked differently, many responded they didn't have exposure to fetal surgery during fellowship" — Brittany Levy (epidemiological) [Ep 21 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337) - "Fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental" — Brittany Levy (opinion) [Ep 21 · 5:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354) - "In an emerging field like fetal surgery, there are disparities in what is happening at different centers" — Todd Ponsky (opinion) [Ep 21 · 6:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398) - "There is value in having some centers with dedicated teams focusing on fetal care even if they don't do interventions" — Todd Ponsky (opinion) [Ep 21 · 6:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=406) - "The survey results suggest people would not be interested in subspecialization for fetal surgery in America for a variety of reasons" — Brittany Levy (opinion) [Ep 21 · 7:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=424) - "The study was not designed to link subspecialization of fetal surgery to outcomes and wasn't designed to provide a clear definition of a fetal surgery center" — Natalie Lopian (clinical) [Ep 21 · 7:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446) - "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 14 · 5:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=343) - "Fetal surgery for lung lesions is extremely rare, performed less than once every couple of years even at high-volume centers" — Steven Rothenberg (epidemiological) [Ep 14 · 6:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=371) - "Cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis in prenatal lung lesions" — Steven Rothenberg (clinical) [Ep 14 · 7:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=474) - "Hybrid lesions showing features of both CPAM and sequestration are not uncommon on pathology" — Steven Rothenberg (clinical) [Ep 14 · 9:09](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=549) - "Chest X-ray or ultrasound are inadequate to ensure there is no lesion present after prenatal diagnosis" — Steven Rothenberg (clinical) [Ep 14 · 14:44](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=884) - "20-40% of untreated congenital lung lesions will develop significant infection at some point" — Steven Rothenberg (epidemiological) [Ep 14 · 15:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=955) - "The incidence of malignancy in untreated congenital lung lesions is over 1%" — Steven Rothenberg (epidemiological) [Ep 14 · 16:58](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1018) - "Surgery is technically easier in smaller infants because vessels are smaller and anatomy is fresh" — Steven Rothenberg (clinical) [Ep 14 · 18:24](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1104) - "Even in asymptomatic children, significantly enlarged lymph nodes and inflammation are often found in the fissures around one year of age" — Steven Rothenberg (clinical) [Ep 14 · 18:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1126) - "Hospital stay, chest tube duration, recovery, and operative time are less in patients under 5 kg compared to those under 10 kg" — Steven Rothenberg (clinical) [Ep 14 · 19:32](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1172) - "Most asymptomatic children on room air will tolerate single lung ventilation without problem" — Steven Rothenberg (clinical) [Ep 14 · 23:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1418) - "All babies initially desaturate when the lung is collapsed, sometimes to high 80s or low 90s, but saturations come up once shunting to the collapsed lung stops" — Steven Rothenberg (clinical) [Ep 14 · 26:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=1562) - "Using energy devices that seal and cut simultaneously on major vessels is dangerous and can lead to unrecoverable bleeding" — Steven Rothenberg (clinical) [Ep 14 · 37:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2266) - "Making two separate seals 4-5mm apart on vessels and cutting partway between them allows recovery if the seal fails" — Steven Rothenberg (clinical) [Ep 14 · 35:15](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2115) - "The pulmonary vein trunk must not be taken near the pericardium because device failure will cause the vessel to retract and result in fatal bleeding" — Steven Rothenberg (clinical) [Ep 14 · 50:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3033) - "Using both sealing technology and clips on the same vessel can cause delayed bleeding as the vessel changes and clips lose secure footing" — Steven Rothenberg (clinical) [Ep 14 · 59:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3595) - "Extra-lobar sequestrations can have up to 6 systemic vessels, with diameters ranging from small to 15mm" — Steven Rothenberg (clinical) [Ep 14 · 58:42](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3522) - "Average length of stay for lobectomy in patients who come in the morning is about 2.5 days" — Steven Rothenberg (clinical) [Ep 14 · 65:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=3933) - "CT scan at 4-6 weeks allows for less atelectasis during the study and easier interpretation compared to earlier imaging" — Steven Rothenberg (clinical) [Ep 14 · 13:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=791) - "The bronchus sits directly underneath the pulmonary artery in the lower lobe and can be felt to aid dissection" — Steven Rothenberg (clinical) [Ep 14 · 45:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2723) - "APSA created a peer support program for pediatric surgeons in 2020" — Lizzie Lee (clinical) [Ep 25 · 1:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=60) - "The program's goal was to support surgeons after traumatic events" — Lizzie Lee (clinical) [Ep 25 · 1:12](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=72) - "The most common referral reasons were toxic work environments and adverse events" — Lizzie Lee (epidemiological) [Ep 25 · 1:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=76) - "50 surgeons total agreed to receive training on how to be a supporter" — Lizzie Lee (epidemiological) [Ep 25 · 1:20](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=80) - "Over 80% of trained supporters were able to use peer support skills informally with colleagues, partners, and trainees" — Lizzie Lee (epidemiological) [Ep 25 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=85) - "Tracheomalacia was 5% more common in tracheal occluded infants with 4% more cases" — Carlos Colunga (epidemiological) [Ep 25 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "Tracheomalacia symptoms in tracheal occluded infants typically receded within 55 months" — Carlos Colunga (clinical) [Ep 25 · 2:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "Tracheal occluded infants typically showed a larger trachea, which was around 31% wider" — Carlos Colunga (clinical) [Ep 25 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "37% of tracheal occluded cases retained metallic balloon components" — Carlos Colunga (epidemiological) [Ep 25 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "No significant complications were reported from retained metallic balloon components" — Carlos Colunga (clinical) [Ep 25 · 2:34](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "While tracheal occlusion is effective in promoting lung growth, it is associated with a higher risk of tracheomalacia" — Carlos Colunga (clinical) [Ep 25 · 2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167) - "Most cases of tracheomalacia after tracheal occlusion resolve and do not appear to have long-term effects" — Carlos Colunga (clinical) [Ep 25 · 2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167) - "The IPSO meta-analysis gathered 8 retrospective studies with 490 patients" — Cecilia Gigena (epidemiological) [Ep 25 · 3:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220) - "Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups" — Cecilia Gigena (clinical) [Ep 25 · 3:40](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220) - "Intraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 25 · 3:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234) - "Complications were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 25 · 3:54](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234) - "Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma" — Cecilia Gigena (clinical) [Ep 25 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=240) - "Faster prenatal diagnosis enables detection of many genetic conditions early" — Lizzie Lee (clinical) [Ep 27 · 0:14](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=14) - "Medications can be given to the mother that cross the placenta" — Lizzie Lee (clinical) [Ep 27 · 0:18](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18) - "Enzyme replacement therapy can be delivered directly to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:18](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18) - "Protein therapy can be delivered to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:24](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24) - "Stem cells can be delivered to the fetus" — Lizzie Lee (clinical) [Ep 27 · 0:24](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24) - "The fetus has a more tolerant immune system compared to postnatal life" — Lizzie Lee (clinical) [Ep 27 · 0:27](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27) - "The fetus has a more permissive blood-brain barrier compared to postnatal life" — Lizzie Lee (clinical) [Ep 27 · 0:27](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27) - "Most fetal therapies for genetic diseases are still experimental" — Lizzie Lee (clinical) [Ep 27 · 