# Single Ventricle / HLHS — GCMD Library living collection

Also covered as: cloaca · anorectal malformation · perineal fistula · tethered cord · pulmonary hypoplasia · scoliosis · hypoplastic left heart syndrome · urogenital sinus

Experts: Dr. Todd Ponsky, Dr. Ian Glenn, Dr. Marc Levitt, Dr. Dr. Veldman

Updated: n/a · 37 episodes · 1079 cited statements

## Episodes
### Foundations
- [How Does the Blood Go Round in Single Ventricles and Fontans? New Horizons in...](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896) — video · 24:58 · [machine version](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896.md)
- [Pyloric Stenosis](https://library.globalcastmd.com/watch/pyloric-stenosis-2532) — video · 12:30 · [machine version](https://library.globalcastmd.com/watch/pyloric-stenosis-2532.md)

### Diagnosis & Workup
- [Case Review Dynamic Assessment of the Fontan Part II: New Horizons in Medical...](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894) — video · 14:38 · [machine version](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894.md)
- [Case Review Dynamic Assessment of the Fontan Part I: New Horizons in Medical...](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895) — video · 22:46 · [machine version](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895.md)
- [Advanced Imaging of the Fontan, What is Driving Fontan Failure: New Horizons...](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892) — video · 24:44 · [machine version](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892.md)

### Medical Management
- [How do we manage thrombogenicity and thrombosis in the Fontan? New Horizons...](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886) — video · 16:51 · [machine version](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886.md)
- [The Role of Trans-Catheter Arrhythmia Management - Patient Based Decision...](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890) — video · 20:55 · [machine version](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890.md)

### Surgical Management
- [Update on Surgical Practice and Current State on Fontan Conversion Surgery:...](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889) — video · 25:00 · [machine version](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889.md)
- [Transplantation and Ventricular Assist Devices: New Horizons in Medical and...](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891) — video · 23:13 · [machine version](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891.md)
- [Trans-Catheter Interventions: New Horizons in Medical and Surgical Fontan...](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893) — video · 17:26 · [machine version](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893.md)
- [Ovarian Torsion with Dr. Jennifer Dietrich](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949) — podcast · 47:22 · [machine version](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949.md)
- [Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957) — podcast · 43:47 · [machine version](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957.md)
- [Neonatal Lung Lesions with Dr. Steven Rothenberg](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948) — podcast · 66:58 · [machine version](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950) — podcast · 46:50 · [machine version](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950.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)
- [Ovarian Torsion with Dr. Jennifer Dietrich](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306) — podcast · 47:22 · [machine version](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305) — podcast · 46:50 · [machine version](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305.md)
- [Cloaca Management with Dr. Marc Levitt & Dr. Aaron Garrison](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299) — podcast · 43:47 · [machine version](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299.md)

### Complications
- [Complications of Anorectal Malformations with Dr. Marc Levitt](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951) — podcast · 48:09 · [machine version](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951.md)
- [Management of Retained Central Venous Catheters](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330) — video · 3:41 · [machine version](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330.md)
- [Complications of Anorectal Malformations with Dr. Marc Levitt](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304) — podcast · 48:09 · [machine version](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304.md)

### Evidence & Research
- [Posterior Tracheopexy For Severe Tracheomalacia](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320) — video · 2:17 · [machine version](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320.md)
- [Posterior Tracheopexy For Severe Tracheomalacia](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375) — video · 2:18 · [machine version](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375.md)
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563) — video · 2:49 · [machine version](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563.md)
- [Esophagogastric Dissociation for GERD in Severe Neurodisability](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962) — video · 2:49 · [machine version](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962.md)
- [Do we need Bowel Prep](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331) — video · 1:15 · [machine version](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331.md)
- [Outcomes of Fontan Patients Undergoing Combined Heart - Liver Transplantation in Pediatric Hospitals Across the U.S.](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307.md)
- [Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866.md)
- [Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566) — video · 0:57 · [machine version](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566.md)

### Case-Based Learning
- [Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678) — video · 19:53 · [machine version](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678.md)
- [Pregnancy in a Fontan Patient:  New Horizons in Medical and Surgical Fontan...](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887) — video · 18:27 · [machine version](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887.md)
- [Pilonidal Cyst Case Presentation: Update Course 2015](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982) — video · 5:08 · [machine version](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982.md)

### In-Depth Reviews
- [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952) — podcast · 82:05 · [machine version](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952.md)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959) — podcast · 52:45 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959.md)
- [Congenital Diaphragmatic Hernia with Dr. Charlie Stolar](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303) — podcast · 82:05 · [machine version](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303.md)
- [Abdominal Wall Defects with Dr. Jacob Langer](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821) — podcast · 52:45 · [machine version](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821.md)

### Long-Term Care
- [Psychosocial Outcomes: New Horizons in Medical and Surgical Fontan Management...](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888) — video · 22:39 · [machine version](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=0) Introduction and Podcast Context (Ep 33)
- [2:38](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=158) Prenatal Evaluation and Diagnosis (Ep 33)
- [5:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=315) Newborn Physical Examination (Ep 33)
- [10:03](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=603) Initial Workup and Colostomy Creation (Ep 33)
- [18:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1097) Hydrocolpos Pathophysiology and Management (Ep 33)
- [22:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1337) Urogenital Sinus Management (Ep 33)
- [24:46](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1486) Imaging: Endoscopy and Cloacogram (Ep 33)
- [30:04](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1804) Surgical Planning and Urogenital Mobilization (Ep 33)
- [37:37](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2257) Vaginal Replacement Techniques (Ep 33)
- [40:22](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2422) Common Redo Scenarios and Closing (Ep 33)
- [0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0) Introduction and Study Context (Ep 36)
- [0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13) Study Design and Pancreatic Findings (Ep 36)
- [0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43) Body Composition Changes and Clinical Implications (Ep 36)
- [0:00](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=0) Respiratory-Driven Fontan Flow (Ep 13)
- [3:14](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=194) Pulmonary Vascular Resistance and Vasodilator Response (Ep 13)
- [6:10](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=370) Right Ventricle as Non-Risk Factor (Ep 13)
- [9:29](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=569) Diastolic Dysfunction Pathophysiology (Ep 13)
- [13:37](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=817) Progressive Ventricular Compliance Deterioration (Ep 13)
- [16:29](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=989) Panel Discussion (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=0) Surgical vs Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis (Ep 37)
- [0:00](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=0) Introduction (Ep 21)
- [1:22](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=82) Patient Evaluation and Surgical Indications (Ep 21)
- [7:20](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=440) Diagnostic Testing and Surgical Criteria (Ep 21)
- [15:20](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=920) Preoperative Planning and Patient Preparation (Ep 21)
- [21:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1264) Nuss Procedure Technical Details (Ep 21)
- [31:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1862) Postoperative Management and Complications (Ep 21)
- [37:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2231) Non-operative Treatment and Ravitch Procedure (Ep 21)
- [39:56](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2396) Pectus Carinatum Management (Ep 21)
- [45:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2715) Closing and Resources (Ep 21)
- [0:00](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=0) Introduction and Prenatal Evaluation (Ep 17)
- [2:38](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=158) Prenatal Counseling and Indications for Intervention (Ep 17)
- [6:05](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=365) Newborn Evaluation and Physical Examination (Ep 17)
- [9:45](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=585) Initial Workup and Management of Hydrocolpos (Ep 17)
- [18:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1097) Surgical Technique for Colostomy and Vaginostomy (Ep 17)
- [22:16](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1336) Management of Urogenital Sinus (Ep 17)
- [23:43](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1423) Timing and Imaging for Definitive Repair (Ep 17)
- [28:40](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1720) Surgical Planning and Repair Techniques (Ep 17)
- [37:36](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2256) Management of Short Vagina and Vaginal Replacement (Ep 17)
- [40:21](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2421) Common Errors and Contact Information (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=0) Introduction and Prenatal Counseling (Ep 18)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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)" — Marc Levitt (clinical) [Ep 33 · 2:38](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=158)
- "Associated anomalies that increase suspicion for cloaca include missing radius, absent sacrum, single kidney, or hydronephrosis, particularly in a female fetus" — Marc Levitt (clinical) [Ep 33 · 3:35](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=215)
- "Fetal intervention for cloaca is unlikely to be necessary, with the only indication being massive hydronephrosis with impending renal loss" — Marc Levitt (clinical) [Ep 33 · 3:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=236)
- "At least one case report from Japan describes prenatal drainage of hydrocolpos for severe hydronephrosis, similar to bladder drainage for urethral valves" — Marc Levitt (epidemiological) [Ep 33 · 5:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=317)
- "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" — Marc Levitt (clinical) [Ep 33 · 6:35](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=395)
- "Urogenital sinus with virilizing component (hypertrophied clitoris) requires evaluation for adrenal hyperplasia to rule out urgent electrolyte abnormality" — Marc Levitt (clinical) [Ep 33 · 7:02](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=422)
- "Cloaca is not ambiguous genitalia; the patient is a normal female with two normal ovaries and will be hormonally normal with no adrenal problem" — Marc Levitt (clinical) [Ep 33 · 7:27](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=447)
- "The most common anorectal malformation in females is three holes (normal urethra, normal vagina, and third hole in wrong place - vestibular or perineal fistula)" — Marc Levitt (epidemiological) [Ep 33 · 8:06](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=486)
- "Proper perineal examination requires very good lighting and lifting the labia up and out to accentuate visualization of the single hole in cloaca" — Marc Levitt (clinical) [Ep 33 · 8:36](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=516)
- "Many patients have been misdiagnosed as cloaca when better examination would reveal three distinct holes indicating vestibular fistula" — Marc Levitt (clinical) [Ep 33 · 9:03](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=543)
- "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" — Marc Levitt (guideline) [Ep 33 · 9:59](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=599)
- "Intermittent catheterization of the common channel may decompress hydrocolpos but is unreliable because the catheter may enter urethra, right vagina, left vagina, or rectum" — Marc Levitt (clinical) [Ep 33 · 11:14](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=674)
- "If intermittent catheterization of common channel is attempted, ultrasound confirmation is needed to verify actual decompression of the hydrocolpos" — Marc Levitt (clinical) [Ep 33 · 12:09](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=729)
- "Hydrocolpos should be drained at the time of colostomy creation if intermittent catheterization is not successful" — Marc Levitt (guideline) [Ep 33 · 12:33](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=753)
- "For bilateral hydrocolpos, the septum between vaginas must be removed so one tube can drain both sides" — Marc Levitt (clinical) [Ep 33 · 13:28](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=808)
- "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" — Marc Levitt (clinical) [Ep 33 · 14:21](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=861)
- "Vesicostomy does not relieve hydronephrosis in cloaca because the problem is hydrocolpos compressing the distal ureters at the trigone, not bladder outlet obstruction" — Marc Levitt (clinical) [Ep 33 · 15:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=915)
- "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" — Marc Levitt (clinical) [Ep 33 · 15:46](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=946)
- "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" — Marc Levitt (clinical) [Ep 33 · 16:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=975)
- "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" — Marc Levitt (clinical) [Ep 33 · 16:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1016)
- "Massive bilateral ureteral reflux is an exception where vesicostomy may be needed to decompress the system until later in life" — Marc Levitt (clinical) [Ep 33 · 17:54](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1074)
- "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" — Marc Levitt (clinical) [Ep 33 · 18:24](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1104)
- "Some centers report hydrocolpos resolution with intermittent catheterization after maternal estrogen effect wanes at a couple weeks of age" — Marc Levitt (clinical) [Ep 33 · 18:48](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1128)
- "Hydrocolpos fluid is typically clear turbid fluid (combination of mucus and urine), though blood has been seen related to estrogen effect" — Marc Levitt (clinical) [Ep 33 · 19:03](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1143)
- "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" — Marc Levitt (clinical) [Ep 33 · 19:31](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1171)
- "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" — Marc Levitt (opinion) [Ep 33 · 20:29](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1229)
- "Laparoscopic approach for colostomy and hydrocolpos drainage, as described by the Michigan group, provides excellent visualization" — Marc Levitt (clinical) [Ep 33 · 20:49](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1249)
- "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" — Marc Levitt (clinical) [Ep 33 · 21:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1277)
- "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" — Marc Levitt (clinical) [Ep 33 · 21:47](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1307)
- "Urogenital sinus without anorectal malformation requires workup for adrenal problems causing virilization and may need hydrocolpos drainage if present" — Marc Levitt (clinical) [Ep 33 · 22:27](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1347)
- "Most urogenital sinus cases can be managed with perineal urogenital mobilization without touching the rectum; high UG sinus may require transrectal (Astra) approach" — Marc Levitt (clinical) [Ep 33 · 23:08](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1388)
- "Endoscopy with cystoscopy and vaginoscopy is performed at 2-3 months of age, with definitive cloaca repair typically within one year, ideally before 6 months if managing from birth" — Marc Levitt (guideline) [Ep 33 · 23:57](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1437)
- "Common channel length (traditionally 3cm cutoff) has been the standard measure for cloaca complexity, but urethral length from urethral takeoff to bladder neck is equally important for surgical planning" — Marc Levitt (clinical) [Ep 33 · 25:10](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1510)
- "Endoscopy alone can falsely suggest the rectum is reachable when it is actually a long narrow fistula with healthy rectum high in the abdomen; contrast study is needed to determine this" — Marc Levitt (clinical) [Ep 33 · 26:21](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1581)
- "Cloacogram is performed by injecting distal colostomy, vaginostomy (if present), and common channel, with catheters left in place during fluoroscopy or 3D reconstruction in interventional radiology" — Marc Levitt (clinical) [Ep 33 · 26:44](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1604)
- "Lateral fluoroscopic image is the most important view to assess rectal position, vaginal reachability, and urethral location" — Marc Levitt (clinical) [Ep 33 · 27:55](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1675)
- "A study comparing 2D cloacogram, 3D reconstruction, 3D printed model, and virtual reality found that more complex modalities yielded more correct anatomic descriptions by experienced surgeons" — Marc Levitt (epidemiological) [Ep 33 · 28:34](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1714)
- "3D imaging is definitively better than 2D for cloacogram interpretation, and 3D printed models may be better than 3D reconstruction alone" — Marc Levitt (opinion) [Ep 33 · 29:03](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1743)
- "Cloaca patients benefit from collaborative multidisciplinary approach including pediatric surgery, urology, and gynecology" — Marc Levitt (opinion) [Ep 33 · 30:29](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1829)
- "The days of a single surgeon handling cloaca complexity are over" — Marc Levitt (opinion) [Ep 33 · 30:44](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1844)
- "Urogenital mobilization, first described by Alberto Pena in 1996, mobilizes urethra and vagina as a unit without operating on the wall between them, eliminating the 10% urethral-vaginal fistula rate of prior techniques" — Marc Levitt (clinical) [Ep 33 · 32:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=1935)
- "Urogenital mobilization is appropriate when common channel is 3cm or less AND urethral length above the takeoff is at least 1.5-2cm" — Marc Levitt (clinical) [Ep 33 · 33:39](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2019)
- "Well-trained general pediatric surgeons can perform urogenital mobilization for appropriate cases (adequate urethral length), though it is more technically demanding for those who do it infrequently" — Marc Levitt (opinion) [Ep 33 · 34:06](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2046)
- "When urethral length is inadequate, the common channel must be preserved as the urethra by separating the vagina from it, which is technically demanding" — Marc Levitt (clinical) [Ep 33 · 34:34](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2074)
- "After vaginal separation, the common channel repair should be reinforced with anorectal fat pad and possibly SIS to ensure healing and avoid urethral-vaginal fistula" — Marc Levitt (clinical) [Ep 33 · 34:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2096)
- "If urogenital mobilization is attempted but the complex does not reach, the only option is abdominal delivery of the urogenital complex, which often fails and can result in devascularized urethral loss requiring Mitrofanoff" — Marc Levitt (clinical) [Ep 33 · 35:09](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2109)
- "Performing urogenital mobilization with inadequate urethral length leaves the patient with urinary leakage that cannot be controlled without tightening or closing the bladder neck" — Marc Levitt (clinical) [Ep 33 · 35:52](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2152)
- "Preserving the common channel as the entire urethra provides approximately 4cm urethral length, allowing intermittent catheterization and continence" — Marc Levitt (clinical) [Ep 33 · 36:05](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2165)
- "Type 1 cloaca has common channel of 1cm with adequate urethral length; only vaginal mobilization is needed, and a slightly hypospadiac urethra is acceptable if the patient will void and not require catheterization" — Marc Levitt (clinical) [Ep 33 · 36:40](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2200)
- "Patients with neurogenic bladder component (whether from tethered cord or not) require a visible urethral orifice that is easily catheterized" — Marc Levitt (clinical) [Ep 33 · 37:11](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2231)
- "When native vagina does not reach after full mobilization including abdominal approach, options include vaginal switch (disconnecting one side while preserving ovarian blood supply) or vaginal replacement" — Marc Levitt (clinical) [Ep 33 · 37:42](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2262)
- "For vaginal replacement, colon (particularly left colon or sigmoid depending on arcade) is the preferred conduit over rectum or small bowel" — Marc Levitt (opinion) [Ep 33 · 38:46](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2326)
