# Pulmonary Hypertension — GCMD Library living collection

Everything in the library about pulmonary hypertension — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 77 cited statements

## Episodes
### Acute Management
- [CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002) — video · 10:45 · [machine version](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002.md)

### Surgical Management
- [Challenges in Diaphragmatic Hernia Repair: Update Course 2016](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559) — video · 44:15 · [machine version](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559.md)
- [CDH-ECMO Routine Patient Preoperative Workup, Timing, Technique: Update...](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003) — video · 3:31 · [machine version](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003.md)

### Complications
- [Update Course Rewind: Omphalocele & Gastroschisis 2020](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507) — podcast · 15:18 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=0) Indications and Technical Approach to MIS CDH Repair (Ep 1)
- [12:39](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=759) Mesh Layering Technique and ECMO Considerations (Ep 1)
- [16:32](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=992) Case 1: Timing of Repair in Stable Term Neonate (Ep 1)
- [21:09](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1269) Case 2: ECMO Cannulation Strategy (Ep 1)
- [25:42](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1542) Repair Timing Relative to ECMO Run (Ep 1)
- [35:51](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2151) Case 3: Recurrent Right-Sided CDH with Sac (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=0) VV versus VA ECMO cannulation strategies and institutional approaches (Ep 2)
- [3:10](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=190) Patch techniques and management of respiratory acidosis during thoracoscopic repair (Ep 2)
- [5:01](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=301) Comparative outcomes of VA versus VV ECMO in CDH (Ep 2)
- [7:40](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=460) Timing of CDH repair relative to ECMO run and patch material selection (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=0) Case presentation and timing of CDH repair (Ep 3)
- [1:11](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=71) Waiting for subsystemic pulmonary pressures before repair (Ep 3)
- [1:59](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=119) Surgical approach: thoracoscopy vs laparoscopy (Ep 3)
- [2:32](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=152) Pleural dissection technique to reduce recurrence (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=0) Giant omphalocele: pulmonary hypertension and management options (Ep 4)
- [3:46](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=226) Hydrocolloid dressing technique and Ladd procedure considerations (Ep 4)
- [6:42](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=402) Large abdominal wall defect management: mesh scaffolding and delayed reconstruction (Ep 4)
- [12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745) Gastroschisis management: sutureless closure and antibiotic stewardship (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Giant omphalocele is typically defined as five centimeters or greater or liver in the sac" (clinical) [Ep 4 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "In a two-center retrospective study encompassing 20 years with 97 survivors of giant omphalocele, patients had greater time to full feeds, required more TPN, had more chromosomal anomalies, and had higher incidence of respiratory insufficiency" (epidemiological) [Ep 4 · 0:36](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=36)
- "56 patients of 97 giant omphalocele survivors were identified as having pulmonary hypertension, most diagnosed within the first week of life" (epidemiological) [Ep 4 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Five patients out of 56 with pulmonary hypertension had no signs in their first echo within the first seven days of life, then subsequently developed severe pulmonary hypertension after an episode of sepsis; two died and one required pulmonary vasodilator for more than a year" (clinical) [Ep 4 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Even in omphalocele patients without signs of respiratory compromise early, sepsis later puts these patients at high risk for pulmonary hypertension" (clinical) [Ep 4 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=74)
- "Dr. Miguel Guelfand uses hydrocolloid dressing to make a silo for giant omphalocele without painting the sac, achieving closure in 97% within 30 days and 92% within 15 days in 40 patients" (clinical) [Ep 4 · 3:46](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=226)