0:34](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=34) - "Fetal intervention aims to prevent lifelong disease by treating during fetal development" — Lizzie Lee (clinical) [Ep 27 · 0:38](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=38) - "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing that becomes progressive obstruction as pelvic anatomy matures)." — Mark (clinical) [Ep 6 · 0:32](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=32) - "Incomplete urethral obstruction leads to progressive oligohydramnios until anhydramnios, resulting in physical deformations (joint contractures, flattened ears, Potter phenotype), pulmonary hypoplasia from inability to expand chest, and severe hydronephrosis with progressive renal fibrocystic dysplasia and renal failure." — Mark (clinical) [Ep 6 · 1:30](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=90) - "In sheep model, early mid-gestational reversal of urethral obstruction prevented progressive dysplastic changes to kidneys and preserved kidney function, giving rise to the concept of vesico-amniotic shunting." — Mark (clinical) [Ep 6 · 2:58](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=178) - "Early shunting had highly variable outcomes and success rates." — Mark (clinical) [Ep 6 · 4:32](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=272) - "A stepwise approach to identifying fetuses for shunt therapy includes: high-resolution ultrasound to assess anatomy and rule out associated anomalies (myelomeningocele, cardiac disease, genetic syndromes), karyotype confirmation to rule out chromosomal abnormalities, and renal function evaluation by serial bladder drainage." — Mark (guideline) [Ep 6 · 4:50](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=290) - "Amnioinfusion is sometimes necessary to expand amniotic fluid space and restore fluid interface for better ultrasound resolution when initial evaluation is difficult." — Mark (clinical) [Ep 6 · 5:19](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=319) - "Not an insignificant portion of LUTO cases have chromosomal abnormalities such as major trisomies or Klinefelter syndrome." — Mark (epidemiological) [Ep 6 · 5:36](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=336) - "It is important to confirm male fetus because female fetuses with large bladder-like structures are usually cloacal abnormalities that do not benefit from shunting due to different pathophysiology." — Mark (clinical) [Ep 6 · 5:53](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=353) - "Renal function evaluation involves draining the bladder completely on several occasions and analyzing sodium, chloride, calcium, osmolarity, total proteins, and beta-2-microglobulin as reflections of proximal tubular injury and possible glomerular injury." — Mark (guideline) [Ep 6 · 6:17](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=377) - "Increased kidney echogenicity is evidence of compression of renal parenchyma rather than a poor prognostic sign per se; following serial bladder drainages and allowing kidneys to drain, re-expansion of parenchyma occurs with more normal echogenicity." — Mark (clinical) [Ep 6 · 8:10](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=490) - "Hydronephrosis pathophysiology: as collecting system (balloon) enlarges within kidney (sponge in fishbowl), it compresses parenchyma against serosa, impairing delicate vasculature and causing cell death, progressive fibrosis, and eventually cystic dysplasia." — Mark (clinical) [Ep 6 · 8:49](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=529) - "Presence of cortical cysts indicates irreversibly damaged kidney not amenable to in utero therapy." — Mark (clinical) [Ep 6 · 10:18](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=618) - "Patent urachus (tract from bladder dome to umbilical cord that reopens with high bladder pressure) is one etiology for LUTO with normal amniotic fluid volume." — Mark (clinical) [Ep 6 · 12:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=761) - "Megacystis-microcolon-hypoperistalsis syndrome is a neurologic defect in bladder and ureteral muscles preventing contraction and emptying; these patients have massively distended bladder with normal amniotic fluid, thin bladder walls after drainage, and extremely poor survival (most do not survive more than a few years)." — Mark (clinical) [Ep 6 · 14:47](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=887) - "The first urine specimen from bladder tap is not predictive or reliable because it is exposed to degradation products and osmotic gradients that change electrolyte composition; serial taps (second at 2 days, third at 4 days) sample urine from ureters/intrarenal collecting system and then freshly produced urine, which have much higher predictive value." — Mark (clinical) [Ep 6 · 19:05](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1145) - "Prognostic urinary electrolyte cutoff thresholds (sodium <100, chloride <90, osmolarity <210, calcium <8, beta-2-microglobulin <6, total protein <40 mg/dL) predict potential for survival with successful shunt placement; values above these indicate significant renal injury." — Mark (guideline) [Ep 6 · 18:00](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1080) - "All prognostic urinary electrolyte cutoff thresholds were based on urine analyzed between 18 to 22 weeks gestation; they cannot be used before 18 weeks or after 22 weeks without adjustment for gestational age." — Mark (guideline) [Ep 6 · 26:18](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1578) - "Bladder morphology after drainage can suggest etiology: symmetric thick-walled bladder with difficult keyhole suggests urethral atresia; elongated bladder with more proximal thickening suggests posterior urethral valves; snowman appearance (head-chest-body shape) suggests mid-urethral hypoplasia/prune belly variant with smooth muscle deficiency in bladder dome." — Mark (clinical) [Ep 6 · 21:19](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1279) - "In mid-urethral hypoplasia cases, histology shows abnormal smooth muscle from proximal ureters to renal pelvis and severe abnormalities in bladder dome smooth muscle development." — Mark (clinical) [Ep 6 · 25:13](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1513) - "The Paris group (Francis Muller, Humberto Nicolini) emphasized importance of using gestational-age-specific cutoffs for urinary electrolytes." (guideline) [Ep 6 · 25:53](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1553) - "Primary goal of fetal bladder shunting is to prevent pulmonary hypoplasia secondary to oligohydramnios; secondary goals are preservation of renal function and bladder function." (guideline) [Ep 6 · 28:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1721) - "Vesico-amniotic shunt is a double-tailed silastic pigtail catheter (Rocket or Harrison shunt) with coils in different directions; flat end outside baby's abdomen prevents baby from grabbing and pulling it out, other end inside bladder." (clinical) [Ep 6 · 29:08](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1748) - "Shunt placement is outpatient procedure with IV remifentanyl/propofol, local anesthetic, antibiotic, indomethacin, and possibly nifedipine; mother goes home couple hours later." (clinical) [Ep 6 · 29:43](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1783) - "Amnioinfusion before shunt placement is critical because without good fluid volume around fetus, external end of shunt cannot be deposited properly (most difficult part of procedure)." (clinical) [Ep 6 · 30:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1806) - "Shunt should ideally be inserted inferior to bladder because higher placement risks holes in shunt ending up in peritoneal cavity as bladder deflates, causing fetal urinary ascites." (clinical) [Ep 6 · 31:05](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1865) - "Birmingham group meta-analysis showed in good-prognosis cases (by urinary electrolytes), there appeared to be some benefit to drainage; in poor-prognosis cases, drainage appeared to have even better result." (clinical) [Ep 6 · 31:37](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1897) - "PLUTO trial was only randomized trial of bladder shunting; babies randomized when physician was uncertain whether to shunt; karyotype and urinalysis were not mandatory, amniotic fluid volume not used as prognostic evaluator." (clinical) [Ep 6 · 32:27](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=1947) - "PLUTO trial designed to collect 150 patients over 4 years but only 31 patients randomized; trial stopped early due to poor recruitment (only 20% of planned patients)." (epidemiological) [Ep 6 · 33:41](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2021) - "PLUTO trial showed approximately 3-fold increase in survival in shunted fetuses compared to conservative management, but numbers very small and benefit unproven (confidence intervals crossed unity, results not significant)." (clinical) [Ep 6 · 33:55](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2035) - "All 12 deaths in PLUTO trial were from pulmonary hypoplasia; improved survival inferred to be related to decrease in lung hypoplasia." (clinical) [Ep 6 · 34:36](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2076) - "Only 7 of 12 live-born shunted babies in PLUTO trial were alive at age 2, and only 2 of shunted survivors had normal renal function; all 3 conservatively managed survivors had significant renal impairment." (epidemiological) [Ep 6 · 34:47](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2087) - "Six studies reporting long-term outcomes of shunted babies show consistent results: approximately 40-50% have normal renal function, approximately one-third require dialysis or transplant." (epidemiological) [Ep 