- "Tissue engineering of vaginas using patient stem cells is on the horizon, with work already done at Wake Forest and in Mexico, which could revolutionize cloaca care by eliminating need for vaginal replacement" — Marc Levitt (clinical) [Ep 33 · 39:10](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2350)
- "Complex cloaca cases requiring expertise include common channel greater than 3cm or urethral length less than 1.5cm from takeoff to bladder neck" — Marc Levitt (clinical) [Ep 33 · 39:48](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2388)
- "The most common problem in redo cloaca cases is that the surgeon never realized they were dealing with a cloaca and only repaired the rectum, leaving the urogenital sinus untouched" — Marc Levitt (epidemiological) [Ep 33 · 40:27](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2427)
- "The second most common redo scenario is inadequate mobilization of structures resulting in stenosed or lost vagina" — Marc Levitt (epidemiological) [Ep 33 · 40:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-299?t=2456)
- "Radiation improves survival in high-risk neuroblastoma" — Sophia Schermerhorn (clinical) [Ep 36 · 0:00](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0)
- "This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy" — Sophia Schermerhorn (clinical) [Ep 36 · 0:13](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13)
- "The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment" — Sophia Schermerhorn (clinical) [Ep 36 · 0:19](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=19)
- "There was a significant decrease in pancreatic volume after radiation" — Sophia Schermerhorn (clinical) [Ep 36 · 0:27](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=27)
- "Very few patients developed clinically apparent pancreatic insufficiency" — Sophia Schermerhorn (clinical) [Ep 36 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- "Pancreatic insufficiency wasn't systematically screened for in this study" — Sophia Schermerhorn (clinical) [Ep 36 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- "Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients" — Sophia Schermerhorn (opinion) [Ep 36 · 0:31](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31)
- "Pancreatic dysfunction could be an under-recognized late effect" — Sophia Schermerhorn (opinion) [Ep 36 · 0:43](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43)
- "Patients had a significant drop in weight percentile with smaller decreases in fat and muscle" — Sophia Schermerhorn (clinical) [Ep 36 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- "Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone" — Sophia Schermerhorn (opinion) [Ep 36 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- "These findings highlight the importance of nutritional screening during cancer treatments" — Sophia Schermerhorn (opinion) [Ep 36 · 0:48](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48)
- "As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself" — Sophia Schermerhorn (opinion) [Ep 36 · 1:03](https://library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=63)
- "40-50% of cardiac output at baseline in Fontan patients is driven directly by the work of breathing" — Andrew Reddington (clinical) [Ep 13 · 2:43](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=163)
- "Mean airway pressure makes the blood go round; negative pressure during normal ventilation draws blood into the Fontan circuit" — Andrew Reddington (clinical) [Ep 13 · 3:14](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=194)
- "Valsalva maneuver at 20 cm H2O cuts off all spontaneous respiratory flow, leaving only tiny ventricular systole-driven flow" — Andrew Reddington (clinical) [Ep 13 · 3:28](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=208)
- "Low pulmonary vascular resistance is a prerequisite for good Fontan outcome" — Andrew Reddington (clinical) [Ep 13 · 4:01](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=241)
- "Nitric oxide caused approximately 1 indexed wood unit fall in pulmonary vascular resistance in Fontan patients" — Andrew Reddington (clinical) [Ep 13 · 4:52](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=292)
- "Only half of adolescent Fontan patients showed benefit from nitric oxide" — Andrew Reddington (clinical) [Ep 13 · 5:33](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=333)
- "If only half of patients benefit from nitric oxide, they are unlikely to further benefit from PDE5 inhibitors" — Andrew Reddington (opinion) [Ep 13 · 5:51](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=351)
- "CHOP data showed no difference in 10-year outcomes between hypoplastic left heart syndrome and systemic left ventricle Fontan patients" — Andrew Reddington (clinical) [Ep 13 · 6:54](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=414)
- "Boston data showed patients with systemic left ventricle or single right ventricle do better than all other diagnoses" — Andrew Reddington (clinical) [Ep 13 · 7:22](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=442)
- "Melbourne data showed right ventricular dominance is a risk factor at birth, but after surviving the first couple years post-Fontan, survival curves are identical regardless of ventricular morphology" — Andrew Reddington (clinical) [Ep 13 · 7:45](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=465)
- "Systemic ventricles in Fontan circulation are hypercontractile to match increased afterload" — Andrew Reddington (clinical) [Ep 13 · 8:22](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=502)
- "Force-frequency relationships in systemic right and left ventricles in univentricular circulation outperformed normal ventricles" — Andrew Reddington (clinical) [Ep 13 · 8:37](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=517)
- "End-systolic elastance in Fontan patients is orders of magnitude higher than normals and greater than systemic right ventricle in Mustard patients" — Andrew Reddington (clinical) [Ep 13 · 9:03](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=543)
- "The problem in Fontan circulation is in diastole, not systole" — Andrew Reddington (clinical) [Ep 13 · 9:29](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=569)
- "Early diastole (E wave) is affected post-Fontan, not late diastole (A wave), with virtual abolishment of early rapid filling" — Andrew Reddington (clinical) [Ep 13 · 10:06](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=606)
- "Time constant of relaxation and isovolumic relaxation time are prolonged post-Fontan, indicating impaired ventricular relaxation" — Andrew Reddington (clinical) [Ep 13 · 10:43](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=643)
- "Incoordinate wall motion during isovolumic relaxation causes early diastolic dysfunction, with some ventricular segments 180 degrees out of phase" — Andrew Reddington (clinical) [Ep 13 · 10:56](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=656)
- "Longer isovolumic relaxation time correlates with longer hospital stay immediately post-Fontan" — Andrew Reddington (clinical) [Ep 13 · 12:23](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=743)
- "Pseudonormalized E/A ratio in late post-operative Fontan patients indicates rising left atrial pressure with persistent incoordinate relaxation" — Andrew Reddington (clinical) [Ep 13 · 13:03](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=783)
- "Left ventricular end-diastolic pressure rises by approximately 2 mmHg per decade after age 30 in normal individuals" — Andrew Reddington (clinical) [Ep 13 · 13:36](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=816)
- "Eight-year follow-up showed Fontan patients maintained incoordinate relaxation but developed shortened IVRT (suggesting rising left atrial pressure) and faster E-wave deceleration (suggesting falling compliance)" — Andrew Reddington (clinical) [Ep 13 · 14:18](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=858)
- "Diastolic compliance of Fontan ventricles (predominantly left) is highly abnormal compared to systemic right ventricles in Mustard patients" — Andrew Reddington (clinical) [Ep 13 · 15:06](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=906)
- "Fontan patients can have normal left ventricular end-diastolic pressure despite profoundly abnormal ventricular compliance because reduced preload causes the ventricle to become smaller and pressure to fall" — Andrew Reddington (clinical) [Ep 13 · 15:33](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=933)
- "PHN data on 500 Fontan patients showed systemic right ventricles have far more patients with increased E/E' ratio (indicating greater stiffness) compared to systemic left ventricles at 10-12 years post-Fontan" — Andrew Reddington (clinical) [Ep 13 · 20:04](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1204)
- "End-diastolic pressure rise in normals is more rapid with hypertension, diabetes, other risk factors, and ventricular volume load" — Andrew Reddington (clinical) [Ep 13 · 21:58](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1318)
- "Fontan patients frequently have volume load and raised arterial impedance/systemic vascular resistance" — Andrew Reddington (clinical) [Ep 13 · 22:33](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1353)
- "Recent European conductance catheter work shows tight relationship between arterial elastance and ventricular end-diastolic pressure" — Andrew Reddington (clinical) [Ep 13 · 23:01](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1381)
- "There is no evidence-based role for ACE inhibition in Fontan patients in the short term" — Andrew Reddington (opinion) [Ep 13 · 23:18](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1398)
- "Management of left ventricular end-diastolic pressure, fibrosis, and vascular biology (not just systemic vasodilation) have potential as long-term therapeutic targets" — Andrew Reddington (opinion) [Ep 13 · 23:38](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1418)
- "Understanding impact of long-term therapies will require 10-20 years of follow-up" — Andrew Reddington (opinion) [Ep 13 · 23:58](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1438)
- "Mayo Clinic series with longer follow-up shows right ventricular morphology appears to be a risk factor late (beyond 20-30 years)" — Toy (clinical) [Ep 13 · 19:32](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1172)
- "Abnormalities in diastolic relaxation will likely become clinically manifest at 20-30 years, and we lack the long-term RV/LV data to know the answer" (opinion) [Ep 13 · 24:38](https://library.globalcastmd.com/watch/how-does-the-blood-go-round-in-single-ventricles-and-fontans-new-horizons-in-896?t=1478)
- "Pulmonary vein stenosis is a rare but serious condition where the veins from the lungs to the heart become narrowed" — Lizzie Lee (clinical) [Ep 37 · 0:06](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=6)
- "A study from Cincinnati Children's examined 56 children comparing surgery versus catheter-based interventions for pulmonary vein stenosis" — Lizzie Lee (epidemiological) [Ep 37 · 0:12](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=12)
- "Over time, catheter-based treatments became the preferred first option for pulmonary vein stenosis" — Lizzie Lee (clinical) [Ep 37 · 0:23](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=23)
- "Surgery was reserved for complex cases involving multiple severely affected veins or other heart defects" — Lizzie Lee (clinical) [Ep 37 · 0:28](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=28)
- "92% of children with pulmonary vein stenosis needed another intervention after initial treatment" — Lizzie Lee (epidemiological) [Ep 37 · 0:34](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Most reinterventions for pulmonary vein stenosis occurred within the first year after initial treatment" — Lizzie Lee (epidemiological) [Ep 37 · 0:34](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Recurrence of pulmonary vein stenosis remained common regardless of the initial intervention type" — Lizzie Lee (clinical) [Ep 37 · 0:34](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=34)
- "Pulmonary vein stenosis requires ongoing surveillance, repeated interventions, and a long-term multidisciplinary approach" — Lizzie Lee (clinical) [Ep 37 · 0:48](https://library.globalcastmd.com/watch/surgical-and-catheter-based-intervention-in-pediatric-pulmonary-vein-stenosis-13566?t=48)
- "Common symptoms of pectus excavatum are easy fatigability with exertion, shortness of breath with exertion, and chest pain in the area of the pectus depression, generally occurring with exertion rather than at rest" — Robert Kelly (clinical) [Ep 21 · 1:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=93)
- "Marfan syndrome and Ehlers-Danlos syndrome are conditions for which pectus excavatum is a marker" — Robert Kelly (clinical) [Ep 21 · 2:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=175)
- "In patients with normal chest anatomy, ribs move like the handle of a bucket during respiration, and the sternum moves like the handle of an old-fashioned water pump toward the ceiling and out" — Robert Kelly (clinical) [Ep 21 · 4:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=244)
- "In pectus excavatum, the depressed area of the chest is frequently fixed or in younger patients may move paradoxically, with the xiphoid pulling back toward the spine during deep inspiration" — Robert Kelly (clinical) [Ep 21 · 4:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=269)
- "Just over 25% of patients evaluated for pectus excavatum have scoliosis in a series of more than 4000 patients" — Robert Kelly (epidemiological) [Ep 21 · 6:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=375)
- "When both severe scoliosis and pectus excavatum are present, the more clinically disruptive problem should be addressed first" — Robert Kelly (opinion) [Ep 21 · 6:36](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=396)
- "In the multi-center study of pectus excavatum at 11 centers, roughly two-thirds of patients had symptoms of fatigue, dyspnea, or chest pain" — Robert Kelly (epidemiological) [Ep 21 · 8:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=519)
- "The Haller index is the ratio of the inner transverse diameter divided by the distance between the back of the sternum and the front of the spine, with an index greater than 3.25 indicating severe pectus" — Robert Kelly (clinical) [Ep 21 · 9:44](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=584)
- "In patients with barrel chest, the Haller index underestimates the depth of pectus depression because the AP diameter is increased" — Robert Kelly (clinical) [Ep 21 · 10:09](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=609)
- "The Kansas City group advocates an alternative index showing the distance between the back of the sternum and front of the spine at the depression divided by that same distance more laterally, with more than 10% drop considered significant" — Robert Kelly (clinical) [Ep 21 · 10:21](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=621)
- "Mitral valve prolapse is present in about 14% of pectus excavatum patients, compared to 1% in the general young population" — Robert Kelly (epidemiological) [Ep 21 · 12:53](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=773)
- "On average in large numbers of patients, pulmonary function tests are down by about one standard deviation from average, typically 85-90% predicted" — Robert Kelly (clinical) [Ep 21 · 13:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=817)
- "Patients with pectus excavatum come up by close to a standard deviation in pulmonary function when the bellows action of the chest is restored surgically" — Robert Kelly (clinical) [Ep 21 · 14:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=855)
- "Restrictive lung disease is defined as FVC less than 80% predicted with a normal FEV1/FVC ratio, and is corrected by pectus operation unlike asthma" — Robert Kelly (clinical) [Ep 21 · 14:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=880)
- "Surgical indications require at least 3 of 6 criteria: Haller index >3.2, pulmonary function <80% predicted, cardiac abnormalities on echo, symptoms, progressive pectus, or major psychosocial issues" — Robert Kelly (guideline) [Ep 21 · 15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=911)
- "The ideal age for pectus excavatum repair is just prior to or early in puberty: ages 11-13 in girls and 1-2 years older in boys" — Robert Kelly (opinion) [Ep 21 · 16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1007)
- "Having the bar in place during the rapid growth spurt of puberty results in extremely low likelihood of recurrence" — Robert Kelly (clinical) [Ep 21 · 17:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1022)
- "Pain management is the top priority in the immediate post-operative period after pectus repair" — Robert Kelly (guideline) [Ep 21 · 17:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1075)
- "The center no longer uses epidurals for pectus excavatum repair" — Robert Kelly (clinical) [Ep 21 · 19:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1179)
- "Post-operative protocol includes spirometry hourly when awake, walking beginning day 1, and eating small amounts (a couple hundred calories) every couple hours" — Robert Kelly (guideline) [Ep 21 · 19:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1187)
- "Activity restrictions after pectus repair: first month only walking and activities of daily living, liberalize at 1 month, return to most activities by 3-6 months except activities with known chest blows" — Robert Kelly (guideline) [Ep 21 · 20:46](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1246)
- "Metal allergy testing using the Allergies test from Canada includes all components of the stainless steel bar, with reactions possible to nickel, chromium, cobalt and other minor components" — Robert Kelly (clinical) [Ep 21 · 21:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1297)
- "Titanium bars must be bent at the factory and ordered in advance, and are much more expensive than stainless steel bars" — Robert Kelly (clinical) [Ep 21 · 22:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1337)
- "Thoracoscopy should be standard practice in patients with any difficulty in visualization during Nuss procedure to see the introducer tip at all times" — Robert Kelly (guideline) [Ep 21 · 24:30](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1470)
- "Sternal elevation techniques include vacuum bell, subxiphoid finger or bone hook elevation, or Rultract device used as a crane" — Robert Kelly (clinical) [Ep 21 · 24:57](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1497)
- "The most important part of the Nuss procedure is seeing the tip of the introducer at all times when passing from one side to the other" — Robert Kelly (guideline) [Ep 21 · 26:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1562)
- "Bar stabilization uses tongue-in-groove stabilizer on one end plus wrapping with 4 thicknesses of #1 PDS suture around the bar-rib intersection" — Robert Kelly (clinical) [Ep 21 · 26:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1603)
- "The bar should rest medial to the pectus ridge on ribs that provide counterforce, not laterally where only intercostal muscles would prevent movement" — Robert Kelly (clinical) [Ep 21 · 28:54](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1734)
- "In growing patients, stabilizers on both sides can cause a wasp-waist effect, so they are generally placed on only one side" — Robert Kelly (clinical) [Ep 21 · 30:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1807)
- "Patients over approximately 6 feet 2 inches tall almost always require two bars" — Robert Kelly (clinical) [Ep 21 · 30:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1839)
- "PCA pump weaning protocol: stop basal rate on day 2, stop PCA altogether on day 3, transition to all oral medications by day 3" — Robert Kelly (guideline) [Ep 21 · 32:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1922)
- "Bar displacement occurred in about 2.7% of patients in a series of over 2000 Nuss procedures, reduced to about half that rate with stabilizers and pericostal sutures" — Robert Kelly (epidemiological) [Ep 21 · 33:14](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1994)
- "Bar allergy occurred in less than 1% (0.9%) of patients since screening began in 2004, down from 6.4% who had clinical or patch test evidence of metal allergy" — Robert Kelly (epidemiological) [Ep 21 · 34:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2053)
- "Wound infection occurred in 2.3% of patients, with more than two-thirds being superficial or cellulitis" — Robert Kelly (epidemiological) [Ep 21 · 34:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2080)
- "Recurrence occurred in about 1.2% of patients, with prevention poorly understood" — Robert Kelly (epidemiological) [Ep 21 · 35:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2107)
- "Bars should remain in place for at least 2 years, with preference for closer to 3 years rather than 2 years" — Robert Kelly (guideline) [Ep 21 · 36:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2199)
- "Vacuum bell treatment eliminated pectus excavatum in 23 of 73 patients (31.5%) in a French study, and is effective in patients under 10 years old" — Robert Kelly (clinical) [Ep 21 · 37:19](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2239)
- "Brace therapy for pectus carinatum is successful in somewhere between two-thirds and three-quarters of patients" — Robert Kelly (epidemiological) [Ep 21 · 40:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2404)
- "Any operation carries more morbidity than almost any brace, making brace therapy the appropriate first-line treatment for most pectus carinatum patients" — Robert Kelly (opinion) [Ep 21 · 40:27](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2427)
- "There is a broad perception among surgeons that recurrence rate after Ravitch operation for carinatum is extremely low, as opposed to 10% recurrence after excavatum Ravitch" — Robert Kelly (opinion) [Ep 21 · 43:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2623)
- "Approximately 40% of pectus patients have a family history, but the majority do not" — Robert Kelly (epidemiological) [Ep 21 · 44:52](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2692)
- "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)" — Marc Levitt (clinical) [Ep 17 · 2:38](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=158)
- "Fetal intervention for cloaca is unlikely to be necessary; there is almost never a situation requiring fetal intervention" — Marc Levitt (clinical) [Ep 17 · 3:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=236)
- "In cloaca, there is one perineal hole in the area just below the clitoris and no anus" — Marc Levitt (clinical) [Ep 17 · 6:35](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=395)
- "A single hole underneath the clitoris with a completely normal anus is not a cloaca but a urogenital sinus" — Marc Levitt (clinical) [Ep 17 · 6:57](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=417)
- "Cloaca is not ambiguous genitalia, not adrenal hyperplasia, and the baby is a normal female with two normal ovaries who will be hormonally normal" — Marc Levitt (clinical) [Ep 17 · 7:25](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=445)
- "Many patients considered cloacas actually have three holes (vestibular fistula) when examined properly with good lighting and labial retraction" — Marc Levitt (clinical) [Ep 17 · 9:03](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=543)
- "The hydronephrosis in cloaca is usually caused by the hydrocolpos pressing forward on the trigone and compressing the distal ureters, not by bladder obstruction" — Marc Levitt (clinical) [Ep 17 · 15:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=915)
- "Draining the hydrocolpos relieves pressure on the ureteral orifices, allowing them to drain into the bladder; vesicostomy does not resolve the hydronephrosis" — Marc Levitt (clinical) [Ep 17 · 15:40](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=940)
- "Vesicostomy is only indicated if the bladder still does not drain after successful hydrocolpos drainage, which is exceedingly rare" — Marc Levitt (clinical) [Ep 17 · 16:15](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=975)
