Single Ventricle / HLHS
Also covered as: cloaca · anorectal malformation · perineal fistula · tethered cord · pulmonary hypoplasia · scoliosis · hypoplastic left heart syndrome · urogenital sinus
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
Content of this collection
Foundations
2 items
How Does the Blood Go Round in Single Ventricles and Fontans? New Horizons in...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Andrew Redin
video · 24:58 · Jan 2019
Pyloric Stenosis
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Dr. Bhargava Mullapudi, Pediatric Surgeon at Cincinnati Children’s, and Dr. Gillian Goddard, Pediatric Surgery Research Fellow at Cincinnati Children's, joins Dr. Rae Hanke to review the essentials of pyloric stenosis in this videocast.Pylo
video · 12:30 · May 2020
Diagnosis & Workup
3 items
Case Review Dynamic Assessment of the Fontan Part II: New Horizons in Medical...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Veldtman foc
video · 14:38 · Jan 2019
Case Review Dynamic Assessment of the Fontan Part I: New Horizons in Medical...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Bryan Goldst
video · 22:46 · Jan 2019
Advanced Imaging of the Fontan, What is Driving Fontan Failure: New Horizons...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Andrew Crean
video · 24:44 · Jan 2019
Medical Management
2 items
How do we manage thrombogenicity and thrombosis in the Fontan? New Horizons...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Joseph Palum
video · 16:51 · Jan 2019
The Role of Trans-Catheter Arrhythmia Management - Patient Based Decision...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Richard Czos
video · 20:55 · Jan 2019
Surgical Management
11 items
Update on Surgical Practice and Current State on Fontan Conversion Surgery:...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session,Dr. James Tweddel
video · 25:00 · Jan 2019
Transplantation and Ventricular Assist Devices: New Horizons in Medical and...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Angela Lorts
video · 23:13 · Jan 2019
Trans-Catheter Interventions: New Horizons in Medical and Surgical Fontan...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Dr. Bryan Goldst
video · 17:26 · Jan 2019
Ovarian Torsion with Dr. Jennifer Dietrich
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Dr Jennifer E. Dietrich, discusses ovarian torsion with Dr Todd A. Ponsky Edited by Nicholas E. Bruns, MD Ian C. Glenn, MD
podcast · 47:22 · Jan 2019
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast · 43:47 · Jan 2019
Neonatal Lung Lesions with Dr. Steven Rothenberg
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Dr. Steven Rothenberg discusses Newborn Lung Lesions with Dr Todd Ponsky. Edited by Ian C. Glenn, MD Nicholas E. Bruns, MD
podcast · 66:58 · Jan 2019
Chest Wall Deformities with Dr. Robert Kelly
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Dr. Robert Kelly discuses chest wall deformities with Dr. Todd Ponsky. Edited by Ian C Glenn, MD and Nicholas Bruns, MD
podcast · 46:50 · Jan 2019
Neonatal Lung Lesions with Dr. Steven Rothenberg
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Dr. Steven Rothenberg discusses Newborn Lung Lesions with Dr Todd Ponsky. Edited by Ian C. Glenn, MD & Nicholas E. Bruns, MDPrenatal evaluationPatients with prenatal diagnosis of cystic lung lesions are referred for prenatal evaluation and
podcast · 66:58 · Dec 2020
Ovarian Torsion with Dr. Jennifer Dietrich
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Dr Jennifer E. Dietrich, discusses ovarian torsion with Dr Todd A. Ponsky Edited by Nicholas E. Bruns, MD & Ian C. Glenn, MDEvaluation of the adolescent female with pelvic painObtain sexual history and urine b-hCGMenstrual history (hemorrha
podcast · 47:22 · Dec 2020
Chest Wall Deformities with Dr. Robert Kelly
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Dr. Robert Kelly discuses chest wall deformities with Dr. Todd Ponsky. Edited by Ian C Glenn, MD and Nicholas Bruns, MDPectus excavatumHistoryApproximately 2/3 of patients presenting with symptoms, which include dyspnea on exertion, easy fa
podcast · 46:50 · Dec 2020
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
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Marc Levitt, MD discusses Cloaca with Todd Ponsky, MD and Aaron Garrison, MDEdited by Ian C Glenn, MD and Sophia Abdulhai, MDDr. Levitt is surgical director of the Center for Colorectal and Pelvic Reconstruction as well as program director
podcast · 43:47 · Dec 2020
Complications
3 items
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky Edited by Nicholas Bruns, MD and Ian C. Glenn, MD In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast · 48:09 · Jan 2019
Management of Retained Central Venous Catheters
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Ian Glenn and Todd Ponsky discuss the management of retained central venous canulas.