6 · 36:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2166) - "In Canadian population, when parents review outcome studies, many opt for termination of pregnancy rather than shunting." (epidemiological) [Ep 6 · 37:13](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2233) - "Some LUTO cases can resolve spontaneously, either by baby peeing and filling amniotic sac, spontaneous bladder decompression resulting in asymmetric hydronephrosis or urinary ascites, or development of perinephric urinoma." (clinical) [Ep 6 · 37:23](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2243) - "Bladder rupture usually occurs after drainage (not spontaneously) and always resolves after a few days." (clinical) [Ep 6 · 38:06](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2286) - "Megacystis-microcolon-hypoperistalsis syndrome and cloacal dysgenesis are cases where intervention by shunting is not indicated; clues include female fetus and normal amniotic fluid volume." (guideline) [Ep 6 · 38:26](https://library.globalcastmd.com/watch/prenatal-diagnosis-of-fetal-lower-urinary-tract-obstruction-fetal-919?t=2306) - "CVR greater than 1.6 in microcystic CCAM lesions predicts less than 3-5% likelihood of evolving hydrops" — Alan (clinical) [Ep 11 · 27:50](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1670) - "EXIT procedures at CHOP are reserved for cases with average CVR over 2, evidence of compression including diaphragmatic aversion and marked mediastinal shift" — Alan (clinical) [Ep 11 · 0:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=46) - "It is very rare to need ECMO in CCAM patients" — Alan (clinical) [Ep 11 · 1:41](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=101) - "There is no clear reduction in ability to have subsequent pregnancy after fetal surgery" — Alan (clinical) [Ep 11 · 2:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=166) - "Patients who have had fetal surgery should never labor with future pregnancies due to classical cesarean-type uterine incision" — Alan (guideline) [Ep 11 · 2:59](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=179) - "No cases of placenta accreta at hysterotomy site have been observed following fetal surgery" — Alan (clinical) [Ep 11 · 3:22](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=202) - "EXIT procedure requires anesthetic team expertise in uterine relaxation and maternal issues, distinct from standard cesarean section" — Alan (clinical) [Ep 11 · 4:03](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=243) - "CHOP has performed close to 100 EXIT procedures in the past 10 years" — Alan (epidemiological) [Ep 11 · 4:49](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=289) - "Maternal expertise must be available at the hospital performing EXIT procedures to protect the mother" (guideline) [Ep 11 · 5:13](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=313) - "Four or five centers in the US clearly have qualifications and background to do good EXIT procedures" — Alan (epidemiological) [Ep 11 · 6:04](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=364) - "EXIT procedures require weeks of planning and involve 15-20 people in the team" (clinical) [Ep 11 · 6:56](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=416) - "One EXIT procedure per year is probably not enough volume to justify doing them; 3-5 per year is a reasonable threshold" — Alan (opinion) [Ep 11 · 7:15](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=435) - "Most bronchopulmonary sequestrations causing hydrops have associated pleural effusions and mediastinal shift rather than high-output failure physiology" — Alan (clinical) [Ep 11 · 8:27](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=507) - "Injecting alcohol into fetal vessels has potential for systemic thrombosis, with documented case of thrombi in heart chambers" — Alan (clinical) [Ep 11 · 16:27](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=987) - "Neurologic effects of using alcohol as sclerosant in the fetus have not been adequately studied and are very worrisome" — Alan (opinion) [Ep 11 · 17:06](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1026) - "Radiofrequency ablation in fetus causes uncontrolled heat dispersion due to 90% water content, with energy dispersing unpredictably and causing collateral damage" — Alan (clinical) [Ep 11 · 17:26](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1046) - "Probably 95% of CCAMs seen now are prenatally diagnosed" (epidemiological) [Ep 11 · 18:11](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1091) - "Almost none of prenatally diagnosed congenital lung lesions require prenatal intervention, and very few require intervention the day the child is born" (clinical) [Ep 11 · 18:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1098) - "Many large congenital lung lesions have been referred after recommendation for termination by practitioners who don't understand natural history" — Alan (clinical) [Ep 11 · 19:46](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1186) - "True cystic CCAMs often regress and become isoechogenic in third trimester but remain present and prominent on CT scan one month after birth" — Alan (clinical) [Ep 11 · 20:56](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1256) - "CCAM is a pathological diagnosis once specimen is in the bucket, not a prenatal diagnosis" — Jean-Martin (guideline) [Ep 11 · 22:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1338) - "Congenital lung lesions should be classified as macrocystic, hyperechoic, or mixed rather than called CCAMs prenatally" — Jean-Martin (opinion) [Ep 11 · 22:18](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1338) - "Lung agenesis is frequently misdiagnosed as microcystic CCAM elsewhere and referred to fetal centers" — Alan (clinical) [Ep 11 · 23:58](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1438) - "EXIT is more invasive than regular C-section for the mother" — Jean-Martin (clinical) [Ep 11 · 24:25](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1465) - "Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops" — Alan (guideline) [Ep 11 · 25:34](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1534) - "Hydrops requires more than just ascites; must include pleural effusion, pericardial effusion, and skin or scalp edema" — Alan (clinical) [Ep 11 · 25:50](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1550) - "Pure ascites is not necessarily hydrops and can be related to mediastinal shift and hepatic venous return" — Alan (clinical) [Ep 11 · 25:53](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=1553) - "Fetal tissue at 20-23 weeks becomes very gelatinous and friable, requiring careful handling" — Alan (clinical) [Ep 11 · 10:53](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=653) - "Fetus is anesthetized from maternal anesthesia plus direct fetal anesthetic and paralytic injection" — Alan (clinical) [Ep 11 · 11:48](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=708) - "Small piece of residual lung tissue grows dramatically after fetal lobectomy as long as airway and vasculature are preserved" — Alan (clinical) [Ep 11 · 13:43](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=823) - "No successful fetal pneumonectomies have been performed; one case of bronchial atresia with attempted pneumonectomy resulted in fetal death" — Alan (clinical) [Ep 11 · 12:58](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=778) - "Most C-sections are done through lower uterine segment and do not interfere with fetal surgery incision" — Alan (clinical) [Ep 11 · 14:08](https://library.globalcastmd.com/watch/lung-lesions-fetal-interventions-parts-i-ii-1088?t=848) - "The three major causes of LUTO are urethral atresia (complete obstruction with no communication from bladder neck through urethra), posterior urethral valves (flap of tissue in proximal urethra), and mid-urethral hypoplasia (significant tapering and narrowing that becomes progressive obstruction as pelvic anatomy matures)" — Mark (clinical) [Ep 2 · 0:44](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=44) - "Complete urethral obstruction leads to progressive oligohydramnios until anhydramnios, physical deformations (joint contractures, ear flattening, Potter's phenotype), pulmonary hypoplasia due to inability to expand and contract chest, and severe hydronephrosis with progressive renal fibrocystic dysplasia resulting in renal failure after birth" — Mark (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=101) - "In sheep models, early mid-gestational reversal of obstruction prevented progressive dysplastic changes to kidneys and preserved kidney function, giving rise to the concept of in utero shunting" — Mark (clinical) [Ep 2 · 3:10](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=190) - "A stepwise approach to identifying fetuses for shunt therapy involves: (1) high-resolution ultrasound to evaluate anatomy and rule out associated anomalies like myelomeningocele or cardiac disease, (2) karyotype confirmation to rule out chromosomal abnormalities, and (3) renal function evaluation by serial bladder drainage" — Mark (clinical) [Ep 2 · 4:44](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=284) - "Amnioinfusions can be performed to expand the amniotic fluid space and restore fluid interface for better high-resolution ultrasound imaging when evaluation is difficult" — Mark (clinical) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=331) - "It is important to confirm male fetus because female fetuses with large bladder-like structures are usually cloacal abnormalities that do not benefit from shunting due to completely different pathophysiology" — Mark (clinical) [Ep 2 · 6:04](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=364) - "The