- "The exception for vesicostomy is massive bilateral ureteral reflux, where vesicostomy is a safe way to decompress the system" — Marc Levitt (clinical) [Ep 17 · 17:54](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1074)
- "Hydrocolpos forms because the bladder preferentially fills the vagina through the fistula rather than exiting the common channel, combined with vaginal mucus and maternal estrogen effect" — Marc Levitt (clinical) [Ep 17 · 18:24](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1104)
- "Cystoscopy in the newborn period is not advantageous; the scope is tiny, visualization is poor, and the perineum is swollen" — Marc Levitt (opinion) [Ep 17 · 20:29](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1229)
- "For massive hydrocolpos above the umbilicus, a tubeless vaginostomy can be created by suturing the vagina to the abdominal wall like a G-tube" — Marc Levitt (clinical) [Ep 17 · 21:22](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1282)
- "Urogenital sinus patients need workup for adrenal problems and electrolyte abnormalities if there is virilization" — Marc Levitt (clinical) [Ep 17 · 22:28](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1348)
- "Cloaca repair timing: colostomy at birth, endoscopy and cloacagram at 2-3 months, definitive repair within one year, ideally by 6 months" — Marc Levitt (guideline) [Ep 17 · 23:57](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1437)
- "The length of the urethra (from urethral takeoff to bladder neck) is a critical measurement not mentioned in traditional papers but determines which operation to perform" — Marc Levitt (clinical) [Ep 17 · 25:41](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1541)
- "Endoscopy can falsely suggest the rectum is reachable when it is actually a long narrow fistula with the healthy rectum in the abdomen; contrast study is needed" — Marc Levitt (clinical) [Ep 17 · 26:21](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1581)
- "3D cloacagram reconstruction is better than 2D, and printed 3D models where you can hold the anatomy in your hand may be even more valuable" — Marc Levitt (clinical) [Ep 17 · 28:34](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1714)
- "Cloaca patients benefit from collaborative approach with urology and gynecology; the days of a single surgeon handling this complexity are over" — Marc Levitt (opinion) [Ep 17 · 30:29](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=1829)
- "Urogenital mobilization is appropriate when common channel is ≤3 cm and urethra above the takeoff is at least 1.5-2 cm" — Marc Levitt (clinical) [Ep 17 · 33:39](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2019)
- "If urethral length is inadequate, the common channel should be left alone to become the urethra, and the vagina must be separated from it" — Marc Levitt (clinical) [Ep 17 · 34:34](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2074)
- "If urogenital mobilization is attempted but the complex does not reach, the only option is abdominal delivery, which often fails and can result in urethral loss from devascularization" — Marc Levitt (clinical) [Ep 17 · 35:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2117)
- "Leaving a patient with inadequate urethral length after urogenital mobilization results in leakage that cannot be controlled without tightening or closing the bladder neck" — Marc Levitt (clinical) [Ep 17 · 35:52](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2152)
- "For type 1 cloaca (1 cm common channel with adequate urethral length), only vaginal mobilization is needed and a slightly hypospadiac urethra is acceptable if the patient will void" — Marc Levitt (clinical) [Ep 17 · 36:33](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2193)
- "When native vagina does not reach after full mobilization, options include vaginal switch or vaginal replacement with colon (preferred), rectum, or small bowel" — Marc Levitt (clinical) [Ep 17 · 38:00](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2280)
- "Tissue engineering of vaginas using patient stem cells is on the horizon and would revolutionize cloaca care by eliminating the need for vaginal replacement" — Marc Levitt (opinion) [Ep 17 · 39:17](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2357)
- "The most common problem in redo cloaca is that the surgeon never realized they were dealing with a cloaca and only fixed the rectum, leaving the urogenital sinus untouched" — Marc Levitt (clinical) [Ep 17 · 40:27](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2427)
- "The second most common redo problem is inadequate mobilization of structures leaving the patient with a stenosed or lost vagina" — Marc Levitt (clinical) [Ep 17 · 40:56](https://library.globalcastmd.com/watch/cloaca-management-with-dr-marc-levitt-dr-aaron-garrison-957?t=2456)
- "CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies" — Charlie Stolar (epidemiological) [Ep 18 · 2:45](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=165)
- "80-85% of children with CDH survive to become teenagers" — Charlie Stolar (epidemiological) [Ep 18 · 10:13](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=613)
- "CDH is a growth arrest of both lungs with the ipsilateral side more severely affected than the contralateral side" — Charlie Stolar (clinical) [Ep 18 · 4:14](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=254)
- "CDH is not a surgical emergency but a medical physiologic emergency" — Charlie Stolar (clinical) [Ep 18 · 5:00](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=300)
- "The diagnosis of CDH alone is not an indication for cesarean section" — Charlie Stolar (guideline) [Ep 18 · 5:24](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=324)
- "Babies with CDH should be born at a full-service children's facility with ECMO capability" — Charlie Stolar (guideline) [Ep 18 · 7:23](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=443)
- "Maybe 10-15% of babies with CDH will benefit from ECMO" — Charlie Stolar (epidemiological) [Ep 18 · 7:34](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=454)
- "Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8)" — Charlie Stolar (clinical) [Ep 18 · 8:50](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=530)
- "Antenatal steroids have no proven benefit for near-term CDH babies but no downside" — Charlie Stolar (clinical) [Ep 18 · 10:54](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=654)
- "Exit to ECMO is not beneficial for CDH except potentially for investigational liquid ventilation protocols" — Charlie Stolar (opinion) [Ep 18 · 12:06](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=726)
- "All therapy should be guided by preductal oximetry, not postductal" — Charlie Stolar (guideline) [Ep 18 · 19:06](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1146)
- "Babies with CDH should not be paralyzed and should have minimal sedation to allow spontaneous breathing" — Charlie Stolar (guideline) [Ep 18 · 21:56](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1316)
- "Most CDH babies require unconventional ventilation at 100 breaths per minute with low peak pressure" — Charlie Stolar (clinical) [Ep 18 · 22:53](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1373)
- "Permissive hypercapnia is acceptable in CDH management" — Charlie Stolar (guideline) [Ep 18 · 21:13](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1273)
- "High-frequency oscillatory ventilation as rescue therapy rarely spares CDH patients from ECMO" — Charlie Stolar (clinical) [Ep 18 · 24:38](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1478)
- "Nitric oxide is of no value in babies with CDH" — Charlie Stolar (clinical) [Ep 18 · 25:45](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1545)
- "The best drug for CDH is oxygen" — Charlie Stolar (opinion) [Ep 18 · 26:07](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1567)
- "ECMO indication is oxygenation index in excess of 40 for 4 hours or more" — Charlie Stolar (guideline) [Ep 18 · 18:21](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1101)
- "ECMO is a drug delivery system for oxygen; if end organs are functioning (making urine, heart not failing, brain working), ECMO is not needed" — Charlie Stolar (clinical) [Ep 18 · 17:11](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1031)
- "Gestational age less than 35-36 weeks is a relative contraindication to ECMO due to intracranial hemorrhage risk" — Charlie Stolar (guideline) [Ep 18 · 26:33](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1593)
- "VA ECMO is preferred over VV ECMO for CDH because heart function is often depressed and mediastinal shift makes cannula placement difficult" — Charlie Stolar (clinical) [Ep 18 · 30:31](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1831)
- "Echocardiographic guidance during ECMO cannulation is helpful to ensure proper cannula position" — Charlie Stolar (clinical) [Ep 18 · 32:17](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=1937)
- "Target ECMO flow for VA support is 100-125 cc/kg/min, which is about 80% of cardiac output" — Charlie Stolar (clinical) [Ep 18 · 35:10](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2110)
- "A platelet thrombus has a lifespan of 48-72 hours, so there is a 2-3 day window after surgery on ECMO before bleeding risk increases" — Charlie Stolar (clinical) [Ep 18 · 40:52](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2452)
- "Optimal timing for CDH repair is when stable on minimal ventilator settings, typically 3-4 days after birth" — Charlie Stolar (guideline) [Ep 18 · 45:42](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2742)
- "Infant ventilators should be used intraoperatively instead of anesthesia machines to continue respiratory care strategy" — Charlie Stolar (guideline) [Ep 18 · 46:07](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2767)
- "Thoracoscopic CDH repair has a recurrence rate of approximately 25% within one year" — Charlie Stolar (clinical) [Ep 18 · 49:46](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=2986)
- "When no diaphragm tissue is available medially, an upside-down U-shaped pericardial flap can be rotated down to begin the repair" — Charlie Stolar (clinical) [Ep 18 · 56:33](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3393)
- "Monofilament suture (like PDS) is preferred because it does not saw through tissue when pulled" — Charlie Stolar (opinion) [Ep 18 · 57:21](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3441)
- "Patches should have some redundancy to allow ballooning and prevent suture pull-through" — Charlie Stolar (clinical) [Ep 18 · 58:52](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=3532)
- "Chest tubes are not indicated after CDH repair unless there is active air leak or anticipated bleeding (such as repair on ECMO)" — Charlie Stolar (guideline) [Ep 18 · 67:30](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4050)
- "The pneumothorax after CDH repair is ex vacuo (not under pressure) because the ipsilateral lung is small and cannot fill the pleural space" — Charlie Stolar (clinical) [Ep 18 · 66:50](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4010)
- "CDH is a field defect affecting the entire foregut from pharynx to ligament of Treitz" — Charlie Stolar (clinical) [Ep 18 · 69:39](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4179)
- "Foregut dysmotility in CDH is not true reflux and fundoplication should be approached as palliation, not cure" — Charlie Stolar (opinion) [Ep 18 · 70:23](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4223)
- "CDH patients should be on proton pump inhibitors for life due to risk of Barrett's esophagitis" — Charlie Stolar (guideline) [Ep 18 · 73:32](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4412)
- "For right-sided CDH, hepatic veins may drain directly into the right atrium rather than the suprahepatic IVC" — Charlie Stolar (clinical) [Ep 18 · 77:55](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4675)
- "Hepatopulmonary fusion exists in some right-sided CDH cases and cannot be surgically separated" — Charlie Stolar (clinical) [Ep 18 · 78:36](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4716)
- "Right-sided CDH should be approached with preparation for both thoracic and abdominal incisions" — Charlie Stolar (guideline) [Ep 18 · 79:50](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-952?t=4790)
- "Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy" — Bargave Muliudi (clinical) [Ep 27 · 0:31](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=31)
- "Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age" — Bargave Muliudi (clinical) [Ep 27 · 0:37](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=37)
- "Pyloric stenosis is more common in males" — Bargave Muliudi (epidemiological) [Ep 27 · 0:46](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=46)
- "There is increased risk for first born infants with a positive family history" — Bargave Muliudi (epidemiological) [Ep 27 · 0:49](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=49)
- "Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting" — Bargave Muliudi (clinical) [Ep 27 · 1:12](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=72)
- "Emesis will progress until it is projectile" — Bargave Muliudi (clinical) [Ep 27 · 1:16](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=76)
- "Hyperbilirubinemia can occur in up to 14% of patients due to downregulation of hepatic enzymes associated with starvation" — Bargave Muliudi (clinical) [Ep 27 · 1:24](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=84)
- "Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus" — Bargave Muliudi (guideline) [Ep 27 · 2:00](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=120)
- "Ultrasound is the gold standard for diagnosing pyloric stenosis" — Bargave Muliudi (guideline) [Ep 27 · 2:50](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=170)
- "Pyloric thickness of 3 millimeters and length of 14 millimeters or above is diagnostic on ultrasound" — Bargave Muliudi (clinical) [Ep 27 · 2:55](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=175)
- "The classic electrolyte abnormality is a hypochloremic, hypokalemic, metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 27 · 3:19](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=199)
- "Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 27 · 3:29](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=209)
- "The kidneys increase sodium potassium pump activity to retain fluid, leading to urinary excretion of potassium and hypokalemia" — Bargave Muliudi (clinical) [Ep 27 · 3:41](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=221)
- "Excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis" — Bargave Muliudi (clinical) [Ep 27 · 3:56](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=236)
- "In the US, pyloromyotomy is the standard of care" — Bargave Muliudi (guideline) [Ep 27 · 4:17](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=257)
- "In some countries, atropine is used as a non-surgical option, with a success rate of about 60 to 90%" — Bargave Muliudi (clinical) [Ep 27 · 4:22](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=262)
- "Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30" — Bargave Muliudi (guideline) [Ep 27 · 5:48](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=348)
- "The distal extent of myotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction" — Bargave Muliudi (clinical) [Ep 27 · 7:07](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=427)
- "After pyloromyotomy is completed, the submucosa should bulge into the myotomy site and each side of the pylorus should move independently" — Bargave Muliudi (clinical) [Ep 27 · 8:18](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=498)
- "Complications include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias" — Bargave Muliudi (clinical) [Ep 27 · 8:42](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=522)
- "There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence decreases the clinical significance" — Bargave Muliudi (clinical) [Ep 27 · 8:52](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=532)
- "Most infants can be fed immediately after the operation" — Bargave Muliudi (clinical) [Ep 27 · 10:05](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=605)
- "Evidence supports ad-lib feeds; infants achieve full feeds sooner with no increase in readmission rates" — Bargave Muliudi (clinical) [Ep 27 · 10:13](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=613)
- "Small episodes of emesis are almost to be expected as the stomach recovers from days to weeks of progressive dilation" — Bargave Muliudi (clinical) [Ep 27 · 10:32](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=632)
- "Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter" — Bargave Muliudi (clinical) [Ep 27 · 10:44](https://library.globalcastmd.com/watch/pyloric-stenosis-2532?t=644)
- "More Fontan patients are surviving into adolescence and adulthood" — Lizzie Lee (epidemiological) [Ep 35 · 0:11](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=11)
- "Liver disease is becoming a rising issue in Fontan patients" — Lizzie Lee (epidemiological) [Ep 35 · 0:11](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=11)
- "Combined heart-liver transplantation is happening more often in Fontan patients" — Lizzie Lee (epidemiological) [Ep 35 · 0:11](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=11)
- "The study examined children and young adults undergoing combined heart-liver transplant at hospitals across the US in the last few years" — Lizzie Lee (clinical) [Ep 35 · 0:21](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=21)
- "Many of the patients in the study had hypoplastic left heart syndrome" — Lizzie Lee (clinical) [Ep 35 · 0:28](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=28)
- "About 85% of patients survived at 1 year after combined heart-liver transplant" — Lizzie Lee (clinical) [Ep 35 · 0:36](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=36)
- "Long-term outcomes after combined heart-liver transplant were excellent" — Lizzie Lee (clinical) [Ep 35 · 0:36](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=36)
- "Three-year survival after combined heart-liver transplant was basically identical to patients who received heart transplant alone" — Lizzie Lee (clinical) [Ep 35 · 0:41](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=41)
- "Combined heart-liver transplant is effective for Fontan patients with advanced liver disease" — Lizzie Lee (clinical) [Ep 35 · 0:48](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=48)
- "Combined heart-liver transplant is increasingly common for Fontan patients with advanced liver disease" — Lizzie Lee (epidemiological) [Ep 35 · 0:48](https://library.globalcastmd.com/watch/outcomes-of-fontan-patients-undergoing-combined-heart-liver-transplantation-in-pediatric-hospitals-across-the-u-s-11307?t=48)
- "Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period" — Marc Levitt (clinical) [Ep 31 · 2:57](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=177)
- "Male babies with perineal fistula may pass meconium and no one notices anything wrong with their anorectal anatomy, typically presenting in the first year of life with severe constipation" — Marc Levitt (clinical) [Ep 31 · 3:06](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=186)
- "A newborn should accept a size 12 Hagar dilator and a 1 year old should accept a size 15" — Marc Levitt (clinical) [Ep 31 · 6:16](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=376)
- "Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation" — Marc Levitt (clinical) [Ep 31 · 4:54](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=294)
- "Patients with uncorrected perineal fistula will soil with loose stool or athletic activity because they cannot completely close the hole when squeezing sphincters" — Marc Levitt (clinical) [Ep 31 · 5:38](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=338)
- "Female perineal fistula diagnosis requires assessment of three criteria: hole size, adequate perineal body, and hole centered in sphincter" — Marc Levitt (clinical) [Ep 31 · 8:02](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=482)
- "If the hole is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, the patient does not need surgery and the perineal body will lengthen with growth" — Marc Levitt (clinical) [Ep 31 · 8:47](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=527)
- "The standard now is to not check rectal temperature but check temperature on forehead or ear, making it easier to miss anorectal malformations" — Marc Levitt (clinical) [Ep 31 · 4:25](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=265)
- "Rectourethral fistula patients should not be approached primarily because you cannot know where the rectum is (bladder neck, prostatic, or bulbar level)" — Marc Levitt (clinical) [Ep 31 · 12:45](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=765)
- "All rectourethral fistula patients should be managed with colostomy and distal colostogram, except exceedingly rare cases with very low rectum on cross table lateral at 20 hours" — Marc Levitt (clinical) [Ep 31 · 13:20](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=800)
- "Colostomy opened too distal in the sigmoid restricts the ultimate pull-through by location of colostomy or mucous fistula" — Marc Levitt (clinical) [Ep 31 · 17:18](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1038)
- "Incompletely diverting loop colostomies allow stool to spill across and contaminate distal segment, leading to urinary tract infections" — Marc Levitt (clinical) [Ep 31 · 17:45](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1065)
- "Transverse colostomies can prolapse and if there is a large rectourethral fistula, the left colon absorbs all the urine causing acidosis" — Marc Levitt (clinical) [Ep 31 · 18:38](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1118)
- "Proximal sigmoid colostomy leaves entire sigmoid loop for pull-through and only the distal segment can prolapse because left colon is fixed to retroperitoneum" — Marc Levitt (clinical) [Ep 31 · 19:14](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1154)
- "Prolapse is related to mobility of colon proximal or distal to the stoma; ileostomies prolapse frequently because they are free floating unless tacked to anterior abdominal wall" — Marc Levitt (clinical) [Ep 31 · 20:04](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1204)
- "Mark the anoplasty location on skin surface before making incision to avoid getting lost when looking at jumping muscles from stimulator" — Marc Levitt (clinical) [Ep 31 · 21:30](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1290)
- "Really good surgeons have put anuses in wrong places because they do not have sense of center once everything is disrupted and open" — Marc Levitt (clinical) [Ep 31 · 23:04](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1384)
- "Common distal colostogram mistake is not giving enough contrast or pressure, creating false impression that rectum is high with no fistula" — Marc Levitt (clinical) [Ep 31 · 24:11](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1451)
- "If you see flattening of rectum corresponding to pubococcygeal line, the radiologist did not give enough contrast or pressure to overcome the sphincters" — Marc Levitt (clinical) [Ep 31 · 24:26](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1466)
- "Fistula location can be determined by viewing urethra as reverse C or elbow: at or below elbow is bulbar, above elbow is prostatic, at bladder neck is bladder neck fistula" — Marc Levitt (clinical) [Ep 31 · 25:23](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1523)
- "Bulbous rectum might be reachable posterior sagittally and hard laparoscopically; tapered rectum is better approached laparoscopically" — Marc Levitt (clinical) [Ep 31 · 25:58](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1558)
- "Opening posterior sagittally without knowing where rectum is will lead to finding whitish shiny structures that are urinary tract (bladder neck) rather than rectum" — Marc Levitt (clinical) [Ep 31 · 27:00](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1620)
- "Bulbar and low prostatic rectums with bulge are more easily approached posterior sagittally; high prostatic tapered rectums and bladder neck fistulas are best served by laparoscopy" — Marc Levitt (clinical) [Ep 31 · 30:09](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1809)