video · 3:41 · Apr 2019
Complications of Anorectal Malformations with Dr. Marc Levitt
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Dr Marc Levitt discusses ARM Complications with Dr Todd Ponsky
Edited by Nicholas Bruns, MD and Ian C. Glenn, MD
In this episode, Dr. Marc Levitt from Nationwide Children’s Hospital discusses complications of anorectal malformations. This e
podcast · 48:09 · Dec 2020
Evidence & Research
8 items
Posterior Tracheopexy For Severe Tracheomalacia
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Dr. Ian Glenn and Dr. Todd Ponsky give a two minute review of "posterior tracheopexy for severe tracheomalacia," and article published in the Journal of Pediatric Surgery. Dr. Hester Shieh and colleagues performed posterior tracheopexy on p
video · 2:17 · Sep 2018
Posterior Tracheopexy For Severe Tracheomalacia
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Dr. Ian Glenn and Dr. Todd Ponskygive a two minute review of "posterior tracheopexy for severe tracheomalacia," and article published in the Journal of Pediatric Surgery.Dr. Hester Shieh and colleagues performed posterior tracheopexy on pat
video · 2:18 · Sep 2018
Esophagogastric Dissociation for GERD in Severe Neurodisability
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Dr. Ian Glenn and Dr. Todd Ponsky discuss an article comparing esophagogatric dissociation and laparoscopic Nissen fundoplication in patients with severe gastroesophageal reflux disease (GERD) and severe neurodisability
video · 2:49 · Oct 2018
Esophagogastric Dissociation for GERD in Severe Neurodisability
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Dr. Ian Glenn and Dr. Todd Ponsky discuss an article comparing esophagogatric dissociation and laparoscopic Nissen fundoplication in patients with severe gastroesophageal reflux disease (GERD) and severe neurodisability
video · 2:49 · Jan 2019
Do we need Bowel Prep
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Ian Glenn gives a review of the literature to answer the question of whether or not we need bowel prep in children.
video · 1:15 · Apr 2019
Outcomes of Fontan Patients Undergoing Combined Heart - Liver Transplantation in Pediatric Hospitals Across the U.S.
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Grant Chappell, Amir Mehdizadeh-Shrifi, Darren Turner, Alexander Bondoc, Suzanne Evans, Alexander G Miethke, Gregory Tiao, Meghan M Chlebowski, Alexander R Opotowsky, David Lehenbauer, Marco Ricci, Awais Ashfaq, David L S MoralesBackground:
video · 0:59 · Dec 2025
Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma
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Pradipta Debnath, Marissa Ray, Luke Pater, Alexandra O Glenn, Stephen Hartman, Elanchezhian Somasundaram, Todd Jenkins, Juan P Gurria, Katherine Somers, Andrew T Trout, Meera KotagalBackground/objectives: Radiation therapy (RT) is part of s
video · 1:10 · Apr 2026
Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis
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Lizzie Lee from Cincinnati Children's discusses a study on pediatric pulmonary vein stenosis (PVS), a rare but serious condition. The research compares surgical and catheter-based interventions, revealing high recurrence rates for both appr
video · 0:57 · Jul 2026
Case-Based Learning
3 items
Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...