keyhole sign is the dilated proximal urethra down to the level of obstruction, characteristic of posterior urethral valves" — Mark (clinical) [Ep 2 · 7:42](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=462) - "Increased echogenicity of kidneys is evidence of compression of renal parenchyma rather than a poor prognostic sign per se; following bladder drainage and allowing kidneys to drain, re-expansion of parenchyma occurs with more normal echogenicity" — Mark (clinical) [Ep 2 · 8:21](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=501) - "The pathophysiology of hydronephrosis involves the collecting system (like a balloon) expanding within the kidney (like a sponge in a glass fishbowl), compressing parenchyma against the serosa, impairing delicate vasculature, resulting in cell death, progressive fibrosis, and eventually cystic dysplasia" — Mark (clinical) [Ep 2 · 9:01](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=541) - "The presence of discrete cortical cysts indicates irreversible kidney damage and is not amenable to any in utero therapy due to severity of underlying injury" — Mark (clinical) [Ep 2 · 10:29](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=629) - "Patent urachus (a tract from bladder dome to umbilical cord insertion that normally closes early in embryonic development) can reopen with early obstruction and high bladder pressure, draining urine into amniotic fluid space, explaining obstructive uropathy with normal amniotic fluid volume" — Mark (clinical) [Ep 2 · 12:53](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=773) - "Megacystis-microcolon-hypoperistalsis syndrome is a neurologic defect in bladder and ureteral muscles preventing bladder contraction and emptying, more common in females but seen in males, with extremely poor survival (most do not survive more than a few years)" — Mark (clinical) [Ep 2 · 14:58](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=898) - "In megacystis-microcolon-hypoperistalsis syndrome, after bladder drainage the entire bladder remains very thin-walled because it does not develop hyperplasia or thickening typically seen in complete obstruction, and amniotic fluid flows into amniotic cavity through a completely patent urethra" — Mark (clinical) [Ep 2 · 15:34](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=934) - "Karyotype analysis can be obtained through amniocentesis (if possible), chorionic villus sampling, vesicocentesis (with FISH technology to screen and confirm male karyotype and rule out major aneuploidies), or cordocentesis for fetal blood" — Mark (clinical) [Ep 2 · 16:49](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1009) - "Favorable prognostic urinary values for potential survival with shunt placement are: sodium <100 mEq/L, chloride <90 mEq/L, osmolarity <210 mOsm, calcium <8 mg/dL, beta-2 microglobulin <6 mg/L, and total protein <40 mg/dL" — Mark (clinical) [Ep 2 · 18:12](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1092) - "Autopsy studies confirmed that fetuses with urinary values above the cutoff thresholds (not much higher) showed significant fibrotic injury to kidneys, while those with values below thresholds showed very little or very early changes potentially salvageable with in utero therapy" — Mark (clinical) [Ep 2 · 18:35](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1115) - "Serial bladder drainage (first tap, second tap 2 days later, third tap 2 days after that) is necessary because the first urine specimen is not predictive or reliable; the third or fourth values have much higher predictive value for detecting significant underlying injury as they represent freshly produced urine" — Mark (clinical) [Ep 2 · 19:27](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1167) - "Improving urinary electrolyte values across serial taps (e.g., sodium initially poor but dropping with second and third taps) indicates an excellent candidate for shunting with reasonably good prognosis, while worsening values indicate ongoing irreversible damage that shunting won't benefit" — Mark (clinical) [Ep 2 · 20:29](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1229) - "After bladder drainage, urethral atresia cases show symmetric, very thick, universal bladder wall thickening with a typical keyhole; posterior urethral valve cases show elongated bladder shape with more proximal than distal thickening; mid-urethral hypoplasia (prune belly/triad) cases show a 'snowman appearance' with typical hypertrophy in lower bladder but significant smooth muscle deficiency in upper bladder" — Mark (clinical) [Ep 2 · 21:31](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1291) - "All urinary electrolyte cutoff thresholds are based on urine analyzed between 18 to 22 weeks of gestation; these cutoffs cannot be used before 18 weeks or after 22 weeks without adjustment" — Mark (clinical) [Ep 2 · 26:30](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1590) - "Urinary electrolyte cutoff values change with gestational age due to maturation and increasing kidney function; at 17 weeks the cutoff would be higher, and at 24-26 weeks the cutoffs would be much lower" — Mark (clinical) [Ep 2 · 27:00](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1620) - "The primary goal of fetal bladder shunting is to prevent pulmonary hypoplasia secondary to oligohydramnios; secondary goals are preservation of renal function and bladder function" (clinical) [Ep 2 · 28:52](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1732) - "Vesicoamniotic shunting uses a double-tailed silastic pigtail catheter (Rocket shunt) with coils in different directions so the flat end outside the baby's abdomen cannot be grabbed and pulled out, and the other end is inside the bladder" (clinical) [Ep 2 · 29:27](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1767) - "Shunt placement is done as an outpatient procedure with IV remifentanyl and if necessary propofol, local anesthetic, antibiotic, indomethacin, and possibly nifedipine, with mother going home a couple hours later" (clinical) [Ep 2 · 29:54](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1794) - "Amnioinfusion before shunt placement is the most important step because without good fluid volume around the fetus, the external end of the shunt (the trickiest part) cannot be deposited properly" (clinical) [Ep 2 · 30:18](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1818) - "Shunt should ideally be inserted inferior to the bladder because the higher the placement, the greater the risk that when the bladder deflates, some shunt holes will be in the peritoneal cavity, potentially causing fetal urinary ascites" (clinical) [Ep 2 · 31:16](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1876) - "The Birmingham group's meta-analysis showed that in cases with good prognosis from urinary electrolytes, there appeared to be some benefit to drainage, and in the poor prognosis group, drainage appeared to have an even better result" (epidemiological) [Ep 2 · 31:48](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1908) - "The PLUTO trial randomized patients only when the physician was uncertain whether to shunt; if they knew whether shunting worked, patients were not randomized; karyotype and urinalysis were not mandatory, and amniotic fluid volume was not used as a prognostic evaluator" (clinical) [Ep 2 · 32:59](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=1979) - "The PLUTO trial was designed to collect 150 patients over 4 years but only 31 patients were randomized by the end, representing only 20% of planned recruitment" (epidemiological) [Ep 2 · 33:53](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2033) - "In the PLUTO trial, shunted fetuses showed about a 3-fold increase in survival compared to those not shunted, but numbers were very small and the benefit is unproven; all 12 deaths were from pulmonary hypoplasia" (epidemiological) [Ep 2 · 34:33](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2073) - "In the PLUTO trial, only 7 of 12 live-born shunted babies were alive at age 2, and only 2 of the shunted survivors had normal renal function; all 3 conservatively managed survivors had significant renal impairment" (epidemiological) [Ep 2 · 34:59](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2099) - "Difficulties in fetal therapy trials include: conditions are rare, many go undetected prenatally, many parents choose termination when faced with outcome realities, delay in accepting new therapy reflects clinician and patient bias based on small heterogeneous observational studies, and loss of clinical equipoise" (opinion) [Ep 2 · 35:18](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2118) - "Long-term outcome data from 6 studies show consistent results: among shunted fetuses with good electrolytes (the best of the best), only 40-50% have normal renal function and approximately one-third require dialysis or transplant" (epidemiological) [Ep 2 · 36:17](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2177) - "Some LUTO cases can resolve spontaneously, either by the baby starting to void and refill its bladder naturally, or by spontaneous bladder decompression resulting in asymmetrical hydronephrosis or urinary ascites" (clinical) [Ep 2 · 37:40](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2260) - "Bladder rupture usually occurs after bladder drainage rather than spontaneously, and always resolves after a few days" (clinical) [Ep 2 · 38:17](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2297) - "Megacystis-microcolon-hypoperistalsis syndrome and cloacal dysgenesis are cases where there is no role whatsoever for shunting intervention" (clinical) [Ep 2 · 38:38](https://library.globalcastmd.com/watch/overview-of-prenatal-diagnosis-cincinnati-fetal-center-743?t=2318) - "Recurrence