- "Attempting laparoscopy for bulging rectum below peritoneal reflection at low prostatic or bulbar level risks leaving behind remnant of original fistula (roof)" — Marc Levitt (clinical) [Ep 31 · 30:43](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1843)
- "Laparoscopy replaces laparotomy, not PSARP; should do mini-PSARP with laparoscopy to safely enter pelvis and tack rectum to posterior muscle complex to avoid prolapse" — Marc Levitt (clinical) [Ep 31 · 31:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=1908)
- "Prolapse occurs in about 3% of cases, particularly in those without great muscles" — Marc Levitt (epidemiological) [Ep 31 · 33:35](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2015)
- "Rectal prolapse causes bleeding, mucus, and can inhibit bowel control in patients with good potential because they cannot close opening with prolapsed tissue through it" — Marc Levitt (clinical) [Ep 31 · 33:58](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2038)
- "Prolapse more than 3 millimeters should be treated; ideal time is when patient still has colostomy" — Marc Levitt (clinical) [Ep 31 · 34:25](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2065)
- "Circumferential prolapse can be trimmed in two stages (half circumference each) in ambulatory settings, avoiding hospitalization and not requiring dilation because half circumference is untouched" — Marc Levitt (clinical) [Ep 31 · 34:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2088)
- "Key to preventing perineal body dehiscence is mobilizing rectum well to get anterior rectal wall completely separated from posterior vaginal wall to areolar plane, avoiding tension on anoplasty" — Marc Levitt (clinical) [Ep 31 · 35:41](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2141)
- "Perineal body dehiscence is the most common cause of reoperation in female ARM repairs" — Marc Levitt (epidemiological) [Ep 31 · 36:03](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2163)
- "Traditional management is NPO for 7 days on 10% dextrose; recently trialing clear liquids only for a week because major problem is hard stool, not stool volume" — Marc Levitt (clinical) [Ep 31 · 36:35](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2195)
- "If perineal body dehiscence is detected on days 5-8, can salvage by taking patient back to OR to re-suture; by 3-4 weeks later, entire perineal body is dehisced and nothing can be done" — Marc Levitt (clinical) [Ep 31 · 37:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2268)
- "High rectums, particularly bladder neck fistulas, require preservation of IMA because colostomy may have disrupted collaterals down left colic, making rectum completely dependent on IMA" — Marc Levitt (clinical) [Ep 31 · 39:20](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2360)
- "Rectum has excellent intramural blood supply from IMA; taking IMA or branches too close to aorta will cause rectal necrosis without left colic collateralization" — Marc Levitt (clinical) [Ep 31 · 39:47](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2387)
- "ARM continence potential is determined by three factors: original malformation type, quality of sacrum with calculated sacral ratio, and quality of spine" — Marc Levitt (clinical) [Ep 31 · 42:14](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2534)
- "Bulbar fistula with good sacrum (sacral ratio of 1) and normal spine should absolutely have bowel control" — Marc Levitt (clinical) [Ep 31 · 43:19](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2599)
- "Bladder neck fistula with poor sacrum (sacral ratio 0.4) and tethered cord or myelomeningocele has no chance of good bowel control" — Marc Levitt (clinical) [Ep 31 · 43:29](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2609)
- "First step for soiling 4-year-old is to get them clean mechanically with bowel management using enemas; for those with continence potential, try switching to laxatives when older and more mature" — Marc Levitt (clinical) [Ep 31 · 43:54](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2634)
- "Indications for redo procedure include improperly located anus, anal stricture, rectal prolapse, or remnant of original fistula (posterior urethral diverticulum) in patients with any continence potential" — Marc Levitt (clinical) [Ep 31 · 44:39](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-304?t=2679)
- "CDH diagnosis is usually made at about 20 weeks gestation with routine anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart" — Charlie Stolar (clinical) [Ep 32 · 3:37](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=217)
- "CDH should be discussed as a growth arrest of both lungs with the ipsilateral side more severely affected than the contralateral side" — Charlie Stolar (clinical) [Ep 32 · 4:14](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=254)
- "The lungs are affected at birth by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation" — Charlie Stolar (clinical) [Ep 32 · 4:23](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=263)
- "CDH is not a surgical emergency but a medical physiologic emergency" — Charlie Stolar (clinical) [Ep 32 · 5:00](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=300)
- "Diagnosis of CDH alone is not an indication for cesarean section; recommend elective spontaneous vaginal delivery assuming no obstetric issues" — Charlie Stolar (guideline) [Ep 32 · 5:24](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=324)
- "Antenatal interventions for CDH are no better than investigational and experimental at best" — Charlie Stolar (opinion) [Ep 32 · 6:35](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=395)
- "Babies with CDH should be born at a full service children's facility with availability of ECMO, as maybe 10-15% will benefit from ECMO" — Charlie Stolar (guideline) [Ep 32 · 7:23](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=443)
- "In single center experiences, presence of liver in chest or stomach in chest is of no prognostic value" — Charlie Stolar (clinical) [Ep 32 · 8:31](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=511)
- "Lung to head ratio is of no better than limited value except when very low (less than 0.8), where prognosis is concerning" — Charlie Stolar (clinical) [Ep 32 · 8:42](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=522)
- "Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis" — Charlie Stolar (clinical) [Ep 32 · 9:07](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=547)
- "If shown 100 children with CDH, 80-85% will survive to become teenagers" — Charlie Stolar (epidemiological) [Ep 32 · 10:13](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=613)
- "Steroids have tremendous value for preterm labor under 35 weeks but role in near-term babies (37-39 weeks) with CDH is arguable" — Charlie Stolar (clinical) [Ep 32 · 10:37](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=637)
- "Exit to ECMO for CDH is nonsense except potentially for investigational protocol using liquid ventilation with perfluorocarbons as trophic agent to provoke lung growth" — Charlie Stolar (opinion) [Ep 32 · 12:06](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=726)
- "Respiratory care strategy requires babies to be breathing spontaneously with no paralysis and minimal sedation" — Charlie Stolar (guideline) [Ep 32 · 15:12](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=912)
- "ECMO indication is not meeting tissue oxygen requirements despite best medical management, commonly using oxygenation index greater than 40 for 4 hours or more" — Charlie Stolar (guideline) [Ep 32 · 17:52](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1072)
- "All therapy is guided by preductal oximetry, not postductal, because guiding by postductal will lead to premature and precipitous interventions" — Charlie Stolar (guideline) [Ep 32 · 19:06](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1146)
- "If preductal saturation is 90% (PAO2 of 65 torr), the brain is doing fine because this is fetal hemoglobin" — Charlie Stolar (clinical) [Ep 32 · 19:32](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1172)
- "Most babies with CDH don't tolerate conventional ventilator settings and require unconventional mode with 100 breaths per minute, peak pressure turned down to zero, and high gas flow rate" — Charlie Stolar (clinical) [Ep 32 · 22:49](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1369)
- "Nitric oxide is a waste of money for CDH babies; it's terrific for premature babies with immature lung disease but of no value in CDH" — Charlie Stolar (opinion) [Ep 32 · 25:45](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1545)
- "The best drug for CDH is oxygen" — Charlie Stolar (opinion) [Ep 32 · 26:07](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1567)
- "ECMO gestational age limit has been pushed from 36 weeks down to 35 or 34 weeks, with reports as low as 32 weeks, but intracranial hemorrhage rate increases significantly below 34 weeks" — Charlie Stolar (clinical) [Ep 32 · 26:22](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1582)
- "The real issue for ECMO candidacy is whether you have a reversible condition - don't start something you can't finish" — Charlie Stolar (guideline) [Ep 32 · 28:45](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1725)
- "VV ECMO is terrific if the heart works, but in CDH the heart function is often depressed and it's hard to get the cannula in with mediastinum shifted" — Charlie Stolar (clinical) [Ep 32 · 30:27](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1827)
- "VA bypass is basically dial in a PAO2, while VV has mixing issues and canal position concerns making it much more annoying for unstable CDH patients" — Charlie Stolar (clinical) [Ep 32 · 31:53](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1913)
- "Echo guidance during ECMO cannulation is really helpful to avoid driving arterial cannula out subclavian artery or venous cannula into innominate vein" — Charlie Stolar (clinical) [Ep 32 · 32:17](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=1937)
- "Goal ECMO flow on VA is about 100-125 cc/kg/min, which is about 80% of cardiac output assuming open duct" — Charlie Stolar (clinical) [Ep 32 · 35:10](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=2110)
- "Typical stable CDH patient will be crummy for about 1 day postoperatively then get better and be extubated in 4-5 days" — Charlie Stolar (clinical) [Ep 32 · 69:00](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4140)
- "CDH is a field defect affecting the entire foregut from pharynx to ligament of Treitz, causing disordered motility throughout" — Charlie Stolar (clinical) [Ep 32 · 69:39](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4179)
- "GI series in CDH patients shows very dilated, ectatic, abnormal looking esophagus with abnormal motility, gastric motility, and gastric emptying" — Charlie Stolar (clinical) [Ep 32 · 69:55](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4195)
- "The foregut dysmotility is not really reflux, and calling it reflux has suckered surgeons into doing fundoplications and pyloroplasties that are basically torture" — Charlie Stolar (opinion) [Ep 32 · 70:09](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4209)
- "CDH patients do well with continuous feedings slowly condensed to bolus; unusual to need surgical intervention" — Charlie Stolar (clinical) [Ep 32 · 70:28](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4228)
- "Nissen fundoplication is a poor operation for CDH patients because it's fully competent on an esophagus with abnormal motility" — Charlie Stolar (opinion) [Ep 32 · 70:43](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4243)
- "CDH patients followed in multidisciplinary clinic have issues with heart, lungs, foregut, nutrition, neurodevelopmental outcome, and axial skeleton that emerge over time" — Charlie Stolar (clinical) [Ep 32 · 72:18](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4338)
- "Four CDH teenagers developed Barrett's esophagitis, leading to recommendation for lifelong proton pump inhibitors and regular endoscopy" — Charlie Stolar (clinical) [Ep 32 · 73:18](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4398)
- "CDH patients have increased incidence of attention deficit disorders and autism, requiring early intervention for neuropsychiatric issues" — Charlie Stolar (epidemiological) [Ep 32 · 73:57](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4437)
- "As field defect, CDH causes asymmetric chest growth leading to pectus-like deformities requiring Nuss operation and breast implants in girls with no breast development on hernia side" — Charlie Stolar (clinical) [Ep 32 · 74:09](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4449)
- "CDH patients develop thoracolumbar scoliosis (not idiopathic), mostly in boys, requiring early bracing program" — Charlie Stolar (clinical) [Ep 32 · 74:34](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4474)
- "In right-sided CDH, hepatic veins not infrequently enter directly into right atrium rather than suprahepatic cava, and attempting to reduce liver when attached to heart will cause trouble" — Charlie Stolar (clinical) [Ep 32 · 77:55](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4675)
- "Hepatopulmonary fusion exists in CDH where liver and lung are fused and cannot be separated surgically; most patients don't survive and often have severe congenital heart disease and IVC discontinuation" — Charlie Stolar (clinical) [Ep 32 · 78:36](https://library.globalcastmd.com/watch/congenital-diaphragmatic-hernia-with-dr-charlie-stolar-303?t=4716)
- "Pectus excavatum patients commonly present with easy fatigability with exertion, shortness of breath with exertion, and chest pain in the area of the depression, generally not at rest but with exertion" — Robert Kelly (clinical) [Ep 30 · 1:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=93)
- "Both Marfan syndrome and Ehlers-Danlos syndrome are problems for which pectus excavatum is a marker" — Robert Kelly (clinical) [Ep 30 · 2:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=175)
- "In a normal chest, ribs should move like the handle of a bucket (up and out) and the sternum should move like the handle of an old fashioned water pump (towards the ceiling and out)" — Robert Kelly (clinical) [Ep 30 · 4:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=244)
- "In pectus excavatum, the depressed area is frequently absolutely fixed or in younger patients may move paradoxically so the xyphoid pulls back towards the spine during deep inspiration" — Robert Kelly (clinical) [Ep 30 · 4:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=269)
- "In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis" — Robert Kelly (epidemiological) [Ep 30 · 6:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=365)
- "In the multi-center study of pectus excavatum at 11 centers, roughly two-thirds of patients had symptoms of fatigue, dyspnea, or chest pain" — Robert Kelly (epidemiological) [Ep 30 · 8:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=519)
- "The Haller index is the ratio of the inner transverse diameter divided by the distance between the back of the sternum and the front of the spine, with an index greater than 3.25 indicating severe pectus" — Robert Kelly (clinical) [Ep 30 · 9:44](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=584)
- "In patients with barrel chest, the Haller index underestimates the depth of depression because the AP diameter is increased" — Robert Kelly (clinical) [Ep 30 · 10:09](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=609)
- "The Kansas City group advocates an index showing if there is more than a 10% drop in the AP diameter at the depression compared to laterally, this should be considered as a reason to operate" — Robert Kelly (guideline) [Ep 30 · 10:24](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=624)
- "Mitral valve prolapse is present in about 14% of pectus excavatum patients, compared to 1% in young patients generally" — Robert Kelly (epidemiological) [Ep 30 · 12:53](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=773)
- "On average in a large number of patients, pulmonary function tests will be down by about one standard deviation from average (85-90% predicted)" — Robert Kelly (clinical) [Ep 30 · 13:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=817)
- "In the multi-center study, patients came up by close to a standard deviation in pulmonary function when they had the bellows action of the chest restored" — Robert Kelly (clinical) [Ep 30 · 14:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=855)
- "Restrictive lung disease is defined as an FVC less than 80% predicted with a normal FEV1/FVC ratio, and this restrictive process is corrected by pectus operation unlike asthma" — Robert Kelly (clinical) [Ep 30 · 14:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=880)
- "Patients with worse pectus have more likelihood of having restrictive pulmonary problems" — Robert Kelly (clinical) [Ep 30 · 15:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=905)
- "Surgical indications require at least 3 of 6 criteria: Haller index >3.2, PFTs <80% predicted, cardiac abnormalities on echo, symptoms, progressive pectus, or major psychosocial issues" — Robert Kelly (guideline) [Ep 30 · 15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911)
- "Around the time of the teenage growth spurt, there are a lot of kids in whom the pectus gets a lot deeper" — Robert Kelly (clinical) [Ep 30 · 15:35](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=935)
- "The ideal age for surgery is sometime just prior to the onset of puberty or early in puberty: ages 11-13 for girls and a year or two older for boys" — Robert Kelly (guideline) [Ep 30 · 16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007)
- "Having the bar in place during the rapid growth spurt of puberty results in extremely low likelihood of recurrence" — Robert Kelly (clinical) [Ep 30 · 17:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1022)
- "Some Asian groups operate on patients when they are quite young, well under 10 years old, and report good results" — Robert Kelly (clinical) [Ep 30 · 17:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1049)
- "The Allergies test developed in Canada includes all components of the stainless steel bar, and patients have reacted against a number of minor components including nickel, chromium, and cobalt" — Robert Kelly (clinical) [Ep 30 · 21:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1300)
- "Titanium bars must be bent at the factory and ordered in advance, and are much more expensive than stainless steel bars" — Robert Kelly (clinical) [Ep 30 · 22:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1337)
- "The likelihood of transfusion in Nuss procedure is exceedingly low" — Robert Kelly (clinical) [Ep 30 · 22:45](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1365)
- "Bar length is measured from mid-axillary line to mid-axillary line and subtracting an inch" — Robert Kelly (clinical) [Ep 30 · 23:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1409)
- "It should be standard practice in patients with any difficulty in visualization to use some technique of sternal elevation during Nuss procedure" — Robert Kelly (guideline) [Ep 30 · 24:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1483)
- "The most important part of the Nuss procedure is that you see the tip of the introducer at all times when passing from one side to the other" — Robert Kelly (clinical) [Ep 30 · 26:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1562)
- "The bar should be placed medial to the pectus ridge so there is a rib providing counterforce, as placing it very laterally results in only intercostal muscles preventing movement and they will strip or rip" — Robert Kelly (clinical) [Ep 30 · 28:54](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1734)
- "In patients who are growing, stabilizers on both sides can cause a wasp waist effect, so they are generally placed on only one side of the bar" — Robert Kelly (clinical) [Ep 30 · 30:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1807)
- "If a patient is over approximately 6 feet 2 inches tall, the chances of needing two bars are almost 100%" — Robert Kelly (clinical) [Ep 30 · 30:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1839)
- "In the series of past 2000 Nuss procedures, about 2.7% of patients required some sort of revision for bar displacement" — Robert Kelly (epidemiological) [Ep 30 · 33:14](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1994)
- "The incidence of bar displacement has been cut to about half by using stabilizers and wrapping around the crossing of the bar to the rib with pericostal sutures" — Robert Kelly (clinical) [Ep 30 · 33:28](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2008)
- "Bar allergy occurred in 0.9% of patients, and screening for metal allergy has been performed since 2004, dramatically decreasing the incidence" — Robert Kelly (epidemiological) [Ep 30 · 34:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2053)
- "About 6.4% of patients had clinical or patch test evidence of metal allergy" — Robert Kelly (epidemiological) [Ep 30 · 34:27](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2067)
- "Wound infection occurred in 2.3% of patients, with more than two-thirds being superficial or cellulitis" — Robert Kelly (epidemiological) [Ep 30 · 34:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2080)
- "Recurrence occurred in about 1.2% of patients" — Robert Kelly (epidemiological) [Ep 30 · 35:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2107)
- "The bar should remain in place for at least 2 years, with preference for closer to 3 years rather than 2 years" — Robert Kelly (guideline) [Ep 30 · 36:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2207)
- "A study from Saint Etienne, France found vacuum bell treatment effective in eliminating pectus excavatum in 23 of 73 patients" — Robert Kelly (clinical) [Ep 30 · 37:19](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2239)
- "In patients who are young, under 10 years old, the vacuum bell can be very effective in lifting the chest up" — Robert Kelly (clinical) [Ep 30 · 37:58](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2278)
- "A Nuss procedure after a recurrent pectus excavatum following previous Ravitch operation will elevate the chest but won't restore movement of the chest wall, and patients will have restrictive process from scarring" — Robert Kelly (clinical) [Ep 30 · 39:06](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2346)
- "Brace therapy for pectus carinatum is successful in somewhere between two-thirds and three-quarters of patients" — Robert Kelly (clinical) [Ep 30 · 40:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2404)
- "There is a broad perception among surgeons who have done many Ravitch operations for carinatum that there is an extremely low recurrence rate, as opposed to the 10% recurrence rate after excavatum Ravitch" — Robert Kelly (opinion) [Ep 30 · 43:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2623)
- "There is a family tendency in pectus in approximately 40% of patients, but the majority do not have a family history" — Robert Kelly (epidemiological) [Ep 30 · 44:52](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2692)
- "The paper studied 98 patients who had severe tracheomalacia with posterior membranous intrusion" — Ian Glenn (clinical) [Ep 2 · 0:28](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=28)
- "All patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect" — Ian Glenn (clinical) [Ep 2 · 0:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=35)
- "Anterior compression is from the aortic arch, while posterior compression is from collapse" — Ian Glenn (clinical) [Ep 2 · 0:44](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=44)
- "Posterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine" — Ian Glenn (clinical) [Ep 2 · 0:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=54)
- "88% of the 98 patients had esophageal atresia with or without TEF" — Ian Glenn (epidemiological) [Ep 2 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65)
- "Patients were followed anywhere from 1 week to 36 months" — Ian Glenn (clinical) [Ep 2 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=65)