- "For hydrocolloid dressing technique, the dressing should be placed within the first 24 hours so the sac doesn't get very stiff, and the hydrocolloid makes the sac very smooth and hydrated" (clinical) [Ep 4 · 4:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=266)
- "Dr. Guelfand's team keeps all giant omphalocele patients in ICU ventilated and completely paralyzed during active reduction" (clinical) [Ep 4 · 4:20](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=260)
- "For ruptured omphalocele, Dr. Guelfand's team sutures the omphalocele and then applies the hydrocolloid dressing; they have treated three such patients" (clinical) [Ep 4 · 4:45](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=285)
- "The risk of midgut volvulus was higher in patients with omphalocele compared to gastroschisis, and there was increased risk of adhesive bowel obstruction with gastroschisis" (epidemiological) [Ep 4 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "If exposing the intestines in omphalocele patients, it is worthwhile doing a Ladd procedure at the time because these patients have non-rotation or mal-rotation, and non-rotation does not exclude the possibility of having anatomy with a narrow base of mesentery" (clinical) [Ep 4 · 5:17](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=317)
- "Dr. Guelfand uses proline mesh for huge gastroschisis or omphalocele cases when there is no place for hydrocolloid, protecting it with a plastic bag within the bowel; this technique has been used for 15 years" (clinical) [Ep 4 · 8:18](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=498)
- "When a Bentec spring-loaded silo is placed for giant abdominal wall defect and pushed down, the forces go out and actually make the defect much bigger over time" (clinical) [Ep 4 · 8:49](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=529)
- "Dr. Islam's team used biologic mesh as a scaffold for a large abdominal wall defect, which sticks to the bowel and creates a scaffold to allow skin to epithelialize, then used circumcision skin as a graft, followed by plastic surgery tissue expanders and flaps for coverage" (clinical) [Ep 4 · 9:14](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=554)
- "Component separation technique involves separating tissue at the external oblique about a centimeter beyond the rectus sheath on both sides, dissecting between external and internal oblique, and optionally making an incision on the anterior rectus sheath for another centimeter of space" — Ellen Encisco (host_summary) [Ep 4 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "A Texas report described component separation use in nine children aged seven days to 10 years, mostly for omphaloceles and giant defects, achieving fascial closure in the vast majority with some mesh use for bridging" — Ellen Encisco (host_summary) [Ep 4 · 10:26](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=626)
- "Complex gastroschisis is almost a different disease from simple variety; everything is worse including hospital length of stay, requirement for further operations, and sepsis rates" (clinical) [Ep 4 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "In sutureless gastroschisis closure, the silo is placed or bowel is tucked in with occlusive dressing, changed at five days, and mostly closed by the next change, then simple dressings can be used" (clinical) [Ep 4 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Comparing sutured versus sutureless gastroschisis closure, there was no difference in time to full feeds, TPN use, or duration of hospital stay, but sutureless had fewer anesthetics, less frequent antibiotic use, and fewer infections and septic events" (epidemiological) [Ep 4 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "A randomized trial of over 50 gastroschisis patients found no difference between immediate closure and silo placement" (epidemiological) [Ep 4 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "The finding of no difference between silo and immediate closure paved the way for studying sutureless closure, because it established that immediate closure was not superior before moving to sutureless technique" (opinion) [Ep 4 · 12:25](https://library.globalcastmd.com/watch/update-course-rewind-omphalocele-gastroschisis-2020-13507?t=745)
- "Indication for minimally invasive CDH repair is any patient stable enough to transport to OR, with pulmonary pressures lower than systemic." (guideline) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=0)
- "Most centers wait to repair CDH until right-sided (pulmonary) pressures are lower than systemic pressures." (host_summary) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=60)
- "Contraindications to MIS CDH repair include repair on ECMO; liver-up, stomach-up, oscillator use, and redo repair are NOT contraindications." (guideline) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90)
- "A laparotomy for CDH repair carries significant lifelong risk of small bowel obstruction, which may be underestimated and is a major advantage of MIS approach." (opinion) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=180)