rate from thoracoscopic CDH repair is approximately 30%" — Ron (clinical) [Ep 1 · 6:36](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=396) - "Right-sided pulmonary pressures should be lower than systemic before proceeding to repair" — Wolfan (clinical) [Ep 1 · 8:11](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=491) - "Silk suture causes inflammatory reaction that promotes healing at repair edges" — Wolfan (clinical) [Ep 1 · 18:20](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1100) - "End-tidal CO2 may underestimate actual PCO2 in CDH patients, especially when cardiac output decreases" — Wolfan (clinical) [Ep 1 · 17:27](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1047) - "Conversion from MIS to open is good judgment, not a complication" — Wolfan (opinion) [Ep 1 · 20:28](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1228) - "Gore-Tex (PTFE) patches pull away laterally from chest wall at recurrence sites" — Wolfan (clinical) [Ep 1 · 21:32](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1292) - "Absorbable mesh dissolves in the center before adequate tissue ingrowth occurs from the sides" — Wolfan (clinical) [Ep 1 · 21:58](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1318) - "MIS approach greatly reduces small bowel obstruction rates compared to laparotomy" — Wolfan (clinical) [Ep 1 · 22:53](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1373) - "Nitric oxide does not work before ECMO in CDH patients based on available data" — Ron (clinical) [Ep 1 · 26:20](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1580) - "Very bad CDH patients have small left ventricles and hemodynamic problems in addition to pulmonary issues" — Ron (clinical) [Ep 1 · 26:02](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1562) - "VV ECMO sometimes does not work well in CDH patients with small left ventricles" — Ron (clinical) [Ep 1 · 26:02](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1562) - "Early repair on ECMO is associated with increased mortality in some institutional experience" — Ron (clinical) [Ep 1 · 29:11](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1751) - "Timing of CDH repair has no real influence on ultimate survival" — Wolfan (clinical) [Ep 1 · 30:08](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1808) - "Saint Petersburg center reports 100% survival in last 75 CDH patients, all comers including preemies and heart disease" (clinical) [Ep 1 · 31:26](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1886) - "At Saint Petersburg, 80% of CDH patients go on ECMO and are fixed immediately on ECMO" (clinical) [Ep 1 · 31:36](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1896) - "David Kayes switched to using Bivalirudin and reports decreased bleeding rates" — Ron (clinical) [Ep 1 · 32:57](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1977) - "Overall mortality for any baby with CDH that goes on ECMO is about 50%" — Ron (epidemiological) [Ep 1 · 37:34](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2254) - "National survival rate for CDH is 60-70%" (epidemiological) [Ep 1 · 31:19](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1879) - "Most CDH patients have non-rotation with relatively wide mesenteric base and are not at high risk for volvulus" — Wolfan (clinical) [Ep 1 · 38:33](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2313) - "Incidence of volvulus after CDH repair is surprisingly low" — Ron (epidemiological) [Ep 1 · 39:04](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2344) - "Transversalis muscle flap repair has very low recurrence rate but patients develop abdominal wall bulge" — Wolfan (clinical) [Ep 1 · 36:45](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2205) - "Fetal tracheal occlusion shows some benefit for babies with very poor prognosis" — Wolfan (clinical) [Ep 1 · 40:38](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2438) - "FETO trial indications are liver-up and LHR greater than 0.9" — Wolfan (guideline) [Ep 1 · 41:18](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=2478) - "Cauterizing the edge of the diaphragm defect promotes healing" — Wolfan (clinical) [Ep 1 · 10:25](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=625) - "Posterior leaflet of diaphragm must be unfolded during thoracoscopic repair" — Wolfan (clinical) [Ep 1 · 10:39](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=639) - "Using buttress material reduces recurrence rate in CDH repair" — Wolfan (clinical) [Ep 1 · 12:31](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=751) - "Sandwich technique using PTFE with biologic underlay has much lower recurrence rates" — Wolfan (clinical) [Ep 1 · 22:20](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1340) - "Repair on ECMO results in bleeding, more blood products, and longer ECMO run" — Wolfan (clinical) [Ep 1 · 29:58](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1798) - "Rate of return to ECMO and death following off-ECMO repair is very low" — Wolfan (clinical) [Ep 1 · 29:43](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1783) - "Patients with O-to-E lung size 25% and below have really bad predictors" — Ron (clinical) [Ep 1 · 25:35](https://library.globalcastmd.com/watch/controversies-in-congenital-diaphragmatic-hernia-update-course-2018-338?t=1535) - "Not all fetuses with urinary tract obstructions are candidates for interventions - fetus may be too healthy where risk outweighs benefit or too sick where intervention has minimal benefit" — Promote Reddy (clinical) [Ep 3 · 2:04](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=124) - "Resistance of flow across vesicoamniotic shunt is directly proportional to tube length and inversely proportional to radius, limiting pressure relief" — Promote Reddy (clinical) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=250) - "In adult studies, bladder pressure exceeding 40 centimeters of water injures kidneys and pressure of 29 millimeters of mercury results in no net filtration" — Promote Reddy (clinical) [Ep 3 · 4:49](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=289) - "Intravillous pressure that occludes venous flow in placenta is about 23 millimeters of mercury, and resting tone in amniotic fluid is probably 5 to 8 millimeters of mercury" (clinical) [Ep 3 · 5:43](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=343) - "Shunts have provided pulmonary survivors but haven't shifted the needle in terms of renal outcomes" — Promote Reddy (clinical) [Ep 3 · 6:53](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=413) - "When shunt is placed in bladder and bladder completely collapses, upper tracts (ureters, renal pelvis, collecting system) significantly decompress down to almost normal" — Mark (clinical) [Ep 3 · 7:49](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=469) - "Cystoscopy altered diagnosis in about 25% to 33% of fetuses but showed no significant improvement over shunting in terms of survival" — Mark (clinical) [Ep 3 · 11:46](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=706) - "French-Brazilian-Houston study of 111 fetuses showed only cystoscopy may prevent renal function impairment at 6 months of age, while both interventions improved 6-month survival" — Mark (clinical) [Ep 3 · 12:15](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=735) - "Barcelona-Leuven study of 20 fetal cystoscopy cases showed 80% had bladder size and amniotic fluid return to normal, no pulmonary hypoplasia in survivors, and three quarters had normal renal function" — Mark (clinical) [Ep 3 · 13:11](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=791) - "Cystoscopy created urethral fistula in 9 to 10% of cases and severe lower urinary tract obstruction recurred in about 6%" — Mark (clinical) [Ep 3 · 13:39](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=819) - "Earliest successful cystoscopy performed around 19 or 20 weeks gestation" — Mark (clinical) [Ep 3 · 15:35](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=935) - "Bladder cycling enabled by fetoscopic procedures is important for bladder health but doesn't directly impact upper tract - main difference is pressure relief through normal urethral lumen versus shunt" — Promote Reddy (clinical) [Ep 3 · 16:39](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=999) - "Would rather deal with surgically repairable fistula than renal dysplasia when weighing risk-benefit ratio" — Promote Reddy (opinion) [Ep 3 · 17:59](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1079) - "Posterior urethral valves are usually flimsy enough to be physically ablated by pushing catheter and guide wire through, not requiring laser" — Promote Reddy (clinical) [Ep 3 · 18:30](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1110) - "Hydrodistention alone unlikely to open valves because if it could, the pressure developing in urinary tract should blow them open naturally" — Promote Reddy (clinical) [Ep 3 · 18:46](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1126) - "Cincinnati case: 22-week fetus with severe oligohydramnios and keyhole sign underwent fetoscopic urethral stent placement, delivered at 37 weeks with normal fluid and birth weight over 3 kg, at 9 months has slowly climbing creatinine" — Fong (clinical) [Ep 3 · 19:15](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1155) - "If first and second bladder taps show good values at or below threshold with downward trend, third tap not necessary due to complication risk including bladder rupture" — Fong (clinical) [Ep 3 · 22:42](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1362) - "Fetoscopic procedures can be done with epidural supplemented by IV sedation and local anesthetic, unlike open fetal procedures requiring deep anesthesia for complete uterine