- "Clinical symptoms including cough, barking cough, noisy breathing, and infections improved across the board" — Ian Glenn (clinical) [Ep 2 · 1:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=75)
- "Patients improved on bronchoscopic evaluation" — Ian Glenn (clinical) [Ep 2 · 1:25](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=85)
- "Exercise tolerance did not improve statistically but showed a trend towards improvement" — Ian Glenn (clinical) [Ep 2 · 1:30](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=90)
- "Tracheomalacia is not one homogeneous disease" — Ian Glenn (clinical) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=95)
- "Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both" — Ian Glenn (clinical) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=105)
- "Almost 20% of patients in the study required both posterior and anterior procedures" — Ian Glenn (clinical) [Ep 2 · 1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-375?t=114)
- "Esophagogastric dissociation was historically thought of as a last resort operation when Nissen fundoplication won't work" — Todd Ponsky (clinical) [Ep 3 · 0:14](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=14)
- "Esophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment" — Todd Ponsky (clinical) [Ep 3 · 0:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=24)
- "The study included patients with severe GERD who were neurologically disabled, with half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen" — Ian Glenn (clinical) [Ep 3 · 0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=48)
- "Primary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery" — Ian Glenn (clinical) [Ep 3 · 1:01](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=61)
- "There was a 4% failure rate in the esophagogastric dissociation group" — Ian Glenn (clinical) [Ep 3 · 1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=73)
- "There was a 21% failure rate in the Nissen group" — Ian Glenn (clinical) [Ep 3 · 1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=73)
- "The difference in failure rates between esophagogastric dissociation and Nissen was not statistically significant" — Ian Glenn (clinical) [Ep 3 · 1:21](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=81)
- "17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [Ep 3 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=89)
- "54% of patients in the Nissen group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [Ep 3 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=89)
- "The difference in continued medication requirement between groups was statistically significant" — Ian Glenn (clinical) [Ep 3 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=89)
- "Caregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference" — Ian Glenn (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=99)
- "The lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it" — Ian Glenn (opinion) [Ep 3 · 2:03](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=123)
- "A multi-center study will probably be needed to really understand the difference between the procedures" — Todd Ponsky (opinion) [Ep 3 · 2:12](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=132)
- "The study did not look at complication rates such as leaks and strictures" — Todd Ponsky (clinical) [Ep 3 · 2:15](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=135)
- "Leaks and strictures are the main concern for why most surgeons don't do esophagogastric dissociation" — Todd Ponsky (opinion) [Ep 3 · 2:18](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=138)
- "Esophagogastric dissociation is a much bigger surgery than Nissen fundoplication" — Ian Glenn (clinical) [Ep 3 · 2:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=144)
- "The study looked at perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends" — Ian Glenn (clinical) [Ep 3 · 2:26](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=146)
- "The study did not report on long-term requirement for additional surgeries other than anti-reflux operations" — Ian Glenn (clinical) [Ep 3 · 2:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-563?t=159)
- "Cincinnati changed practice 6-8 months ago to discharge intussusception patients home from ER after 4-hour observation period" (clinical) [Ep 4 · 0:57](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=57)
- "48 patients sent home from ED after intussusception reduction, only one recurred within 48 hours and did not require operation" — Nick Bruns (clinical) [Ep 4 · 2:01](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=121)
- "Discharge criteria for intussusception: tolerating oral hydration, hemodynamically stable, afebrile" — Nick Bruns (guideline) [Ep 4 · 2:14](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=134)
- "When contrast fills appendix but won't reflux into small bowel, bring patient back for repeat reduction in a few hours" (clinical) [Ep 4 · 2:36](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=156)
- "Inability of contrast to reflux into small bowel attributed to ileocecal edema" — Nick Bruns (clinical) [Ep 4 · 2:44](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=164)
- "Repeat enema study after failed reflux proves reduction occurred because edema has decreased, does not actually reduce the intussusception" (clinical) [Ep 4 · 3:04](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=184)
- "Ultrasound after intussusception reduction is difficult to interpret due to inflammation" (clinical) [Ep 4 · 3:19](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=199)
- "Current practice is to leave appendix in place during intussusception reduction to avoid risk of appendiceal stump dehiscence if reoperation needed" (opinion) [Ep 4 · 3:58](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=238)
- "Age 5-6 years is cutoff for high suspicion of pathologic lead point in intussusception" (clinical) [Ep 4 · 4:22](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=262)
- "For suspected pathologic lead point, may attempt reduction then work up electively and perform resection in better circumstances" (opinion) [Ep 4 · 4:55](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=295)
- "Over age 5, 30-60% of intussusception cases have pathologic lead point depending on series" — Nick Bruns (epidemiological) [Ep 4 · 5:28](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=328)
- "Many soft tissue abscesses drained in ED by emergency physicians with sedation" (clinical) [Ep 4 · 6:52](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=412)
- "Admission criteria for abscess: cellulitis, fever, and leukocytosis in combination" (guideline) [Ep 4 · 8:08](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=488)
- "Antibiotics prescribed for abscess only if cellulitis present" (clinical) [Ep 4 · 8:31](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=511)
- "Treatment failure rate (readmission or repeat I&D within 2 weeks) was 0.9% for same-day discharge after abscess drainage" — Nick Bruns (clinical) [Ep 4 · 8:57](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=537)
- "Only 2 of 138 patients with leukocytosis had treatment failure after same-day discharge" — Nick Bruns (clinical) [Ep 4 · 9:11](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=551)
- "Patients with white counts of 35 sent home after abscess drainage did fine" — Nick Bruns (clinical) [Ep 4 · 9:26](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=566)
- "Definitive pilonidal surgery typically performed after second recurrence" (clinical) [Ep 4 · 10:27](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=627)
- "Bascom technique: excise pits at skin level with 11 blade under local, 70% never recur" (clinical) [Ep 4 · 10:57](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=657)
- "Pit excision performed 10 days after I&D once acute infection subsided" (clinical) [Ep 4 · 11:26](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=686)
- "For recurrence after pit excision or large draining sinuses, perform formal excision with off-midline layered closure and drain" (clinical) [Ep 4 · 11:37](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=697)
- "Physical exam findings (deep gluteal fold, excessive hair) affect pilonidal management decisions" (clinical) [Ep 4 · 12:24](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=744)
- "For severe pilonidal disease, may leave wound open with wet-to-dry dressing changes or wound vac" (clinical) [Ep 4 · 12:50](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=770)
- "Karydakis flap superior to excision only and comparable to modified Limberg flap for pilonidal disease" — Ian Glenn (clinical) [Ep 4 · 13:18](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=798)
- "Post-operative management is key to pilonidal success: keep patient prone on bed until wound heals" (opinion) [Ep 4 · 13:43](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=823)
- "One patient reported laser hair removal was most painful thing ever experienced, discontinued after half session" (clinical) [Ep 4 · 14:26](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=866)
- "After negative Meckel's scan for hematochezia, perform colonoscopy with intent to do laparoscopy at same anesthetic if colonoscopy negative" (clinical) [Ep 4 · 15:34](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=934)
- "PPI will stop bleeding from Meckel's diverticulum, should never be emergency operation" (opinion) [Ep 4 · 16:14](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=974)
- "For bleeding Meckel's with ulcer at base, perform small bowel resection rather than simple diverticulectomy" (clinical) [Ep 4 · 17:00](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1020)
- "Ulcers in bleeding Meckel's are in the Meckel's itself, not in adjacent small bowel" (clinical) [Ep 4 · 17:29](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1049)
- "Stapling off Meckel's removes acid source but bleeding ulcer remains for next day" (clinical) [Ep 4 · 17:39](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1059)
- "Ectopic gastric mucosa almost always at tip of Meckel's diverticulum" (clinical) [Ep 4 · 18:09](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1089)
- "When resecting Meckel's through umbilicus, let it relax and mark edges with marker before stapling to avoid distortion and narrowing" (clinical) [Ep 4 · 18:48](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1128)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 34 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=0)
- "With gastroschisis, the main issue is that the bowel gets damaged through fetal life" — Jacob Langer (clinical) [Ep 34 · 4:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=276)
- "Most gastroschisis patients don't have any other associated anomalies" — Jacob Langer (clinical) [Ep 34 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=286)
- "It's pretty rare to have other anomalies or abnormal chromosomes with gastroschisis" — Jacob Langer (clinical) [Ep 34 · 4:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=292)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis" — Jacob Langer (clinical) [Ep 34 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=373)
- "Most people nowadays would not do routine cesarean section for gastroschisis" — Jacob Langer (opinion) [Ep 34 · 6:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=378)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 34 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 34 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly due to inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 34 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=427)
- "In gastroschisis pregnancies, labor induction at 37 weeks is usually successful, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 34 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=461)
- "Most evidence from the CapsNet database suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 34 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 34 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (clinical) [Ep 34 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=657)
- "Using forceps at the bedside to push bowel back in can damage the bowel" — Jacob Langer (clinical) [Ep 34 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=689)
- "Intraabdominal pressure should be kept below 20 during gastroschisis reduction" — Jacob Langer (clinical) [Ep 34 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=734)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 34 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1131)
- "There are two different kinds of intestinal atresia in gastroschisis: early-onset atresia and late-onset atresia associated with vanishing gastroschisis" — Jacob Langer (clinical) [Ep 34 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect gets very small as the baby grows, causing ischemia and necrosis of the exteriorized bowel" — Jacob Langer (clinical) [Ep 34 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN, and improved sepsis control" — Jacob Langer (clinical) [Ep 34 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1215)
- "There is no good evidence for how to manage atresia in gastroschisis—whether to repair at initial closure, create stomas, or delay repair" — Jacob Langer (opinion) [Ep 34 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1275)
- "Neonatal stomas prolapse no matter what technique is used" — Jacob Langer (clinical) [Ep 34 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1380)
- "Three weeks is average for gastroschisis patients to start having bowel movements" — Jacob Langer (clinical) [Ep 34 · 24:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1470)
- "A UK study showed that cisapride shortened the period of intestinal dysmotility in gastroschisis, but cisapride is no longer available" — Jacob Langer (clinical) [Ep 34 · 25:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1502)
- "Metoclopramide can be given intravenously, ensuring the patient receives the medication even with poor intestinal absorption" — Jacob Langer (clinical) [Ep 34 · 25:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1520)
- "Going in too early to explore for mechanical obstruction in gastroschisis with prolonged dysmotility is a mistake" — Jacob Langer (opinion) [Ep 34 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1641)
- "In gastroschisis, the exteriorized testis is usually the right testis" — Jacob Langer (clinical) [Ep 34 · 28:03](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1683)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 34 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 34 · 28:43](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1723)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 34 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1787)
- "There is no rationale for routine cesarean section or preterm delivery for small omphaloceles" — Jacob Langer (opinion) [Ep 34 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1805)
- "Small omphaloceles are simple to repair from a surgical point of view" — Jacob Langer (clinical) [Ep 34 · 30:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1829)
- "Giant omphaloceles are associated with pulmonary hypoplasia, which is difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 34 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1915)
- "The pressure guideline of 20 for abdominal wall defect closure was established by Stuart Lacy in the 1980s based on rabbit studies and then validated in children" — Jacob Langer (clinical) [Ep 34 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2008)
- "Intraabdominal pressure can be measured through the nasogastric tube or via Foley catheter measuring intravesical pressure" — Jacob Langer (clinical) [Ep 34 · 34:02](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2042)
- "The trend of intraabdominal pressure is more important than the absolute number during reduction" — Jacob Langer (clinical) [Ep 34 · 34:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2057)
- "The Montreal group described using the omphalocele sac as a silo by sequentially ligating it over several days" — Jacob Langer (clinical) [Ep 34 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2107)
- "Spring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time" — Todd Ponsky (clinical) [Ep 34 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1090)
- "A larger abdominal wall defect after silo use takes longer to close on its own after bowel reduction" — Jacob Langer (clinical) [Ep 34 · 18:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=1121)
- "Using Duoderm to gradually reduce giant omphaloceles appears to achieve reduction more quickly than other methods" — Jacob Langer (clinical) [Ep 34 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, severe cardiac disease, pulmonary hypoplasia, multiple anomalies, chromosomal abnormalities, or extremely large size" — Jacob Langer (clinical) [Ep 34 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2292)
- "Mushroom-shaped omphaloceles with a small abdominal wall defect but large external component will never reduce spontaneously" — Jacob Langer (clinical) [Ep 34 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2470)
- "In mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 34 · 41:20](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2480)
- "In delayed omphalocele repair, the defect often extends to the costal margin, requiring patch closure of the upper portion" — Jacob Langer (clinical) [Ep 34 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2615)
- "Surgisis patch fails to provide adequate closure in approximately 50% of omphalocele repairs" — Jacob Langer (clinical) [Ep 34 · 44:04](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2644)
- "Omphalocele may be part of pentalogy of Cantrell, commonly associated with diaphragmatic hernia of Morgagni" — Jacob Langer (clinical) [Ep 34 · 44:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2684)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 34 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2768)
- "Interventional radiology can usually place a G-tube lateral to a giant omphalocele defect under fluoroscopy" — Jacob Langer (clinical) [Ep 34 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2790)
- "Performing fundoplication in a child with an unreduced giant omphalocele is extremely difficult because the liver is midline and blocks access to the hiatus" — Jacob Langer (clinical) [Ep 34 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2835)
- "In giant omphaloceles, the midline liver can compress the duodenum or pylorus, causing mechanical gastric outlet obstruction" — Jacob Langer (clinical) [Ep 34 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus" — Jacob Langer (clinical) [Ep 34 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2929)
- "Children with omphalocele who develop appendicitis may have delayed diagnosis due to abnormal appendix location" — Jacob Langer (clinical) [Ep 34 · 49:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=2954)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not carefully identified" — Jacob Langer (clinical) [Ep 34 · 50:16](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-821?t=3016)
- "Fontan circulation is a profoundly prothrombotic state" — Joe (clinical) [Ep 6 · 1:01](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=61)
- "Thrombosis is a major cause of death in patients with Fontan's" — Joe (clinical) [Ep 6 · 1:10](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=70)
- "Many thrombotic events in Fontan patients are subclinical but clinically significant" — Joe (clinical) [Ep 6 · 1:10](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=70)
- "The prevalence of silent pulmonary embolism in adults with Fontan circulation may be as high as 1 in 5 (20%)" — Joe (epidemiological) [Ep 6 · 1:23](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=83)
- "In newer style Fontans, patients had an overall cumulative risk of 22% for thrombotic events" — Joe (epidemiological) [Ep 6 · 1:39](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=99)
- "The cumulative hazard risk of thrombotic events goes up over time in Fontan patients" — Joe (clinical) [Ep 6 · 2:19](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=139)
- "Over time, Fontan circulation becomes essentially a freight train of thrombogenicity" — Joe (opinion) [Ep 6 · 2:33](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=153)
- "Fontan thrombogenicity ranks with paroxysmal nocturnal hemoglobinuria, which carries 30-40% risk of thrombotic events over 5 years" — Joe (clinical) [Ep 6 · 2:47](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=167)
- "Fontan thrombogenicity compares to antiphospholipid antibody syndrome" — Joe (clinical) [Ep 6 · 3:00](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=180)
- "Fontan thrombogenicity compares to patients with unprovoked venous thromboembolism who have recurrence rates in the 20-30% range" — Joe (clinical) [Ep 6 · 3:05](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=185)
- "Relative hypoxia and loss of pulsatile flow in the venous system is very thrombogenic for endothelial cells" — Joe (clinical) [Ep 6 · 4:52](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=292)
- "Hypoxia and loss of pulsatile flow result in upregulation of tissue factor expression, the primary initiator of the clotting cascade" — Joe (clinical) [Ep 6 · 5:01](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=301)
- "Endothelial activation results in upregulation of adhesion molecules that activate inflammatory cells and increased excretion of factor 8 and von Willebrand factor" — Joe (clinical) [Ep 6 · 5:01](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=301)
- "PLE is a serious potential complication of Fontan circulation that results in increased inflammatory system activation" — Joe (clinical) [Ep 6 · 5:17](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=317)
- "The data overall support that warfarin is better thromboprophylaxis than aspirin in Fontan patients" — Joe (clinical) [Ep 6 · 6:05](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=365)
- "Reanalysis of Monagle's data showed warfarin with time in therapeutic range of 60% or better edged out aspirin over time" — Joe (clinical) [Ep 6 · 6:14](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=374)
- "Retrospective data from Cedric Manliot's group showed warfarin was clearly better than aspirin" — Joe (clinical) [Ep 6 · 6:39](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=399)
- "Both warfarin and aspirin were significantly better than no thromboprophylaxis" — Joe (clinical) [Ep 6 · 6:47](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=407)
- "Excellent time in therapeutic range above 80% is achievable with warfarin" — Joe (clinical) [Ep 6 · 7:05](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=425)
- "In patients with excellent time in therapeutic range (>80%), only one thrombotic event was observed over 53 patient years" — Joe (clinical) [Ep 6 · 7:14](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=434)
- "Excellent time in therapeutic range is achievable using a paternalistic approach with aggressive monitoring and phone follow-up" — Joe (clinical) [Ep 6 · 7:26](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=446)
- "With well managed anticoagulation, bleeding risk is around 2% per year" — Joe (clinical) [Ep 6 · 8:36](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=516)
- "Warfarin is very problematic from a pharmacokinetic standpoint" — Joe (clinical) [Ep 6 · 8:43](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=523)
- "Poorly managed warfarin may actually increase thrombotic risk" — Joe (clinical) [Ep 6 · 8:52](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=532)
- "Direct oral anticoagulants seem to be superior to warfarin in many ways but are completely unproven in Fontan patients" — Joe (clinical) [Ep 6 · 8:52](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=532)
- "Thrombotic risk in Fontan patients follows a bimodal incidence with initial post-surgical risk, honeymoon phase of variable duration, and then inexorable increase" — Joe (clinical) [Ep 6 · 9:24](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=564)