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Dr. Nicholas Bruns gives a presentation on intussusception, soft tissue abscess, pilonidal cyst, bleeding Meckel's Diverticulum. His presentation generates discussion onreduced ileocolic intussusception and an appendectomy, age cutoff for a
video · 19:53 · Nov 2018
Pregnancy in a Fontan Patient: New Horizons in Medical and Surgical Fontan...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session, Drs Anisa Chaudr
video · 18:27 · Jan 2019
Pilonidal Cyst Case Presentation: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. Ian Glenn leads this case based discussionon pilonidal cysts. Topics discussed include definitive treatment for pilonidal cyst disease, factors altering mana
video · 5:08 · Jan 2019
In-Depth Reviews
4 items
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
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Dr Charlie Stolar discusses key points of CDH with Dr. Todd Ponsky. EDITED BY NICHOLAS BRUNS, MD and IAN GLENN, MD.
podcast · 82:05 · Jan 2019
Abdominal Wall Defects with Dr. Jacob Langer
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Dr Jacob Langer discusses abdominal wall defects with Dr. Todd Ponsky.Edited by Ian C. Glenn, MD and Sophia Abdulhai, MDAn interactive discussion about gastroschisis and omphalocele between Todd Ponsky, MD and Jacob "Jack" Langer, MD. Dr. L
podcast · 52:45 · Jan 2019
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
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Dr Charlie Stolar discusses key points of CDH with Dr. Todd Ponsky. EDITED BY NICHOLAS BRUNS, MD and IAN GLENN, MD.In this episode, Dr. Charles Stolar from Columbia University College of Physicians and Surgeons and California Pediatric Sur
podcast · 82:05 · Dec 2020
Abdominal Wall Defects with Dr. Jacob Langer
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Dr Jacob Langer discusses abdominal wall defects with Dr. Todd Ponsky.Edited by Ian C. Glenn, MD and Sophia Abdulhai, MDAn interactive discussion about gastroschisis and omphalocele between Todd Ponsky, MD and Jacob "Jack" Langer, MD. Dr. L
podcast · 52:45 · Dec 2020
Long-Term Care
1 item
Psychosocial Outcomes: New Horizons in Medical and Surgical Fontan Management...
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Physicians from theCincinnati Children’s Heart Institutediscuss the long-term care of single ventricle patients from infancy to adulthood, including new insights on Fontan management and quality of life.During this session,Dr. Stacey Morris
video · 22:39 · Jan 2019
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Every statement below comes from the recorded discussions, with its speaker and moment.
Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison
The most common prenatal ultrasound finding in cloaca is a pelvic mass, often initially thought to be the bladder but actually representing a dilated vagina (hydrocolpos)
clinicalMarc Levitt2:38 ↗
Associated anomalies that increase suspicion for cloaca include missing radius, absent sacrum, single kidney, or hydronephrosis, particularly in a female fetus
clinicalMarc Levitt3:35 ↗
Fetal intervention for cloaca is unlikely to be necessary, with the only indication being massive hydronephrosis with impending renal loss
clinicalMarc Levitt3:56 ↗
At least one case report from Japan describes prenatal drainage of hydrocolpos for severe hydronephrosis, similar to bladder drainage for urethral valves
epidemiologicalMarc Levitt5:17 ↗
In cloaca, there is one perineal hole below the clitoris with no anus; if there is a normal anus present with one hole, it is a urogenital sinus, not a cloaca
clinicalMarc Levitt6:35 ↗
Urogenital sinus with virilizing component (hypertrophied clitoris) requires evaluation for adrenal hyperplasia to rule out urgent electrolyte abnormality
clinicalMarc Levitt7:02 ↗
Cloaca is not ambiguous genitalia; the patient is a normal female with two normal ovaries and will be hormonally normal with no adrenal problem
clinicalMarc Levitt7:27 ↗
The most common anorectal malformation in females is three holes (normal urethra, normal vagina, and third hole in wrong place - vestibular or perineal fistula)