- "Early studies from Babies Hospital showed relatively high recurrence rate for primary MIS CDH repair, but this may be related to technique." (host_summary) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=150)
- "Technical pearls for MIS CDH repair include pericostal sutures, mesh reinforcement, and avoiding tension; agenesis or near-agenesis should prompt conversion to open." (clinical) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=210)
- "All CDH patients have obligate pneumothorax post-repair due to pulmonary hypoplasia; chest tube use is debated." (clinical) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=420)
- "Biologic mesh alone to bridge a CDH defect is associated with higher recurrence rates; biologics dissolve in the middle due to lack of tissue ingrowth on the chest side." (clinical) [Ep 1 · 10:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=600)
- "PTFE-biologic sandwich technique (PTFE on lung side, biologic on abdominal side) reduces recurrence compared to biologic alone, particularly for dome recurrences." (clinical) [Ep 1 · 10:40](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=640)
- "Pericostal 'seesaw' suture technique involves bringing suture through small stab incision, around rib, and tying externally; scars fade over time." (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=480)
- "Biologic underlay should extend beyond the primary repair edge by 1-2 cm, with sutures taking bites of diaphragm and mesh away from the edge to create overlap." (clinical) [Ep 1 · 12:39](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=759)
- "In multivariate analysis of institutional experience, use of biologic mesh alone was a major risk factor for CDH recurrence." (epidemiological) [Ep 1 · 12:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=720)
- "Recent study suggests waiting until after ECMO decannulation for CDH repair may improve survival rates." (host_summary) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=90)
- "VV ECMO overall outcomes may favor VV over VA ECMO for CDH; VA ECMO associated with more neurologic events, VV with more renal complications." (host_summary) [Ep 1 · 25:42](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1542)
- "Propensity analysis showed VV ECMO survival 60% versus VA ECMO 46% for CDH." (host_summary) [Ep 1 · 26:20](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1580)
- "Institutional comfort and experience with VV ECMO management affects outcomes; some centers routinely convert VV to VA due to instability." (clinical) [Ep 1 · 27:02](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1622)
- "Oxygen is an incredible inotrope; oxygenated blood via VV ECMO often allows weaning of pressors." (host_summary) [Ep 1 · 28:32](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1712)
- "VV ECMO cannulation technique uses open cut-down with cephalad cannula to smooth out first 24 hours and improve flows." (clinical) [Ep 1 · 29:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1740)
- "ELSO registry study of matched patients showed higher survival for CDH repair after ECMO versus on ECMO." (host_summary) [Ep 1 · 35:51](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2151)
- "Some institutions repair very sick CDH patients early in ECMO run (first 24-48 hours) with reported decreased bleeding risk, though this is debated." — Jason (clinical) [Ep 1 · 37:16](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236)
- "Patients who linger then have acute hypertensive crisis and go on ECMO may be repaired off ECMO after short run; long-riders may be repaired early if stable." — Jason (clinical) [Ep 1 · 37:16](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2236)
- "Muscle flap repair (transversus abdominis) has dramatically lower recurrence rate than patch repair for large CDH defects, particularly in ECMO population." (host_summary) [Ep 1 · 33:10](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1990)
- "Transversus abdominis flap technique involves transverse abdominal incision at umbilicus level, developing transversus plane, maintaining blood supply; half the flap remains naturally attached to lateral wall." (clinical) [Ep 1 · 43:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580)
- "Muscle flap reconstruction carries risk of abdominal wall deformity; patient selection is important." (clinical) [Ep 1 · 43:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2580)
- "In recurrent-recurrent CDH, latissimus flaps or large chest wall muscle flaps may be used as salvage." (clinical) [Ep 1 · 42:20](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540)
- "Sewing to good tissue is critical; recurrences may occur when suturing to scar tissue rather than viable diaphragm." (clinical) [Ep 1 · 42:20](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2540)
- "Consensus among audience: wait 2-4 days before repairing stable term CDH neonate to ensure pulmonary hypertension does not develop." (host_summary) [Ep 1 · 16:32](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=992)