- "Elevated D-dimer is a strong marker of increased thrombotic risk" — Joe (clinical) [Ep 6 · 10:08](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=608)
- "Elevated factor 8 is a strong marker of increased thrombotic risk" — Joe (clinical) [Ep 6 · 10:17](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=617)
- "Factor 8 can be elevated genetically, as a marker of endothelial cell activation (made by endothelial cells), or as an acute phase reactant marking inflammation" — Joe (clinical) [Ep 6 · 10:25](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=625)
- "Factor 8 activity increases significantly post-Fontan" — Joe (clinical) [Ep 6 · 10:49](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=649)
- "In one study, the four patients with highest factor 8 levels ultimately developed thrombotic complications" — Joe (clinical) [Ep 6 · 10:49](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=649)
- "In post-Fontan patients, natural anticoagulants like antithrombin and protein C are often lower, consistent with liver synthetic dysfunction developing over time" — Joe (clinical) [Ep 6 · 11:10](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=670)
- "Post-Fontan patients have elevated prothrombin fragment 1.2, a sensitive and specific marker for prothrombin activation to thrombin" — Joe (clinical) [Ep 6 · 11:38](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=698)
- "Despite lower procoagulants from liver dysfunction, Fontan patients are not at bleeding risk but at thrombotic risk" — Joe (clinical) [Ep 6 · 11:59](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=719)
- "Fontan circulation, even in the context of liver dysfunction, shifts hemostatic balance toward a thrombophilic state" — Joe (clinical) [Ep 6 · 12:13](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=733)
- "Aspirin VerifyNow is an extremely reliable and reproducible test that the patient is taking aspirin and having an antiplatelet response" — Joe (clinical) [Ep 6 · 14:40](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=880)
- "Direct oral anticoagulants need to be studied in the Fontan population before determining how good or bad they are" — Joe (opinion) [Ep 6 · 15:26](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=926)
- "To use direct oral anticoagulants routinely in Fontan population, we need the ability to monitor them reliably" — Joe (opinion) [Ep 6 · 15:45](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=945)
- "Organ function can change very rapidly in patients with Fontan, necessitating monitoring capability for direct oral anticoagulants" — Joe (clinical) [Ep 6 · 16:00](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=960)
- "Direct oral anticoagulants are most likely better than poorly controlled warfarin" — Joe (opinion) [Ep 6 · 16:21](https://library.globalcastmd.com/watch/how-do-we-manage-thrombogenicity-and-thrombosis-in-the-fontan-new-horizons-886?t=981)
- "The presence of a congenital heart defect, especially Fontan, results in enormous emotional and financial strain on families with ongoing medical care and routine disruptions" — Stacey Morrison (clinical) [Ep 8 · 2:40](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=160)
- "Early life experiences and their impact resonate across a lifetime for Fontan patients and families" — Stacey Morrison (clinical) [Ep 8 · 3:14](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=194)
- "Children with complex CHD are at risk of neurological and cognitive impairment, and Fontan patients may be especially vulnerable" — Stacey Morrison (clinical) [Ep 8 · 3:24](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=204)
- "Fontan patients remain at risk for significant sequelae as adults and face unique life stressors that place them at increased risk for ongoing distress" — Stacey Morrison (clinical) [Ep 8 · 4:13](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=253)
- "Typical neurodevelopmental issues in Fontan patients include lower IQ, difficulty with math and language-based academic achievement" — Stacey Morrison (clinical) [Ep 8 · 4:32](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=272)
- "Impairments in language skills include expressive and receptive language as well as written expression, including organization and planning of expression" — Stacey Morrison (clinical) [Ep 8 · 4:53](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=293)
- "Executive functioning deficits include flexible attention shifting (distractibility and hyperfocus), poor planning, organization problems, and difficulty with time management" — Stacey Morrison (clinical) [Ep 8 · 5:06](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=306)
- "Executive functioning deficits seen early on play a significant role in ongoing development, progress in school, and transition to work life situations" — Stacey Morrison (clinical) [Ep 8 · 5:31](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=331)
- "Diminished fine and gross motor skills are common, with anecdotally high number of left-handed individuals observed" — Stacey Morrison (clinical) [Ep 8 · 5:44](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=344)
- "Working memory issues and slowed processing speed are commonly seen in Fontan patients" — Stacey Morrison (clinical) [Ep 8 · 5:44](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=344)
- "Approximately 1 in 3 adults with CHD in North America experience difficulty with depression and/or anxiety" — Stacey Morrison (epidemiological) [Ep 8 · 6:02](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=362)
- "Adolescents with single ventricle congenital heart disease have a 5-fold increase in rates of anxiety disorders and ADHD compared with healthy control peers" — Stacey Morrison (epidemiological) [Ep 8 · 6:13](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=373)
- "Adults with CHD may have significantly higher risk of PTSD than the general population" — Stacey Morrison (epidemiological) [Ep 8 · 6:29](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=389)
- "Chronic impact over time of disruption contributes to PTSD in CHD patients, as recognized in recent DSM revisions" — Stacey Morrison (clinical) [Ep 8 · 6:29](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=389)
- "Parents of CHD patients early on also show signs of PTSD" — Stacey Morrison (clinical) [Ep 8 · 6:50](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=410)
- "Mitigating psychosocial factors for adults include body image perceptions, perceived health status or disease severity, poor social support or social anxiety" — Stacey Morrison (clinical) [Ep 8 · 7:07](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=427)
- "High number of CHD patients have performance anxiety, tend to compare themselves and feel different than others, leading to difficulties in social situations" — Stacey Morrison (clinical) [Ep 8 · 7:27](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=447)
- "Communication skill deficits seen early on extend into adulthood, and most individuals lack awareness of how this impacts their self-adjustment, ability to interact with others, and coping skills" — Stacey Morrison (clinical) [Ep 8 · 7:39](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=459)
- "Perceived or real lack of independence, impulsivity, or poor problem solving are contributing psychosocial factors" — Stacey Morrison (clinical) [Ep 8 · 7:57](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=477)
- "Ongoing difficulty maintaining employment can occur for physical or psychological reasons and contributes to financial strain" — Stacey Morrison (clinical) [Ep 8 · 8:05](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=485)
- "Many patients with feeding difficulties early on require G-tube in early childhood, and extra medical requirements contribute to changes in parent-child interactions and family dynamics" — Stacey Morrison (clinical) [Ep 8 · 8:49](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=529)
- "Children and young adults who tend to be anxious do a good job with healthcare regimen and are hypervigilant about taking care of medications" — Stacey Morrison (clinical) [Ep 8 · 9:39](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=579)
- "Missing school days leads to loss of instruction time, piled-up assignments, and loss of social interaction and positive social experiences that contribute to sense of satisfaction and competency" — Stacey Morrison (clinical) [Ep 8 · 11:35](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=695)
- "The case patient's full scale IQ on WISC-5 was 82, falling in the low average range compared to other children her age" — Stacey Morrison (clinical) [Ep 8 · 14:24](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=864)
- "The case patient's verbal performance was in average range, nonverbal in low average range, with weakest areas being working memory and processing speed" — Stacey Morrison (clinical) [Ep 8 · 14:43](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=883)
- "The case patient's stronger academic areas were basic phonetic decoding, reading accuracy, sentence completion, spelling, and numerical sequencing (basic rote skills)" — Stacey Morrison (clinical) [Ep 8 · 14:59](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=899)
- "The case patient had difficulty with higher-level reading comprehension, reading fluency (reads slowly, must reread for understanding), math calculation and reasoning, and listening recall" — Stacey Morrison (clinical) [Ep 8 · 15:10](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=910)
- "The case patient met criteria for ADHD, predominantly inattentive presentation, not the hyperactive or impulsive components" — Stacey Morrison (clinical) [Ep 8 · 17:08](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1028)
- "The case patient had significant levels of anxiety and somatic or health-related complaints, with dysphoria and sense of inadequacy, best represented by diagnosis of generalized anxiety disorder" — Stacey Morrison (clinical) [Ep 8 · 17:17](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1037)
- "Assuming patients will have adjustment issues normalizes the conversation and gives credence to their challenges, making mental health support a basic part of care rather than selective intervention" — Stacey Morrison (opinion) [Ep 8 · 21:11](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1271)
- "Having conversations about mental health support very early with both patients and parents normalizes the need even from the parents' perspective" — Stacey Morrison (opinion) [Ep 8 · 21:48](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1308)
- "A solution-focused approach asking what is working taps into patient and family strengths" — Stacey Morrison (opinion) [Ep 8 · 22:12](https://library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1332)
- "The Fontan is a surgically created condition of severe chronic right heart failure with sequelae including venous hypertension, hepatic congestion, lymphatic congestion, restrictive lung disease, altered pulmonary vasculature, and single ventricle dysfunction" — Twaddle (clinical) [Ep 5 · 1:41](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=101)
- "Fontan takedown is generally done early, with indications being low cardiac output and elevated CVP, frequently resulting in a progressive downward spiral" — Twaddle (clinical) [Ep 5 · 2:45](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=165)
- "Bambino Gesù in Rome reported 18 Fontan takedowns over 25 years (1990-2015), with 2 in immediate postoperative period and 16 within 2 months of completion Fontan" — Twaddle (clinical) [Ep 5 · 4:03](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=243)
- "In the Bambino Gesù series, 17 were early survivors, 3 underwent subsequent successful Fontan palliation, 4 underwent transplantation with 2 late survivors, and 10 remained with bidirectional Glenn physiology at median 7-year follow-up" — Twaddle (clinical) [Ep 5 · 4:33](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=273)
- "European multi-institutional registry study (1971-2012) reported 38 Fontan takedowns with average time from Fontan to takedown of 0.6 years" — Twaddle (clinical) [Ep 5 · 5:10](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=310)
- "In the European registry, early mortality was approximately 25%, with 5 late deaths, 4 underwent heart transplantation with 2 deaths, 2 underwent subsequent Fontan, and 44% reached final endpoint by study conclusion" — Twaddle (clinical) [Ep 5 · 5:43](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=343)
- "Fontan conversion is primarily used for patients after atrial pulmonary Fontan with atrial arrhythmias" — Twaddle (clinical) [Ep 5 · 6:30](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=390)
- "Fontan conversion always involves large reduction of the atrium combined with maze operation or lesion set to prevent propagation of macro-reentrant circuits, which are the mechanism for most arrhythmias encountered" — Twaddle (clinical) [Ep 5 · 6:55](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=415)
- "The more complete the arrhythmia procedure (bi-atrial maze vs right atrial maze vs isthmal ablation), the lower the risk of arrhythmia recurrence" — Twaddle (clinical) [Ep 5 · 9:15](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=555)
- "Chicago group reported Fontan conversion mortality of 1.4%, while multi-center trials showed early mortality around 10%" — Twaddle (clinical) [Ep 5 · 9:53](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=593)
- "Conditional survival after Fontan conversion appears similar between European experience and Chicago, suggesting mortality difference is primarily due to patient selection and execution of operation" — Twaddle (opinion) [Ep 5 · 10:19](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=619)
- "Japanese study of 32 patients found that 7 patients who underwent prophylactic Fontan conversion without arrhythmias had no late deaths and were completely free from arrhythmias and protein-losing enteropathy" — Twaddle (clinical) [Ep 5 · 10:45](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=645)
- "Candidates for Fontan conversion require preserved ventricular function and preserved end organ function" — Twaddle (clinical) [Ep 5 · 12:07](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=727)
- "Contraindications to Fontan conversion include protein-losing enteropathy, older age (related to elevation of end-diastolic pressure), ascites, right or indeterminate ventricular morphology, and bi-atrial arrhythmia operation" — Twaddle (clinical) [Ep 5 · 12:15](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=735)
- "In Australia and New Zealand, the only type of Fontan performed since 2007 is extra-cardiac conduit, with atrial-pulmonary Fontans peaking in early 1990s and now decreasing" — Twaddle (epidemiological) [Ep 5 · 13:04](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=784)
- "All Fontan patients being considered for transplant will have concerning pulmonary artery anatomy" — Twaddle (clinical) [Ep 5 · 14:13](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=853)
- "Pulmonary arteries in Fontan patients have been at low pressure throughout life, can be very delicate and thin-walled, with many aorto-pulmonary collaterals creating surgical challenges" — Twaddle (clinical) [Ep 5 · 14:48](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=888)
- "Hilar pulmonary arteries in Fontan patients are very thin, frequently manipulated at previous surgery, may be deserosalized with adventitia removed, and are very prone to injury that can be challenging to repair" — Twaddle (clinical) [Ep 5 · 15:44](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=944)
- "Preferred strategy for pulmonary artery reconstruction during Fontan transplant is to perform this part of operation with circulatory arrest, manipulating only central pulmonary arteries" — Twaddle (opinion) [Ep 5 · 16:00](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=960)
- "Lymphatic circulation drains into central venous circulation, so venous hypertension results in lymphatic hypertension, leading to protein-losing enteropathy and plastic bronchitis" — Twaddle (clinical) [Ep 5 · 16:59](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1019)
- "Most lymphatic drainage from lower half of body and left half of trunk drains to junction of left internal jugular vein and innominate vein" — Twaddle (clinical) [Ep 5 · 17:17](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1037)
- "Doctor Hiroska published two case reports of innominate vein detachment from SVC and anastomosis to low-pressure atrium, with improvement in protein-losing enteropathy" — Twaddle (clinical) [Ep 5 · 17:55](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1075)
- "Christian Creutzer suggested creating second detachment of proximal innominate vein from left internal jugular and subclavian vein, then restructuring innominate vein using Gore-Tex tube graft to avoid right-to-left shunting and cyanosis" — Twaddle (clinical) [Ep 5 · 18:04](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1084)
- "The best hope for long-term survival probably rests with mechanical support and transplantation, requiring better understanding of support, sensitization, and immunosuppression" — Twaddle (opinion) [Ep 5 · 19:11](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1151)
- "In early Fontan failure scenario with good ventricular function, no pathway obstruction, and sinus rhythm, patient likely has elevation of end-diastolic pressure or increased pulmonary vascular resistance as cause of failure" — Twaddle (clinical) [Ep 5 · 20:56](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1256)
- "ECMO (VA or VV) is unlikely to fix elevated end-diastolic pressure or increased pulmonary vascular resistance and may make them worse" — Twaddle (clinical) [Ep 5 · 21:16](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1276)
- "Older patients who have been acyanotic, even if cardiac output is improved, will not do well if subjected to significant cyanosis that would be well tolerated in a small child" — Twaddle (clinical) [Ep 5 · 24:36](https://library.globalcastmd.com/watch/update-on-surgical-practice-and-current-state-on-fontan-conversion-surgery-889?t=1476)
- "Macro-reentrant atrial tachycardia in Fontan patients was ubiquitous out to 20 years in early Boston data" — Rick Choi (epidemiological) [Ep 9 · 1:45](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=105)
- "After first atrial tachycardia and cardioversion, risk of future tachycardia is upwards of 80 or 90%" — Rick Choi (epidemiological) [Ep 9 · 2:13](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=133)
- "Risk of recurrent tachycardia is the same for all Fontan types once tachycardia has occurred" — Rick Choi (clinical) [Ep 9 · 2:29](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=149)
- "Anti-arrhythmic medications alone result in essentially 100% recurrence of tachycardia over 5-6 years" — Rick Choi (clinical) [Ep 9 · 2:40](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=160)
- "Lateral tunnel Fontans have had significantly less incidence of atrial arrhythmias compared to atrial-pulmonary Fontans" — Rick Choi (epidemiological) [Ep 9 · 4:27](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=267)
- "Evidence on difference between extracardiac and intracardiac conduit arrhythmia incidence is discrepant, with some showing significant improvement for extracardiac" — Rick Choi (epidemiological) [Ep 9 · 4:45](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=285)
- "In Boston series of 90 Fontan ablation patients, over half required trans-baffle procedure with 10% moderate or severe complications" — Rick Choi (clinical) [Ep 9 · 6:11](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=371)
- "Catastrophic complications including death and major shunts with cyanosis occurred in the trans-baffle procedure group" — Rick Choi (clinical) [Ep 9 · 6:30](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=390)
- "In 52 Fontan ablation patients, 80 different arrhythmia mechanisms were identified, with majority having more than one mechanism" — Rick Choi (clinical) [Ep 9 · 7:52](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=472)
- "Macro-reentrant tachycardia was less than half of ablation targets, with focal atrial tachycardia and AVNRT being important mechanisms" — Rick Choi (clinical) [Ep 9 · 8:05](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=485)
- "Atrial fibrillation as an isolated phenomenon in Fontan patients is relatively rare" — Rick Choi (epidemiological) [Ep 9 · 8:23](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=503)
- "Ed Walsh identified atrial tachycardia as a risk factor for sudden death in Fontan patients" — Rick Choi (clinical) [Ep 9 · 10:18](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=618)
- "Fontans with arrhythmias have worse outcomes than Fontans without arrhythmias in terms of freedom from death or transplant" — Rick Choi (epidemiological) [Ep 9 · 10:38](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=638)
- "Arrhythmia is a significant predictor in Fontan risk stratification models" — Rick Choi (clinical) [Ep 9 · 10:52](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=652)
- "In Mayo series of 260 Fontan patients, almost all had recurrence of atrial tachycardia regardless of management strategy" — Rick Choi (epidemiological) [Ep 9 · 11:27](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=687)
- "Catheter ablation in Fontan patients achieved 40-50% freedom from recurrence, compared to near-zero for anti-arrhythmics alone" — Rick Choi (clinical) [Ep 9 · 11:56](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=716)
- "Patients with Fontan ablation showed significant improvement in clinical arrhythmia severity scores even when recurrence occurred" — Rick Choi (clinical) [Ep 9 · 12:22](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=742)
- "Fontan conversion with arrhythmia surgery achieves approximately 50-60% success rate, not substantially different from catheter ablation alone" — Rick Choi (clinical) [Ep 9 · 13:12](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=792)
- "Surgical isthmus ablation only strategy had worse outcomes than more aggressive surgical strategies" — Rick Choi (clinical) [Ep 9 · 16:06](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=966)
- "More aggressive surgical ablation strategies carry risk of sinus node dysfunction" — Rick Choi (clinical) [Ep 9 · 16:16](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=976)
- "In older atrial-pulmonary Fontan patients, two-thirds of the atrial tissue is essentially scar with no electrical activity" — Rick Choi (clinical) [Ep 9 · 16:50](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=1010)
- "Early ablation procedures in Fontan patients are easier with one or two circuits, while delayed procedures become more complex with 5-6 circuits" — Rick Choi (opinion) [Ep 9 · 19:01](https://library.globalcastmd.com/watch/the-role-of-trans-catheter-arrhythmia-management-patient-based-decision-890?t=1141)
- "Fontan-associated plastic bronchitis occurs in less than 2% of patients with Fontan circulation" — Brian (epidemiological) [Ep 14 · 1:56](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=116)
- "Plastic bronchitis is characterized by proteinaceous lymphatic effluent into the tracheobronchial tree where connections exist between lymphatic circulation and airway" — Brian (clinical) [Ep 14 · 2:01](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=121)
- "With evaporation of water content through breathing, characteristic fibrinous airway casts remain and may be expectorated in whole or in part" — Brian (clinical) [Ep 14 · 2:09](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=129)
- "The incidence of fenestration thrombosis or stenosis early after procedure and in short to mid-term follow-up is very high with bare metal stents" — Brian (clinical) [Ep 14 · 5:16](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=316)
- "Bare metal stent thrombosis is presumably from tissue invagination through stent cells and tissue factor exposure to blood, even on anticoagulation" — Brian (clinical) [Ep 14 · 5:16](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=316)
- "A resting absence of gradient does not rule out the presence of hemodynamically meaningful obstruction" — Brian (clinical) [Ep 14 · 7:13](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=433)