relaxation" — Fong (clinical) [Ep 3 · 24:13](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1453) - "Fetoscopic approaches use intramuscular cocktail of vecuronium, atropine, and fentanyl for fetal immobilization and pain mitigation" (clinical) [Ep 3 · 24:57](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1497) - "Cincinnati case showed residual posterior urethral valve band on postnatal cystoscopy requiring subsequent removal despite prenatal intervention" — Fong (clinical) [Ep 3 · 27:23](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1643) - "When guide wire cannot pass through valve (urethral atresia cases), creating perineal fistula is debatable approach - some centers leave vesicoamniotic shunt as fallback" — Fong (opinion) [Ep 3 · 28:11](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1691) - "Equipment used: 3.3 French outer sheath fetoscope with 1.2 millimeter scope with side port for guide wire, sometimes switching to 4.9 French flexible ureteroscope through 10 French sheath for better maneuverability" — Fong (clinical) [Ep 3 · 30:01](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=1801) - "Pluto trial took bladder taps out of protocol because data suggested most powerful effect of shunting is in poor prognosis babies, and even with good prognosis about 50% end up with bad renal function postnatally" (clinical) [Ep 3 · 34:19](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2059) - "Third vesicocentesis provides fresher urine with better predictive value for degree of underlying renal injury, with strong histological correlation in prior studies" — Mark (clinical) [Ep 3 · 34:57](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2097) - "Long-term follow-up study showed one-third of shunted patients who developed end-stage renal disease had pretty good creatinine at hospital discharge, suggesting major renal morbidity comes postnatally" — Mark (clinical) [Ep 3 · 36:47](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2207) - "Centers sub-select patients by severity: better prognosis offered shunt, worse prognosis offered fetoscopic procedure, worst prognosis offered open intervention - making outcome comparisons unfair" — Promote Reddy (opinion) [Ep 3 · 38:56](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2336) - "Dr. Harrison reported 8 open fetal vesicostomies with 100% technical success but 50% mortality rate, leading him to stop and enter era of shunts" — Promote Reddy (clinical) [Ep 3 · 40:24](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2424) - "Cincinnati open vesicostomy experience: 6 families chose procedure, 4 fetal mortalities all from preterm delivery, 2 survivors - one 5 years old with normal voiding and normal right kidney function, one received kidney transplant" — Promote Reddy (clinical) [Ep 3 · 41:33](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2493) - "Open fetal intervention predisposes mother to very shortened gestational age (about 10 more weeks) and operated uterus is very unstable with preterm labor issues" — Promote Reddy (clinical) [Ep 3 · 41:06](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2466) - "Absolutely no role for open surgery for fetus, particularly worst prognosis group - would not do laparotomy for fetoscopic procedure or open fetal surgical procedure" — Mark (opinion) [Ep 3 · 43:18](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2598) - "Open intervention should be considered in patients with good prenatal prognostic profile who failed fetoscopic intervention, not worst population, due to maternal risk not outweighing benefit" — Fong (opinion) [Ep 3 · 46:09](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2769) - "Need better biomarker of fetal renal function to make better decisions about percutaneous versus fetoscopic versus open approaches" — Promote Reddy (opinion) [Ep 3 · 47:57](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=2877) - "Long-term study of shunted patients over 5 years showed 92% survival rate, 8% mortality from pulmonary hypoplasia, 45% normal renal function, 22% mild renal insufficiency, 33% developed end-stage renal disease requiring transplantation" — Mark (clinical) [Ep 3 · 50:14](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3014) - "About 67% of long-term survivors able to spontaneously void, 33% used intermittent catheterization or catheterization alone" — Mark (clinical) [Ep 3 · 50:48](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3048) - "Time to transplant varied by diagnosis: posterior urethral valves 10-12 years, prune belly variants or urethral hypoplasia 4-4.5 years, urethral atresia earlier" — Mark (clinical) [Ep 3 · 51:24](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3084) - "Kids who progressed to end-stage renal disease had repeated infections, bad reflux, and dysfunctional valve bladder - febrile morbidity and infections over time caused progressive injury" — Mark (clinical) [Ep 3 · 52:13](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3133) - "Urologists finding some kids with good bladder function in first 2-3 years start to lose function and behave like valve bladders - trying management strategies including overnight catheterization with some success" — Mark (clinical) [Ep 3 · 53:45](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3225) - "Creatinine at hospital discharge is very misleading - as children triple birth weight in first year, creatinine at age one is better prognostic indicator" — Promote Reddy (clinical) [Ep 3 · 56:35](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3395) - "If creatinine at age one is less than one, most likely will not need renal replacement therapy; if above one at age one, high probability will need renal replacement therapy" — Promote Reddy (clinical) [Ep 3 · 57:14](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3434) - "Bladder-initiated upper tract damage creates vicious cycle: minimal kidney injury causes concentrating defect leading to polyuria, which causes high bladder storage pressures, which damages kidneys further" — Promote Reddy (clinical) [Ep 3 · 57:34](https://library.globalcastmd.com/watch/urologic-fetal-intervention-cincinnati-fetal-center-745?t=3454) - "Only 20% of patent processus vaginalis will ever become a clinical hernia" — Jack (epidemiological) [Ep 5 · 8:07](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=487) - "If you have a patent processus vaginalis, you have 4 times greater risk than the general population of having a hernia on that side" — Todd (epidemiological) [Ep 5 · 8:31](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=511) - "When you see a patent processus with your scope, you are handling the cord in 4 out of 5 kids that didn't need it" — Jack (clinical) [Ep 5 · 8:11](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=491) - "The reincarceration rate started to go back up at 72 hours after reduction" — Jack (clinical) [Ep 5 · 17:18](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1038) - "80% of kids that are going to be incarcerated are under 12 months" (epidemiological) [Ep 5 · 12:01](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=721) - "The VA cooperative study in adults had a 1.7% incidence of incarceration in adults that have an inguinal hernia" — Todd (epidemiological) [Ep 5 · 11:44](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=704) - "Mesh has a 30% incidence of chronic pain that's been validated in multiple studies" — Todd (clinical) [Ep 5 · 28:16](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1696) - "Mesh has significant injury to the vas deferens" — Todd (clinical) [Ep 5 · 28:23](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1703) - "Most mesh repairs done by adult surgeons are in patients who are not planning on having any more kids" — Todd (clinical) [Ep 5 · 28:27](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1707) - "Felix Shear's Z stitch laparoscopic technique has about 6% recurrence rate" — Todd (clinical) [Ep 5 · 32:58](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1978) - "The seal technique at Stanford reports 1.2% recurrence rate, but other people report 3 or 4%" — Todd (clinical) [Ep 5 · 33:06](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=1986) - "CK Young's extraperitoneal percutaneous technique has less than 1% recurrence" — Todd (clinical) [Ep 5 · 33:20](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2000) - "Studies have shown decreased sperm quality in patients that have had bilateral inguinal hernia repairs" — Todd (clinical) [Ep 5 · 37:16](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2236) - "The infertility rate did not appear to be different despite decreased sperm quality" — Todd (clinical) [Ep 5 · 37:29](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2249) - "In rabbits, when you just did the stitch and waited two months and cut the stitch out, they all opened" — Todd (clinical) [Ep 5 · 39:51](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2391) - "When we cauterize then cut the stitch out in rabbits, they all stayed closed" — Todd (clinical) [Ep 5 · 39:58](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2398) - "The learning curve for laparoscopic hernia repair is up to maybe 30 or 40 cases before recurrence rate is acceptable" — Pete (clinical) [Ep 5 · 40:22](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2422) - "There are reports of postoperative cryptorchism after hernia repairs at a few percent" (clinical) [Ep 5 · 48:39](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2919) - "Doctor Ein published a series with 5000 cases with about 1% recurrence rate" — Pete (clinical) [Ep 5 · 35:40](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2140) - "John Atkins had about 4000 cases with about 1% recurrence rate" — Pete (clinical) [Ep 5 · 35:48](https://library.globalcastmd.com/watch/pediatric-hernia-update-course-2013-885?t=2148) - "Long gap esophageal atresia is defined by absence of gas in the abdomen on initial imaging" — Daniel von Allmen (clinical) [Ep 18 · 0:46](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=46) - "Cincinnati Children's uses a standardized interventional radiology protocol for measuring the esophageal gap, performed a couple of weeks after initial G-tube placement" — Daniel von Allmen (clinical) [Ep 18 · 0:46](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=46) - "Stretch is a very strong promoter of growth, and structures placed under tension will grow over time" — Daniel von Allmen (clinical) [Ep 18 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130) - "The cardiovascular system develops in utero using tension-based growth mechanisms" — Daniel von Allmen (clinical) [Ep 18 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130) - "In the Foker technique, surgeons tie sutures to both esophageal ends, externalize them through the chest wall, and progressively tighten them with spacers until the ends approximate" — Rod Gerardo (clinical) [Ep 18 · 1:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=68) - "The van der Zee technique uses the same traction concept as Foker but is performed thoracoscopically with all tension maintained inside the thorax" — Rod Gerardo (clinical) [Ep 18 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130) - "The Kimura technique creates a spit fistula that is progressively moved down the chest wall to stretch the proximal pouch toward the distal pouch" — Rod Gerardo (clinical) [Ep 18 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130) - "The Kimura technique is not used often anymore" — Rod Gerardo (opinion) [Ep 18 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130) - "A 2015 Boston series reported 96% success rate achieving intact esophagus in primary Foker cases" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "In secondary Foker cases (patients with previous operations), success rate was approximately two-thirds" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "Primary Foker cases had median ICU stay of 70 days with median two weeks of paralysis" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "Secondary Foker cases had median ICU stay of 110 days with median one month of paralysis" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "About two-thirds of primary Foker repair patients achieved full oral nutrition" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "About 10% of secondary Foker repair patients achieved full oral nutrition" — Daniel von Allmen (epidemiological) [Ep 18 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) - "The surgical dictum states that every effort should be made to conserve the native esophagus as no other conduit can replace its function satisfactorily" — Rod Gerardo (guideline) [Ep 18 · 4:12](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=252) - "The INOEA surgical group recommends gastric pull-up as the first option for esophageal replacement" — Daniel von Allmen (guideline) [Ep 18 · 4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276) - "In gastric transposition, the esophageal stump is divided at the esophageal hiatus, the fundus is mobilized and pulled up through either anterior or posterior mediastinum" — Daniel von Allmen (clinical) [Ep 18 · 4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276) - "Colon can be used as an interposition conduit for esophageal replacement" — Daniel von Allmen (clinical) [Ep 18 · 4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276) - "The choice of colon segment for interposition is based on blood supply and required diameter" — Rod Gerardo (clinical) [Ep 18 · 5:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308) - "In colonic interposition, the colon is passed behind the stomach while maintaining blood supply" — Rod Gerardo (clinical) [Ep 18 · 5:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308) - "Pyloroplasty is performed during colonic interposition to help with gastric emptying" — Rod Gerardo (clinical) [Ep 18 · 5:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308) - "Common problems with colonic interposition include dilation and tortuosity, with sigmoid redundancy often developing just above the diaphragm" — Daniel von Allmen (clinical) [Ep 18 · 8:00](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=480) - "Traditional teaching held that colonic interposition redundancy cannot be fixed safely due to risk to blood supply" — Daniel von Allmen (opinion) [Ep 18 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497) - "Passing the colonic interposition posterior to the stomach leaves the vascular pedicle along the spine, allowing safe mobilization and revision" — Daniel von Allmen (clinical) [Ep 18 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497) - "Sigmoid redundancy in colonic interposition can be revised transhiatally by dividing the gastroduodenal anastomosis, mobilizing the redundant segment, and re-anastomosing to the stomach" — Daniel von Allmen (clinical) [Ep 18 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497) - "Colonic interposition can achieve extraordinary length, sufficient to reach from pharynx to stomach in cases of extensive caustic injury" — Daniel von Allmen (clinical) [Ep 18 · 9:01](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=541) - "Gastric pull-up is difficult to perform when anastomosis to the pharynx is required" — Daniel von Allmen (clinical) [Ep 18 · 9:01](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=541) - "The short interval between traction initiation and anastomosis (less than five days in some cases) raises questions about whether the mechanism is growth or stretch" — Rod Gerardo (opinion) [Ep 18 · 9:56](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596) - "There is good physiologic data that tension is a growth promoter in organs other than the esophagus" — Daniel von Allmen (clinical) [Ep 18 · 9:56](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596) - "The mechanism of esophageal elongation (growth versus stretch) is not definitively known and requires further basic science research" — Daniel von Allmen (opinion) [Ep 18 · 9:56](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596) - "Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership" — Craig Lillehei (clinical) [Ep 22 · 3:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210) - "Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro'" — Craig Lillehei (clinical) [Ep 22 · 4:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240) - "In the TOTAL trial for severe CDH, FETO significantly improved survival" — Craig Lillehei (clinical) [Ep 22 · 10:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600) - "In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance" — Craig Lillehei (clinical) [Ep 22 · 10:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=620) - "The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols" — Craig Lillehei (clinical) [Ep 22 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=650) - "FETO is associated with prematurity and premature rupture of membranes as complications" — Craig Lillehei (clinical) [Ep 22 · 11:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=680) - "NPO guidelines for children are based on very poor evidence and vary significantly between institutions" (clinical) [Ep 22 · 15:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900) - "Pulmonary aspiration during elective pediatric surgery is very rare and usually occurs in emergency surgeries in high-risk children" (epidemiological) [Ep 22 · 15:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=920) - "Clear liquids containing carbohydrates empty the stomach very quickly regardless of patient age" (clinical) [Ep 22 · 15:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=950) - "British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17" (guideline) [Ep 22 · 16:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=970) - "ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals" (guideline) [Ep 22 · 16:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1000) - "European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else" (guideline) [Ep 22 · 17:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1030) - "Prolonged NPO periods cause ketone body generation, hypoglycemia, and patient irritability" (clinical) [Ep 22 · 17:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1060) - "In standard C-arm configuration, the x-ray source is below the table and the image intensifier is above" (clinical) [Ep 22 · 23:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1400) - "Placing lead shields on top of the patient during fluoroscopy does nothing to protect them because radiation comes from below the table" (clinical) [Ep 22 · 23:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1420) - "If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy, increasing patient exposure" (clinical) [Ep 22 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1450) - "Collimation focuses the x-ray beam to a specific area, increasing detail while decreasing total patient dose by reducing the irradiated surface area" (clinical) [Ep 22 · 25:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500) - "Magnification setting on fluoroscopy significantly increases radiation dose to both patient and room personnel" (clinical) [Ep 22 · 25:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530) - "Pulse mode fluoroscopy is feasible for most pediatric surgery applications and reduces radiation compared to continuous mode" (clinical) [Ep 22 · 25:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1550) - "CT scan for suspected