- "Days to repair are less important than change in pulmonary pressure over time; goal is to avoid repairing during physiologic instability." (clinical) [Ep 1 · 17:45](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1065)
- "Historical 'honeymoon period' where stable CDH neonates suddenly crash to ECMO is seen less often now but remains a concern." (clinical) [Ep 1 · 18:10](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1090)
- "Physiologic defect in CDH is pulmonary, not the intestines in the chest ('not the chits in the chest')." (clinical) [Ep 1 · 19:10](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1150)
- "Audience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall." — Todd Ponsky (host_summary) [Ep 1 · 20:03](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1203)
- "Decision to place CDH patient on ECMO is joint between pediatric surgeon and neonatologist; institutional variability exists." (clinical) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1320)
- "Standard ECMO criteria require repeated evidence of elevated OI over several hours, not single measurement." (host_summary) [Ep 1 · 22:30](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=1350)
- "Institutional practice: if CDH patient cannot be weaned from ECMO, transition to comfort measures rather than last-ditch repair on ECMO." (clinical) [Ep 1 · 35:20](https://library.globalcastmd.com/watch/challenges-in-diaphragmatic-hernia-repair-update-course-2016-559?t=2120)
- "Echocardiography and TR jet measurement are essential to assess pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient." — Todd Ponsky (clinical) [Ep 3 · 0:00](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=0)
- "Jason waits until pulmonary pressures are subsystemic, at least 70% systemic and ideally 50% systemic, before proceeding to CDH repair." — Jason (clinical) [Ep 3 · 1:12](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=72)
- "Jason uses serial echocardiography aggressively to monitor pulmonary pressures before surgery, typically waiting around 2 days." — Jason (clinical) [Ep 3 · 1:12](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=72)
- "Jason performs thoracoscopic CDH repair in well-managed patients." — Jason (clinical) [Ep 3 · 1:59](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=119)
- "Jason tried laparoscopic CDH repair early on and found it quite nice, but considers thoracoscopy an easier operation." — Jason (opinion) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=125)
- "Jason has started dissecting out the pleura to create a raw edge around the CDH defect." — Jason (clinical) [Ep 3 · 2:32](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=152)
- "Sewing pleura to pleura without creating a raw edge may have a high failure rate analogous to laparoscopic inguinal hernia repair (sewing peritoneum to peritoneum)." — Todd Ponsky (opinion) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=155)
- "Scoring the pleura all the way around and unfurling it so that it comes together with more of a scar may reduce recurrence." — Todd Ponsky (opinion) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=155)
- "A lamb model for studying CDH repair techniques would cost $5000 per lamb, making formal study prohibitively expensive." — Jason (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=180)
- "The speaker has a high degree of suspicion that pleural dissection will reduce CDH recurrence, but this has not been formally studied." — Jason (opinion) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/cdh-ecmo-routine-patient-preoperative-workup-timing-technique-update-1003?t=180)
- "Currently the institution does VA ECMO for CDH patients" (clinical) [Ep 2 · 0:18](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=18)
- "One institution performs VV ECMO with cephalad cannula for CDH patients and has been doing so since the late 1990s" (clinical) [Ep 2 · 0:30](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=30)
- "Conversion from VV to VA ECMO is exceedingly rare at this institution, approximately 3 cases in the last 10 years" (epidemiological) [Ep 2 · 0:30](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=30)
- "If an institution is really good at VV ECMO, they should do VV ECMO; if really good at VA ECMO, they should do VA ECMO" — Todd Ponsky (opinion) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=82)
- "There is evidence that the complication rate with VA ECMO is higher than VV ECMO" — Todd Ponsky (host_summary) [Ep 2 · 1:22](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=82)
- "For underlay patches, SIS is used; for full patches, a composite of SIS on the abdominal side and Gore-Tex on the thoracic side is used" (clinical) [Ep 2 · 2:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- "The SIS underlay is secured by taking bites of the diaphragmatic leaf and mesh and tying, which causes some imbrication" (clinical) [Ep 2 · 2:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- "The Gore-Tex provides the security on the thoracic side, not the SIS" (clinical) [Ep 2 · 2:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=122)