- "Left innominate vein obstruction is nearby to where the thoracic duct inserts and all lymphatic circulation returns to systemic circulation" — Brian (clinical) [Ep 14 · 8:37](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=517)
- "Left innominate vein obstruction can create opportunity for plastic bronchitis or protein-losing enteropathy, diagnoses associated with very adverse clinical outcomes" — Brian (clinical) [Ep 14 · 8:37](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=517)
- "Plastic bronchitis and protein-losing enteropathy have been shown increasingly, especially by the Philadelphia group, to be associated with lymphatic pathology" — Brian (clinical) [Ep 14 · 8:37](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=517)
- "Secondary palliations (palliation of a palliation, the Fontan circuit) have limitations and may not offer cure or substantial benefits" — Brian (opinion) [Ep 14 · 9:47](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=587)
- "Sometimes the hypothesis of benefit from intervention cannot be tested until the intervention is actually performed" — Brian (opinion) [Ep 14 · 9:55](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=595)
- "Stent in conduit equals thrombogenic behavior substrate" — Brian (clinical) [Ep 14 · 12:59](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=779)
- "Fluid challenge protocol involves giving 15 cc/kg with no volume limit rapidly via central access in about 2 minutes, then 5 minutes to equilibrate before repeat hemodynamic measurements" — Brian (clinical) [Ep 14 · 13:59](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=839)
- "Fluid challenge is not performed if baseline EDP is greater than 15 (overt diastolic dysfunction)" — Brian (guideline) [Ep 14 · 14:19](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=859)
- "Fluid challenge is not performed if baseline Fontan pressure is greater than 18 or if patient has repeated hospitalizations with heart failure requiring volume removal" — Brian (guideline) [Ep 14 · 14:30](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=870)
- "Gore-Tex tubes can be safely taken to at least 110% of their nominal diameter" — Brian (clinical) [Ep 14 · 15:23](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=923)
- "The stiffness constant of Gore-Tex is very high and sufficient pressure cannot be generated in the balloon to stretch Gore-Tex much more than about 110%" (clinical) [Ep 14 · 16:08](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=968)
- "Extracardiac conduits are three-dimensional structures that are not circular; if a 22mm tube measures 17mm in frontal plane, it often measures 25mm in lateral plane" — Brian (clinical) [Ep 14 · 17:01](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=1021)
- "A non-circular shape of extracardiac conduit with adequate cross-sectional area does not require treatment; there must be a true stenosis" — Brian (clinical) [Ep 14 · 17:17](https://library.globalcastmd.com/watch/trans-catheter-interventions-new-horizons-in-medical-and-surgical-fontan-893?t=1037)
- "Early Fontan failure risk factors for poor transplant outcomes include mechanical ventilation at listing, younger age (0-4 years), status 1 listing, and shorter time interval from Fontan (<6 months)." — Andrew Lotz (clinical) [Ep 10 · 3:08](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=188)
- "If the right Fontan patients are selected, they do just as well as dilated cardiomyopathy patients post-heart transplant." — Andrew Lotz (clinical) [Ep 10 · 4:57](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=297)
- "Protein-losing enteropathy accrues risk factors over time: edema, low albumin, poor nutrition, electrolyte disturbances, low IgG with increased infections, malnutrition, and prothrombotic state." — Andrew Lotz (clinical) [Ep 10 · 5:55](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=355)
- "PLE survival is approximately 50% at 5 years after diagnosis (Mertens Luke 1998 study)." — Andrew Lotz (epidemiological) [Ep 10 · 7:06](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=426)
- "More recent data (2014) shows 85% survival at 5 years after PLE diagnosis." — Andrew Lotz (epidemiological) [Ep 10 · 7:26](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=446)
- "Plastic bronchitis has 50% freedom from death or transplant at 5 years (Schumacher, Michigan data)." — Andrew Lotz (epidemiological) [Ep 10 · 8:01](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=481)
- "Patients with plastic bronchitis do very well post-transplant." — Andrew Lotz (clinical) [Ep 10 · 8:17](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=497)
- "Fontan transplant survival is approximately 80% at 1 year and 75% at 5 years, compared to 92% and 86% for all pediatric transplants." — Andrew Lotz (epidemiological) [Ep 10 · 8:53](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=533)
- "Fontan patients have higher waitlist time and mortality compared to dilated cardiomyopathy patients." — Andrew Lotz (clinical) [Ep 10 · 9:53](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=593)
- "Standard listing criteria underestimate the degree of illness in Fontan patients." — Andrew Lotz (opinion) [Ep 10 · 10:07](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=607)
- "Fontan patients have increased risk for early graft failure post-transplant." — Andrew Lotz (clinical) [Ep 10 · 10:11](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=611)
- "Death from sepsis is more common in Fontan transplant recipients." — Andrew Lotz (clinical) [Ep 10 · 10:17](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=617)
- "Bleeding is more common in Fontan transplant recipients because they are multiple-time redo surgeries." — Andrew Lotz (clinical) [Ep 10 · 10:20](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=620)
- "PLE resolves in survivors post-transplant." — Andrew Lotz (clinical) [Ep 10 · 10:28](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=628)
- "Plastic bronchitis resolves in survivors post-transplant." — Andrew Lotz (clinical) [Ep 10 · 10:28](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=628)
- "Under recent pediatric allocation system changes, congenital patients on one drip must be in the hospital to be status 1A; Fontan patients with PLE or plastic bronchitis not on drips will be status 2." — Andrew Lotz (guideline) [Ep 10 · 11:06](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=666)
- "Patients can no longer go home on low-level dopamine or milrinone and remain status 1A under the new allocation system." — Andrew Lotz (guideline) [Ep 10 · 11:20](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=680)
- "For urgent VAD placement in Fontan patients, continuous-flow short-term devices (CentriMag, Rotaflow) are used to support for weeks to months until transplantation." — Andrew Lotz (clinical) [Ep 10 · 13:04](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=784)
- "Berlin Heart is available for small children, but most Fontan patients are larger and receive HVAD." — Andrew Lotz (clinical) [Ep 10 · 13:42](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=822)
- "HVAD can be safely placed in single-ventricle patients ≥25 kg; some institutions push down to 15 kg." — Andrew Lotz (clinical) [Ep 10 · 13:52](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=832)
- "Continuous-flow VADs work very well in single-ventricle physiology compared to Berlin Heart data." — Andrew Lotz (opinion) [Ep 10 · 13:58](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=838)
- "SynCardia total artificial heart is an option for patients ≥35 kg." — Andrew Lotz (clinical) [Ep 10 · 14:15](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=855)
- "There is limited multi-center published data for VADs in single-ventricle patients." — Andrew Lotz (epidemiological) [Ep 10 · 14:37](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=877)
- "In the Berlin Heart registry, only 5 stage 3 (Fontan) patients were supported, with 3 survivors; support durations were 1 day, 3 days, and 229 days." — Andrew Lotz (epidemiological) [Ep 10 · 14:51](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=891)
- "The Intermacs registry includes only 17 single-ventricle patients, and the devices used are not clearly specified." — Andrew Lotz (epidemiological) [Ep 10 · 15:16](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=916)
- "If a patient does not need respiratory support, supporting an organ that doesn't need support should be avoided (rationale against ECMO in this case)." — Andrew Lotz (opinion) [Ep 10 · 16:03](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=963)
- "Only 2 SynCardia devices have been placed in single-ventricle patients in the US." — Andrew Lotz (epidemiological) [Ep 10 · 17:44](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1064)
- "SynCardia placement in single-ventricle patients requires dealing with the two AV valves, such as building a compliant chamber." — Andrew Lotz (clinical) [Ep 10 · 17:52](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1072)
- "A smaller 50 cc SynCardia device is now available for smaller Fontan patients." — Andrew Lotz (clinical) [Ep 10 · 18:07](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1087)
- "Among adults listed as status 2, only 30-40% get transplanted within one year." — Andrew Lotz (epidemiological) [Ep 10 · 18:25](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1105)
- "Among congenital heart disease patients on medical therapy (status 2), one-third would be transplanted at 1 year." — Andrew Lotz (epidemiological) [Ep 10 · 18:37](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1117)
- "There are only about 20 Fontan patients in all of Intermacs and Pedimacs (the two VAD registries)." — Andrew Lotz (epidemiological) [Ep 10 · 21:46](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1306)
- "A handful of Fontan patients have been successfully supported with atrial cannulation." — Andrew Lotz (clinical) [Ep 10 · 22:22](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1342)
- "In restrictive cardiomyopathy, atrial cannulation does not perform as well as ventricular cannulation based on Berlin Heart data." — Andrew Lotz (clinical) [Ep 10 · 22:31](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1351)
- "Atrial cannulation allows flow into the VAD where a restrictive or small-cavitied ventricle sometimes clamps around the cannula and does not allow flow." — Andrew Lotz (clinical) [Ep 10 · 22:47](https://library.globalcastmd.com/watch/transplantation-and-ventricular-assist-devices-new-horizons-in-medical-and-891?t=1367)
- "T1 mapping shows higher myocardial fibrosis content in Fontan patients compared to normal controls, and significantly higher in those with systemic right ventricles" — Andrew Crean (clinical) [Ep 15 · 1:51](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=111)
- "For most adult Fontan patients, ventricular function is either moderately or severely dysfunctional but does not change very much over years" — Andrew Crean (clinical) [Ep 15 · 2:37](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=157)
- "Embolic complications in Fontan patients occur roughly once per year in their center" — Andrew Crean (epidemiological) [Ep 15 · 3:57](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=237)
- "Timing is everything in imaging of the Fontan circulation, and usually imaging is done too quickly" — Andrew Crean (clinical) [Ep 15 · 6:07](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=367)
- "Radiologists imaging the chest want to image in the pulmonary arterial phase, particularly when asked about pulmonary emboli, which can lead to false-positive thrombus diagnoses in the IVC portion" — Andrew Crean (clinical) [Ep 15 · 7:07](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=427)
- "In large atriopulmonary Fontans, complete opacification can take up to 7 minutes" — Andrew Crean (clinical) [Ep 15 · 8:02](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=482)
- "Late gadolinium enhancement imaging at 10 minutes post-contrast can definitively identify thrombus in Fontan circuits" — Andrew Crean (clinical) [Ep 15 · 10:16](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=616)
- "Both CT and MRI are exquisitely good at detecting thrombus, and CT allows easy volumetric measurement to track response to anticoagulation" — Andrew Crean (clinical) [Ep 15 · 10:40](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=640)
- "Resolution of Glenn shunt thrombus with TPA correlated with normalization of albumin levels, suggesting a link between venous obstruction and protein loss" — Andrew Crean (clinical) [Ep 15 · 12:27](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=747)
- "Fontan patients desaturating in the mid-80s without open fenestrations are unusual and warrant investigation" — Andrew Crean (clinical) [Ep 15 · 13:21](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=801)
- "Veno-venous collaterals and arteriovenous malformations are easily seen by CT or MRI angiography but very difficult to detect in any other way" — Andrew Crean (clinical) [Ep 15 · 14:06](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=846)
- "The spatial resolution of cardiac CT is at worst 0.5 millimeters isotropic" — Andrew Crean (clinical) [Ep 15 · 20:53](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1253)
- "Patients presenting with heart failure phenotype and edema do not necessarily have pump failure; there may be anatomic causes such as conduit stenosis" — Andrew Crean (clinical) [Ep 15 · 16:05](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=965)
- "Plastic bronchitis has not been seen in adult Fontan patients in 10 years at the speaker's center" — Andrew Crean (epidemiological) [Ep 15 · 17:24](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1044)
- "Transesophageal echo is inadequate for thrombus detection in adult Fontan circuits, with equal numbers of false positives and false negatives" — Andrew Crean (opinion) [Ep 15 · 18:13](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1093)
- "For lateral tunnel or extracardiac conduit Fontans, thrombus can be ruled out without TEE 99% of the time" — Andrew Crean (opinion) [Ep 15 · 19:34](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1174)
- "Most thrombus detection problems with TEE occur with atriopulmonary Fontans" — Andrew Crean (clinical) [Ep 15 · 19:43](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1183)
- "Cardiac CT can be obtained within about 1 hour, which is more practical than organizing CCU space for TEE in a sick Fontan patient" — Andrew Crean (opinion) [Ep 15 · 20:13](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1213)
- "In 10 years of using CT instead of TEE for pre-cardioversion thrombus assessment, no strokes have been seen" — Andrew Crean (epidemiological) [Ep 15 · 21:42](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1302)
- "CT allows post-acquisition reconstruction from any angle to follow pectinate muscles and distinguish them from thrombus" — Andrew Crean (clinical) [Ep 15 · 22:33](https://library.globalcastmd.com/watch/advanced-imaging-of-the-fontan-what-is-driving-fontan-failure-new-horizons-892?t=1353)
- "In all reproductive age females presenting with lower abdominal pain, pregnancy testing is mandatory regardless of sexual activity history" — Jennifer Dietrich (guideline) [Ep 16 · 2:02](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=122)
- "Complete absence of blood flow on ultrasound is the most concerning finding and is more reliable than presence of blood flow" — Jennifer Dietrich (clinical) [Ep 16 · 4:33](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=273)
- "Presence of blood flow on ultrasound is less reliable and does not exclude torsion because it could represent a torsed tube with preserved ovarian flow" — Jennifer Dietrich (clinical) [Ep 16 · 4:42](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=282)
- "Intermittent torsion can occur where the ovary twists and untwists, showing normal flow at the time of ultrasound" — Jennifer Dietrich (clinical) [Ep 16 · 6:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=374)
- "When ovary is edematous from torsion, follicles become peripheralized to the ovarian periphery due to vascular congestion in the central ovary" — Jennifer Dietrich (clinical) [Ep 16 · 7:15](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=435)
- "Cysts 5-6 centimeters or larger increase suspicion for torsion in the setting of symptoms because they make the ovary and tube heavy enough to twist" — Jennifer Dietrich (clinical) [Ep 16 · 8:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=530)
- "In prepubertal girls, normal ovaries can torse and torsion is the most common reason for gynecologic surgery in this age group" — Jennifer Dietrich (epidemiological) [Ep 16 · 9:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=571)
- "There is no specific size cutoff for torsion risk; prepubertal ovaries may be only 1-1.5 cm but can still torse" — Jennifer Dietrich (clinical) [Ep 16 · 10:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=619)
- "Complex ultrasound features (partly cystic, partly solid) with hypervascular flow on Doppler raise concern for malignancy" — Jennifer Dietrich (clinical) [Ep 16 · 11:39](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=699)
- "Tumor markers for pediatric ovarian masses include alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125" — Jennifer Dietrich (guideline) [Ep 16 · 15:06](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=906)
- "Salvage rates are higher within the first 24-72 hours of pain onset compared to patients presenting after one week" — Jennifer Dietrich (clinical) [Ep 16 · 17:26](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1046)
- "It is impossible to predict which patients have loose versus tight torsion, and tight torsion can develop ischemia quickly" — Jennifer Dietrich (clinical) [Ep 16 · 17:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1072)
- "Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings" — Jennifer Dietrich (guideline) [Ep 16 · 18:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1127)
- "Patients with equivocal presentation can be observed in hospital for a few hours to see if they declare themselves, but should not be sent home" — Jennifer Dietrich (guideline) [Ep 16 · 18:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1136)
- "Classic torsion presentation includes acute onset pain after physical activity (gymnastics, cartwheels), persistent pain unresponsive to over-the-counter measures, with nausea and vomiting" — Jennifer Dietrich (clinical) [Ep 16 · 19:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1192)
- "Hemorrhagic ovarian cysts are more likely in menstruating females, and menstrual history helps distinguish from torsion" — Jennifer Dietrich (clinical) [Ep 16 · 21:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1282)
- "For hemorrhagic cysts, Doppler shows no flow within the cyst itself but preserved peripheral flow around the cyst" — Jennifer Dietrich (clinical) [Ep 16 · 22:16](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1336)
- "Surgical management includes detorsion and removal of causative lesions (ovarian or paratubal cysts) to eliminate the weight that caused torsion" — Jennifer Dietrich (guideline) [Ep 16 · 22:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1371)
- "Oophorectomy and salpingo-oophorectomy should be avoided at all times; attempt salvage even of purple, black and blue ovaries" — Jennifer Dietrich (guideline) [Ep 16 · 23:16](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1396)
- "Cystectomy rather than simple drainage is performed for non-functional cysts to prevent recurrence, particularly important for paratubal cysts" — Jennifer Dietrich (guideline) [Ep 16 · 24:01](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1441)
- "For hemorrhagic cysts, if the entire cyst wall is not removed, the cyst may continue to bleed" — Jennifer Dietrich (clinical) [Ep 16 · 25:21](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1521)
- "Even necrotic-appearing ovaries should be salvaged unless the tissue is literally falling apart during detorsion" — Jennifer Dietrich (guideline) [Ep 16 · 26:20](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1580)
- "Follow-up studies show return of ovarian function and follicle development even after salvage of necrotic-appearing ovaries, sometimes taking a few months" — Jennifer Dietrich (clinical) [Ep 16 · 26:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1607)
- "Ovarian bivalving involves making an incision into the ovarian cortex after detorsion to release compartment syndrome-like pressure and improve peripheral blood supply" — Jennifer Dietrich (clinical) [Ep 16 · 28:02](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1682)
- "Bivalving is indicated when the ovary remains edematous after detorsion, particularly in normal ovaries without a lesion to remove" — Jennifer Dietrich (guideline) [Ep 16 · 28:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1728)
- "Ovarian debulking via biopsy may be needed if bivalving alone does not adequately decompress a bulky ovary at risk for re-torsion" — Jennifer Dietrich (clinical) [Ep 16 · 29:23](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1763)
- "Oophoropexy is considered in patients who have lost one ovary and present with torsion of the remaining ovary, or in recurrent torsion cases" — Jennifer Dietrich (guideline) [Ep 16 · 30:53](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1853)
- "Oophoropexy changes the position of the ovary which may affect future fertility, but preserving the ovary is better than losing it" — Jennifer Dietrich (opinion) [Ep 16 · 31:18](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1878)
- "Absorbable suture can be used for oophoropexy to hold the adnexa still for 4-6 weeks during inflammation resolution, minimizing near-term re-torsion risk" — Jennifer Dietrich (clinical) [Ep 16 · 31:54](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1914)
- "Clipping the utero-ovarian ligament does not prevent torsion because the ovary can still twist on either the utero-ovarian or infundibulopelvic ligament" — Jennifer Dietrich (clinical) [Ep 16 · 32:37](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1957)
- "Oophoropexy techniques include shortening the utero-ovarian ligament, pexing to the pelvic sidewall (away from ureters), or pexing to the posterior uterus" — Jennifer Dietrich (clinical) [Ep 16 · 33:10](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=1990)
- "For tubal-ovarian abscess, antibiotics should be started and surgical intervention avoided unless the patient is clinically unstable, to prevent spreading infection" — Jennifer Dietrich (guideline) [Ep 16 · 35:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2114)
- "Ectopic pregnancy can present similarly to ovarian torsion with acute pain and adnexal mass, and may not be visible on transabdominal ultrasound in early pregnancy" — Jennifer Dietrich (clinical) [Ep 16 · 35:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2157)
- "Ectopic pregnancy is managed with salpingostomy (longitudinal incision in the tube) to remove the pregnancy; the tube is not sutured closed as it heals well without sutures" — Jennifer Dietrich (clinical) [Ep 16 · 38:37](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2317)
- "Adolescent endometriosis presents with early lesions that are clear or red rather than the classic blue/black lesions seen in adults" — Jennifer Dietrich (clinical) [Ep 16 · 39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2397)
- "Clear endometriosis lesions can be visualized by filling the pelvis with crystalloid and examining underwater with the camera" — Jennifer Dietrich (clinical) [Ep 16 · 40:55](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2455)
- "Endometriosis lesions near the ureter or bowel should be excised with cold scissors rather than cauterized" — Jennifer Dietrich (guideline) [Ep 16 · 41:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2512)
- "Patients meeting postoperative milestones can be discharged within a few hours after laparoscopic surgery for torsion" — Jennifer Dietrich (guideline) [Ep 16 · 42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2542)