epidemiologicalMarc Levitt8:06 ↗
Proper perineal examination requires very good lighting and lifting the labia up and out to accentuate visualization of the single hole in cloaca
clinicalMarc Levitt8:36 ↗
Many patients have been misdiagnosed as cloaca when better examination would reveal three distinct holes indicating vestibular fistula
clinicalMarc Levitt9:03 ↗
Initial workup for cloaca includes ultrasound for hydronephrosis and kidney number, spinal ultrasound for tethered cord, cardiac auscultation, and spine X-ray to assess sacrum quality
guidelineMarc Levitt9:59 ↗
Intermittent catheterization of the common channel may decompress hydrocolpos but is unreliable because the catheter may enter urethra, right vagina, left vagina, or rectum
clinicalMarc Levitt11:14 ↗
If intermittent catheterization of common channel is attempted, ultrasound confirmation is needed to verify actual decompression of the hydrocolpos
clinicalMarc Levitt12:09 ↗
Hydrocolpos should be drained at the time of colostomy creation if intermittent catheterization is not successful
guidelineMarc Levitt12:33 ↗
For bilateral hydrocolpos, the septum between vaginas must be removed so one tube can drain both sides
clinicalMarc Levitt13:28 ↗
An 8 French or 10 French pigtail catheter from interventional radiology is preferred for vaginostomy because curled catheters do not fall out as hydrocolpos recedes, unlike straight catheters
clinicalMarc Levitt14:21 ↗
Vesicostomy does not relieve hydronephrosis in cloaca because the problem is hydrocolpos compressing the distal ureters at the trigone, not bladder outlet obstruction
clinicalMarc Levitt15:15 ↗
Draining the hydrocolpos relieves pressure on the ureteral orifices, allowing ureters to drain into the bladder, which then drains through the common channel or vaginostomy tube
clinicalMarc Levitt15:46 ↗
Vesicostomy or suprapubic tube is only needed in the rare circumstance when hydrocolpos is drained but bladder still does not decompress, typically with very long narrow common channel or absent urethra
clinicalMarc Levitt16:15 ↗
Hydronephrosis in cloaca is often a prenatal finding and will not resolve immediately; it should be monitored to ensure it is stable and not worsening, with resolution expected over several days to two weeks
clinicalMarc Levitt16:56 ↗
Massive bilateral ureteral reflux is an exception where vesicostomy may be needed to decompress the system until later in life
clinicalMarc Levitt17:54 ↗
Hydrocolpos develops because urine preferentially fills the vagina through the fistula rather than exiting the common channel, combined with vaginal mucus and maternal estrogen effect
clinicalMarc Levitt18:24 ↗
Some centers report hydrocolpos resolution with intermittent catheterization after maternal estrogen effect wanes at a couple weeks of age
clinicalMarc Levitt18:48 ↗
Hydrocolpos fluid is typically clear turbid fluid (combination of mucus and urine), though blood has been seen related to estrogen effect
clinicalMarc Levitt19:03 ↗
Urine does not drain easily from hydrocolpos because the urethra is far from the perineum and requires a steep turn upward into the bladder, while the vaginal fistula acts as a pop-off valve
clinicalMarc Levitt19:31 ↗
Cystoscopy is not performed in the newborn period because the required scope is tiny with poor visualization, the perineum is swollen, and minimizing OR time in newborns is important
opinionMarc Levitt20:29 ↗
Laparoscopic approach for colostomy and hydrocolpos drainage, as described by the Michigan group, provides excellent visualization
clinicalMarc Levitt20:49 ↗
For massive hydrocolpos extending above the umbilicus, a lower midline incision is preferred over left lower quadrant oblique incision to access the dome of the hydrocolpos
clinicalMarc Levitt21:17 ↗
For very large hydrocolpos, a tubeless vaginostomy can be created by suturing the vagina to the abdominal wall like a G-tube, avoiding need for indwelling tube
clinicalMarc Levitt21:47 ↗
Urogenital sinus without anorectal malformation requires workup for adrenal problems causing virilization and may need hydrocolpos drainage if present
clinicalMarc Levitt22:27 ↗