airway foreign body has 94% accuracy in identifying foreign bodies when present" (clinical) [Ep 22 · 33:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2000) - "CT scan can identify non-radiopaque foreign bodies including plastic" (clinical) [Ep 22 · 33:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2020) - "In the Midwest Pediatric Surgery Consortium study of 521 primary lung lesions, none of the prenatally diagnosed lesions were malignant" (clinical) [Ep 22 · 36:40](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2200) - "Approximately 10% of postnatally diagnosed lung lesions were malignant in the consortium study" (epidemiological) [Ep 22 · 37:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2230) - "About half of malignant lung lesions were associated with DICER1 mutation" (clinical) [Ep 22 · 37:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2250) - "No malignant lung lesion had a systemic feeding vessel in the consortium study" (clinical) [Ep 22 · 37:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2270) - "CT scan sensitivity and specificity for detecting malignancy in lung lesions was poor with low inter-rater reliability among radiologists" (clinical) [Ep 22 · 38:10](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2290) - "The IMPACT study showed piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis" (clinical) [Ep 22 · 43:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2600) - "A NSQIP study of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole was preferred over piperacillin-tazobactam" (clinical) [Ep 22 · 44:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640) - "Mechanical bowel preparation has no effect on surgical site infection rates" — Paul Yzotrak (clinical) [Ep 22 · 50:00](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3000) - "Some data suggests mechanical bowel prep actually increases surgical site infections" — Paul Yzotrak (clinical) [Ep 22 · 50:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3020) - "The NEC trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage" — Paul Yzotrak (clinical) [Ep 22 · 53:20](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3200) - "The NEC trial cutoff for laparotomy was approximately one kilogram" — Paul Yzotrak (clinical) [Ep 22 · 53:50](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3230) - "Neuroblastoma with segmental chromosomal abnormalities but no MYCN amplification is now classified as high risk based on 2020-21 COG data" — Paul Yzotrak (guideline) [Ep 22 · 62:30](https://library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3750) - "Prenatal diagnosis has had a tremendous impact on the understanding and management of lung lesions" (opinion) [Ep 13 · 0:06](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=6) - "Right CDHs are frequently misdiagnosed as CPAMs and vice versa because of the similar echogenicity of the liver and the right chest" (clinical) [Ep 13 · 1:09](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=69) - "Steroids have reduced the need for surgical fetal intervention to almost zero in most fetal centers over the past 4-8 years" (clinical) [Ep 13 · 1:52](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=112) - "CPAMs tend to grow up until about 25 to 28 weeks when they plateau, then they actually regress in size very often" (clinical) [Ep 13 · 3:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=207) - "If the CVR is less than 1.6 with a solid lesion at presentation, there is less than a 3% chance of that lesion progressing to hydrops" (clinical) [Ep 13 · 3:46](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=226) - "CVR greater than 1.6 has a very high likelihood of developing hydrops, as high as 75%" (clinical) [Ep 13 · 4:10](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=250) - "Lesions with CVR greater than 1.6 are treated with steroids prophylactically to prevent hydrops at their center" (clinical) [Ep 13 · 4:24](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=264) - "The presented case is probably the only case in the last 5 years of a microcystic CPAM that did not respond to steroids at their center" (clinical) [Ep 13 · 4:51](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=291) - "Complete uterine relaxation with deep inhalational anesthetic is required before touching the uterus in fetal surgery" (clinical) [Ep 13 · 5:46](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=346) - "With an anterior placenta, a posterior uterine incision is required, necessitating division of the rectus muscle and a bigger abdominal incision" (clinical) [Ep 13 · 7:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=447) - "Fetuses can become bradycardic when tumors are decompressed out of the chest due to loss of preload on the heart" (clinical) [Ep 13 · 8:40](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=520) - "Fetuses are preloaded via IV before chest decompression to prevent bradycardia" (clinical) [Ep 13 · 8:49](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=529) - "The fetus was delivered at 35 weeks without ventilation required after fetal lobectomy at 23 weeks" (clinical) [Ep 13 · 10:01](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=601) - "At CHOP, overall survival for open fetal surgery is around 60%, consistent over all years" (clinical) [Ep 13 · 10:20](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=620) - "Survivors of open fetal surgery have good quality of life outcomes with no major neurologic sequelae" (clinical) [Ep 13 · 10:30](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=630) - "Losses in open fetal surgery are usually due to hydrops progressing too far, inability to tolerate the procedure, or early preterm labor" (clinical) [Ep 13 · 10:44](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=644) - "Macrocystic CPAMs are less predictable, and even patients with CVR less than 1.6 will occasionally grow rapidly and induce hydrops" (clinical) [Ep 13 · 10:58](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658) - "Thoracoamniotic shunt converted CVR from 3.6 to 0.8 and reversed hydrops in a macrocystic CPAM case" (clinical) [Ep 13 · 11:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=687) - "Shunt experience has been about 70% survival" (clinical) [Ep 13 · 11:53](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=713) - "Losses with shunts are usually due to early delivery and associated prematurity, inadequate compensatory lung growth, or residual mass effect" (clinical) [Ep 13 · 11:57](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=717) - "Marked chest wall deformity can occur if shunts are placed for giant macrocystic CPAMs early in gestation, most prominent at 18-20 weeks" (clinical) [Ep 13 · 12:13](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=733) - "Chest wall deformity from early shunt placement is related to collapse of the chest wall rather than harpoon placement of the shunt" (clinical) [Ep 13 · 12:34](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=754) - "Chest wall deformity from shunts becomes less pronounced over time and thus far has not required chest reconstructive procedures" (clinical) [Ep 13 · 12:42](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=762) - "CPAMs with multiple macrocysts generally communicate, so placement of a shunt can decompress those lesions dramatically" (clinical) [Ep 13 · 13:09](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=789) - "Ascites alone is not considered hydrops" (clinical) [Ep 13 · 13:28](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=808) - "EXIT procedure is designed to maintain uteroplacental blood flow during delivery and resection of the mass" (clinical) [Ep 13 · 13:56](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=836) - "Infants can be maintained with normal blood gases for an hour and a half by a well-performed EXIT procedure" (clinical) [Ep 13 · 15:36](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=936) - "CHOP has performed 16 EXIT procedures for lung lesions, with 4 requiring ECMO and 15 survivors" (clinical) [Ep 13 · 15:44](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=944) - "ECMO is a very unusual requirement for lung lesions because of their late enlargement, so they do not have the same effect on lung hypoplasia as CDH" (clinical) [Ep 13 · 15:50](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=950) - "Fetal intervention is generally considered a contraindication in twin gestations" (clinical) [Ep 13 · 16:19](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=979) - "EXIT procedures are much trickier with twin gestations" (clinical) [Ep 13 · 16:27](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=987) - "EXIT procedures are reserved for cases with mass effect showing diaphragmatic aversion, inability to visualize the opposite lung easily, and dramatic mediastinal shift" (clinical) [Ep 13 · 18:01](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1081) - "Most large CPAMs at birth do not need EXIT procedures and can be managed with C-section and immediate resection" (clinical) [Ep 13 · 17:48](https://library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1068) ## Changelog - Aug 31: 33 doctors auto-found from episode dossiers - Aug 30: 30 doctors auto-found from episode dossiers - Aug 30: 29 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 37 doctors auto-found from episode dossiers - Aug 29: 37 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 39 items, 31 dossiers, summaries for 4 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 1 audience(s) - Aug 29: Collection generated from campaign corpus: 33 items, 31 dossiers, summaries for 3 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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