- "Muscle flaps cause some abdominal wall weakness but not a true hernia because the transversus abdominus muscle is used as the flap" (clinical) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- "Muscle flaps have not been found to cause a significant amount of scoliosis, no more than any other repair method" (clinical) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- "Most CDH patients have issues with scoliosis when sutures are taken around the ribs and bite into the intercostal tissue, causing skeletal defects" (clinical) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=200)
- "The risk of skeletal deformity is higher with patches" (clinical) [Ep 2 · 3:50](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=230)
- "During thoracoscopic repair, transient respiratory acidosis may occur but its clinical significance needs to be evaluated if it is not too severe" (clinical) [Ep 2 · 4:04](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- "For thoracoscopic CDH repair, very low insufflation pressures are used, with the highest being about 5 mmHg" (clinical) [Ep 2 · 4:04](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- "Once the viscera is reduced during thoracoscopic repair, insufflation can be turned off because pulmonary hypoplasia provides adequate domain without gas" (clinical) [Ep 2 · 4:04](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- "The period of insufflation during thoracoscopic CDH repair should be very short" (clinical) [Ep 2 · 4:04](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=244)
- "VA ECMO is associated with more neurological complications compared to VV ECMO" (host_summary) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- "VV ECMO is associated with more renal complications compared to VA ECMO" (host_summary) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- "Aggressive hemofiltration and other measures can obviate some of the renal complications associated with VV ECMO" (clinical) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- "In the ELSO registry for CDH, VA ECMO had 48% survival and VV ECMO had 43% survival, with no statistically significant difference" (host_summary) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- "A propensity-matched analysis of the ELSO registry showed a survival advantage for VV ECMO over VA ECMO in CDH patients" (host_summary) [Ep 2 · 5:31](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=331)
- "There is some data suggesting VV ECMO is probably advantageous over VA ECMO" — Todd Ponsky (host_summary) [Ep 2 · 6:34](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=394)
- "If you have expertise in VA ECMO, you will not get as good results with VV ECMO and vice versa" — Todd Ponsky (opinion) [Ep 2 · 7:17](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=437)
- "You should do what you are good at regarding ECMO modality unless there is overwhelming evidence for one approach" — Todd Ponsky (opinion) [Ep 2 · 7:17](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=437)
- "For really poor prognosis CDH patients, aggressive repair in the first 24 to 48 hours on ECMO is performed" (clinical) [Ep 2 · 8:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- "For acute pulmonary hypertension crisis cases expected to be a short ECMO run, repair is delayed until off ECMO once echoes demonstrate subsystemic pulmonary hypertension" (clinical) [Ep 2 · 8:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- "For patients on ECMO for 2 or 3 weeks, repair is performed towards the end of the ECMO run" (clinical) [Ep 2 · 8:02](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=482)
- "The problem in CDH is not the hole in the diaphragm; that is not causing the pulmonary problems" (clinical) [Ep 2 · 8:38](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=518)
- "Data from Texas Children's Group shows that early repair on ECMO versus off ECMO does not have statistically significant difference in outcomes, though curves suggest a tendency favoring post-ECMO repair" (host_summary) [Ep 2 · 8:43](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=523)
- "Some institutions will stop ECMO and not repair CDH in patients who cannot be weaned from ECMO" — Todd Ponsky (clinical) [Ep 2 · 9:10](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=550)
- "After ECMO, most people will do open CDH repair" — Todd Ponsky (host_summary) [Ep 2 · 9:27](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=567)
- "A scope is put in every CDH patient after ECMO at this institution" (clinical) [Ep 2 · 9:32](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=572)
- "Muscle flap mobilization and placement can potentially be done laparoscopically" — Todd Ponsky (opinion) [Ep 2 · 10:09](https://library.globalcastmd.com/watch/cdh-ecmo-vv-vs-va-repair-on-ecmo-update-course-2015-1002?t=609)

## Changelog
- Sep 16: 4 items added automatically

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