- "Activity should be limited for 4-6 weeks postoperatively to allow incision healing and avoid hernia formation" — Jennifer Dietrich (guideline) [Ep 16 · 42:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2577)
- "Oral contraceptives can prevent recurrence if torsion was caused by a functional cyst, but do not prevent torsion from dermoid or paratubal cysts" — Jennifer Dietrich (clinical) [Ep 16 · 43:35](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2615)
- "Surveillance ultrasound is performed at 3 months post-surgery as it takes several months for inflammation to resolve, then repeated at 3-6 months if recovery is ongoing, then annually" — Jennifer Dietrich (guideline) [Ep 16 · 44:32](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-949?t=2672)
- "The frequency and incidence of abdominal wall defects appears to be increasing" (epidemiological) [Ep 22 · 0:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=0)
- "Most gastroschisis patients don't have any other associated anomalies and it's rare to have abnormal chromosomes" — Jacob Langer (clinical) [Ep 22 · 4:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=286)
- "Early papers showed benefit to cesarean section for gastroschisis, but those cesarean sections were usually done early at 36-37 weeks, raising the question of whether timing rather than mode of delivery gave the benefit" — Jacob Langer (clinical) [Ep 22 · 5:46](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=346)
- "Many studies have failed to show an advantage to cesarean section for gastroschisis and most people nowadays would not do routine cesarean section" — Jacob Langer (clinical) [Ep 22 · 6:13](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=373)
- "There has not been any large randomized trial looking specifically at the issue of early delivery for gastroschisis" — Jacob Langer (clinical) [Ep 22 · 6:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=389)
- "Toronto delivers gastroschisis patients at around 37 weeks unless they've already gone into spontaneous labor" — Jacob Langer (clinical) [Ep 22 · 6:58](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=418)
- "The mean gestational age of onset of labor is earlier in gastroschisis pregnancies, possibly because of inflammatory mediators produced by inflamed bowel" — Jacob Langer (clinical) [Ep 22 · 7:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=427)
- "Labor can usually be successfully induced at 37 weeks in gastroschisis pregnancies, unlike regular pregnancies" — Jacob Langer (clinical) [Ep 22 · 7:41](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=461)
- "Most evidence suggests that delivery in a perinatal center is beneficial for gastroschisis" — Jacob Langer (clinical) [Ep 22 · 8:36](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=516)
- "During transport, gastroschisis babies should be nursed on their side, usually right side down, to prevent kinking of the mesentery and bowel ischemia" — Jacob Langer (clinical) [Ep 22 · 10:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=601)
- "Bedside closure is the first choice for gastroschisis if the bowel is not too thickened and there's not too much peel" — Jacob Langer (opinion) [Ep 22 · 10:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=657)
- "Adrian Bianchi first described bedside closure for gastroschisis" — Jacob Langer (clinical) [Ep 22 · 11:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=681)
- "Using forceps at the bedside to push bowel back in can damage the bowel in a squiggling baby" — Jacob Langer (clinical) [Ep 22 · 11:29](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=689)
- "Intra-abdominal pressure should be kept below 20 mmHg during gastroschisis reduction" — Jacob Langer (clinical) [Ep 22 · 12:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=734)
- "The sutureless closure technique using the umbilical cord stump to cover the defect is based on Anthony Sandler's experience, who trained in Toronto" — Jacob Langer (clinical) [Ep 22 · 13:40](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=820)
- "A study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair" — Todd Ponsky (clinical) [Ep 22 · 14:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=859)
- "Spring-loaded silos create outward pressure as you push down, making the defect larger over time" — Todd Ponsky (clinical) [Ep 22 · 18:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1090)
- "The incidence of intestinal atresia in gastroschisis is between 5 and 10%" — Jacob Langer (epidemiological) [Ep 22 · 18:51](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1131)
- "There are two types of intestinal atresia in gastroschisis: early-onset atresia with dilated but not thick-walled bowel, and late atresia from progressive constriction causing ischemia" — Jacob Langer (clinical) [Ep 22 · 19:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1141)
- "Vanishing gastroschisis occurs when the abdominal wall defect becomes very small and the majority of small bowel becomes necrotic and disappears" — Jacob Langer (clinical) [Ep 22 · 19:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1174)
- "The prognosis for short bowel syndrome has improved dramatically over the last 10-15 years due to intestinal failure centers, better TPN that doesn't damage the liver, and control of sepsis" — Jacob Langer (clinical) [Ep 22 · 20:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1215)
- "Three management options for atresia in gastroschisis: repair at time of closure, bring out stomas, or reduce everything and repair atresia later" — Jacob Langer (clinical) [Ep 22 · 20:54](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1254)
- "There is no good evidence for management of atresia in gastroschisis because it's rare, so treatment should be individualized" — Jacob Langer (opinion) [Ep 22 · 21:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1275)
- "The umbilicus is the preferred site for neonatal stomas because it leaves a scar that would have been there anyway and is convenient for appliance placement" — Jacob Langer (opinion) [Ep 22 · 22:50](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1370)
- "Neonatal stomas prolapse no matter where they are placed" — Jacob Langer (clinical) [Ep 22 · 23:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1380)
- "Three weeks is average time to bowel function in gastroschisis, so investigations typically aren't started until 4 weeks" — Jacob Langer (clinical) [Ep 22 · 24:27](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1467)
- "Metoclopramide can be given intravenously, which is advantageous over oral prokinetics in patients with motility problems" — Jacob Langer (clinical) [Ep 22 · 25:17](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1517)
- "A randomized prospective trial is underway to determine if intravenous metoclopramide can shorten the period of hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 22 · 25:37](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1537)
- "Contrast enema and upper GI studies at 4 weeks may not give clear answers about mechanical obstruction versus hypomotility in gastroschisis" — Jacob Langer (clinical) [Ep 22 · 25:57](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1557)
- "Laparotomy for persistent ileus in gastroschisis is usually performed around 6 weeks if the patient hasn't opened up" — Jacob Langer (clinical) [Ep 22 · 26:44](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1604)
- "Going in too early for persistent ileus in gastroschisis is a mistake" — Jacob Langer (opinion) [Ep 22 · 27:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1641)
- "The exteriorized testis in gastroschisis is usually the right testis" — Jacob Langer (clinical) [Ep 22 · 28:00](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1680)
- "In about half of gastroschisis cases with exteriorized testis, the testis finds its way down into the scrotum after reduction" — Jacob Langer (clinical) [Ep 22 · 28:18](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1698)
- "Omphalocele has a much higher incidence of associated anomalies and chromosomal abnormalities compared to gastroschisis" — Jacob Langer (clinical) [Ep 22 · 28:38](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1718)
- "Small omphaloceles without liver are more likely to be associated with abnormal chromosomes than large omphaloceles" — Jacob Langer (clinical) [Ep 22 · 29:47](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1787)
- "There is no rationale for routine cesarean section, delivery at a perinatal center, or preterm delivery for small omphaloceles" — Jacob Langer (clinical) [Ep 22 · 30:05](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1805)
- "Most surgeons recommend cesarean section for giant omphaloceles, although this is not evidence-based" — Jacob Langer (opinion) [Ep 22 · 31:21](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1881)
- "Pulmonary hypoplasia is associated with giant omphaloceles and is very difficult to diagnose prenatally" — Jacob Langer (clinical) [Ep 22 · 31:55](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1915)
- "Intra-abdominal pressure monitoring is very helpful in omphalocele reduction, with a target pressure below 20 mmHg" — Jacob Langer (clinical) [Ep 22 · 33:14](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=1994)
- "Stuart Lacy established the pressure guideline of 20 mmHg in the 1980s based on rabbit studies and then prospectively validated it in children with abdominal wall defects" — Jacob Langer (clinical) [Ep 22 · 33:28](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2008)
- "The Montreal group first described using the omphalocele sac as a silo with sequential ligation" — Jacob Langer (clinical) [Ep 22 · 35:07](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2107)
- "Using Duoderm to gradually reduce omphalocele appears to achieve reduction more quickly than sac ligation" — Jacob Langer (clinical) [Ep 22 · 37:34](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2254)
- "Indications for escharotic therapy in omphalocele include prematurity, bad cardiac disease, pulmonary hypoplasia, multiple anomalies, abnormal chromosomes, or giant size" — Jacob Langer (clinical) [Ep 22 · 38:12](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2292)
- "Mushroom-shaped omphaloceles with small abdominal wall defects but large external contents will never reduce spontaneously" — Jacob Langer (clinical) [Ep 22 · 41:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2470)
- "For mushroom-shaped omphaloceles, enlarging the abdominal wall defect as a first step can allow more spontaneous reduction before definitive repair" — Jacob Langer (clinical) [Ep 22 · 41:19](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2479)
- "Component separation in pediatric patients is controversial, with concerns about devascularization and worsening the situation" — Jacob Langer (opinion) [Ep 22 · 43:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2586)
- "In omphalocele repair, the defect often extends to the costal margin where closure is impossible, requiring patch placement in the upper portion" — Jacob Langer (clinical) [Ep 22 · 43:35](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2615)
- "Surgisis patch fails about 50% of the time in omphalocele repair, requiring replacement with non-absorbable mesh" — Jacob Langer (clinical) [Ep 22 · 44:01](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2641)
- "Pentalogy of Cantrell may include missing pericardium or Morgagni hernia associated with omphalocele" — Jacob Langer (clinical) [Ep 22 · 44:52](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2692)
- "Reflux is very common in omphalocele patients, especially those with cardiac disease or pulmonary hypoplasia" — Jacob Langer (clinical) [Ep 22 · 46:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2768)
- "GJ tubes placed by interventional radiology lateral to the omphalocele defect allow feeding despite severe reflux" — Jacob Langer (clinical) [Ep 22 · 46:30](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2790)
- "Fundoplication in a child with a large omphalocele defect is extremely difficult because the midline liver makes hiatus access almost impossible" — Jacob Langer (clinical) [Ep 22 · 47:15](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2835)
- "In omphalocele babies, the midline liver can put pressure on the duodenum or pylorus, causing mechanical gastric outlet obstruction that worsens reflux" — Jacob Langer (clinical) [Ep 22 · 48:08](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2888)
- "Non-rotation in omphalocele is not associated with risk of midgut volvulus, so Ladd's procedure is not needed" — Jacob Langer (clinical) [Ep 22 · 48:49](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2929)
- "Inversion appendectomy during omphalocele repair makes sense if performing Ladd's procedure, but appendix should be preserved if renal abnormality exists that might require Mitrofanoff" — Jacob Langer (clinical) [Ep 22 · 49:06](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=2946)
- "Hepatic veins in omphalocele are very superficial and can be injured during fascial dissection if not careful" — Jacob Langer (clinical) [Ep 22 · 50:10](https://library.globalcastmd.com/watch/abdominal-wall-defects-with-dr-jacob-langer-959?t=3010)
- "After 2-3 recurrences of pilonidal abscess, definitive surgery is typically recommended" (opinion) [Ep 24 · 0:30](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=30)
- "Bascom pit-picking technique involves excising 1-millimeter pits at skin level under local anesthesia and allowing secondary intention healing" (clinical) [Ep 24 · 1:10](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=70)
- "Bascom technique reports 70% non-recurrence rate, though no control group exists" (epidemiological) [Ep 24 · 1:10](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=70)
- "For recurrent disease or large draining sinuses after Bascom pit-picking, formal excision with off-midline layered closure and drain is performed" (clinical) [Ep 24 · 1:37](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=97)
- "Deep gluteal fold and heavy hair burden are high-risk physical exam findings for pilonidal disease recurrence" (clinical) [Ep 24 · 2:31](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=151)
- "For severe or recurrent pilonidal disease, open excision with wet-to-dry dressing changes or wound VAC is an option" (clinical) [Ep 24 · 2:53](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=173)
- "Karydakis flap is superior to excision alone and comparable to modified Limberg flap for pilonidal disease" (clinical) [Ep 24 · 3:18](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=198)
- "Modified elliptical rotation flap has short-term results comparable to Limberg and Karydakis flaps, though less data exists" (clinical) [Ep 24 · 3:18](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=198)
- "Pilonidal recurrence is primarily a wound healing problem related to postoperative pressure on the surgical site" (opinion) [Ep 24 · 3:43](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=223)
- "Prone positioning postoperatively until wound healing is complete is critical to prevent recurrence" (clinical) [Ep 24 · 3:45](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=225)
- "Plastic surgery consultation with flap reconstruction and prone positioning is used for multiply recurrent pilonidal disease" (clinical) [Ep 24 · 3:54](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=234)
- "One patient reported laser hair removal for pilonidal disease as the most painful procedure he had experienced and discontinued after half a session" (clinical) [Ep 24 · 4:28](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=268)
- "Some patients tolerate laser hair removal for pilonidal disease without significant complaint" — David (clinical) [Ep 24 · 4:42](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=282)
- "Laser hair removal treatment area may be inadequately extensive if not specifically directed" — David (clinical) [Ep 24 · 4:46](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=286)
- "Insurance reimbursement for laser hair removal in pilonidal disease has not been successful" — David (clinical) [Ep 24 · 4:52](https://library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=292)
- "Adult prospective randomized trials show mechanical bowel prep alone does no good or probably harms patients" — Ian Glenn (clinical) [Ep 26 · 0:35](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=35)
- "Oral antibiotics that are not absorbed are probably beneficial in adult colorectal surgery" — Ian Glenn (clinical) [Ep 26 · 0:41](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=41)
- "One pediatric study showed mechanical bowel prep by itself led to higher infection rates in children" — Ian Glenn (clinical) [Ep 26 · 0:51](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=51)
- "One pediatric study showed mechanical bowel prep by itself led to longer hospital stays in children" — Ian Glenn (clinical) [Ep 26 · 0:51](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=51)
- "In one pediatric study, addition of antibiotics to mechanical bowel prep did not make any difference in outcomes" — Ian Glenn (clinical) [Ep 26 · 0:51](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=51)
- "Another pediatric study showed mechanical bowel prep with oral antibiotics made no difference compared to no prep" — Ian Glenn (clinical) [Ep 26 · 1:01](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=61)
- "For pediatric colostomy takedown, it is reasonable to omit both mechanical bowel prep and oral antibiotics" — Ian Glenn (opinion) [Ep 26 · 1:07](https://library.globalcastmd.com/watch/do-we-need-bowel-prep-1331?t=67)
- "5 to 15% of patients who have catheters removed require some sort of additional intervention to remove the catheter" — Ian Glenn (epidemiological) [Ep 25 · 0:32](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=32)
- "The actual number of catheters or catheter fragments that get left behind is 0.2 to 2%" — Ian Glenn (epidemiological) [Ep 25 · 0:57](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=57)
- "Risk factors for catheter retention include patients who have chemotherapy infused through their lines" — Ian Glenn (clinical) [Ep 25 · 1:12](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=72)
- "Risk factors for catheter retention include patients who have catheters that are indwelling for longer than about a year and a half" — Ian Glenn (clinical) [Ep 25 · 1:12](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=72)
- "There is an association between polyurethane catheter material and catheter retention when compared with silicone catheters" — Ian Glenn (clinical) [Ep 25 · 1:25](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=85)
- "Power ports are polyurethane catheters" (clinical) [Ep 25 · 1:31](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=91)
- "The recommendation would be to go with silastic catheters for long-term chemotherapy cases" — Ian Glenn (opinion) [Ep 25 · 1:46](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=106)
- "Surgical venotomy to retrieve a catheter carries a risk of bleeding" — Ian Glenn (clinical) [Ep 25 · 2:10](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=130)
- "Endovascular catheter removal carries a risk of the line completely breaking and embolizing distally" — Ian Glenn (clinical) [Ep 25 · 2:16](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=136)
- "Endovascular catheter removal carries a risk of thrombosis occurring during the procedure" — Ian Glenn (clinical) [Ep 25 · 2:16](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=136)
- "Multiple studies of patients with retained catheter fragments in follow-up periods from months to the order of 5 years showed no complications" — Ian Glenn (clinical) [Ep 25 · 2:31](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=151)
- "No thrombosis was associated with retained catheter fragments in follow-up studies" — Ian Glenn (clinical) [Ep 25 · 2:42](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=162)
- "No infections were associated with retained catheter fragments in follow-up studies" — Ian Glenn (clinical) [Ep 25 · 2:42](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=162)
- "There has never been a report of a problem by leaving the catheter tip in" (clinical) [Ep 25 · 3:26](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=206)
- "We don't have long-term data on outcomes of retained catheter fragments" (clinical) [Ep 25 · 3:26](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=206)
- "Silastic lines generally have a larger size diameter for a given lumen compared to polyurethane lines" (clinical) [Ep 25 · 3:08](https://library.globalcastmd.com/watch/management-of-retained-central-venous-catheters-1330?t=188)
- "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 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 28 · 45:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-307?t=2723)
- "In normal individuals, acoustic radiation force impulse (ARFI) liver stiffness measures approximately 0.5 to 1 meter per second" (clinical) [Ep 11 · 1:41](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=101)
- "Peripheral venous pressure is highly correlated with central venous pressure in Fontan patients" (clinical) [Ep 11 · 3:18](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=198)
- "Mean capillary filling pressure measured peripherally is highly correlated with values obtained in the catheterization laboratory" (clinical) [Ep 11 · 3:26](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=206)
- "Mean capillary filling pressure is measured by applying an arm cuff to completely occlude arterial inflow and waiting for venous pressures in the arm to equalize" (clinical) [Ep 11 · 3:41](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=221)
- "Mean capillary filling pressure is a measure of intravascular volume status and venous wall tension and compliance" (clinical) [Ep 11 · 3:57](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=237)
- "In Fontan circulation patients, venous compliance is very often reduced" (clinical) [Ep 11 · 4:11](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=251)
- "Fontan patients who respond rapidly with venous pressure elevation during exercise tend to have diminished exercise capacity" (clinical) [Ep 11 · 4:40](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=280)
- "Fontan patients drop their renal near-infrared spectroscopy (NIRS) very precipitously and very early during exercise compared to normal controls" (clinical) [Ep 11 · 5:02](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=302)
- "In Fontan patients, renal NIRS does not return to normal even after 5-6 minutes of recovery following exercise" (clinical) [Ep 11 · 5:15](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=315)
- "Cerebral NIRS shows an early drop in Fontan patients but returns back to normal by the second minute of exercise, in contrast to renal NIRS" (clinical) [Ep 11 · 5:24](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=324)
- "When venous pressures transduced to the hepatic veins exceed 25 millimeters of mercury for any length of time, subclinical evidence of hepatocellular damage occurs due to perfusion problems" (clinical) [Ep 11 · 5:57](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=357)
- "Dynamic assessment of the Fontan patient is essential even in well-functioning Fontans to pick up occult abnormal physiology that would not be appreciated until much later when the patient becomes ill" (opinion) [Ep 11 · 7:31](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=451)
- "Exercise participation, whether formal or informal, improves exercise capacity in Fontan patients" (clinical) [Ep 11 · 8:16](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=496)
- "With exercise comes central venous hypertension which causes liver disease among other things in Fontan patients" (clinical) [Ep 11 · 8:38](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=518)
- "With any form of exercise, if you take the extremes, the detrimental effects may well outweigh the beneficial effects" (opinion) [Ep 11 · 9:04](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=544)
- "Most of the venous pressure rise during exercise is already incorporated into submaximal exercise protocols" (clinical) [Ep 11 · 10:06](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=606)
- "Patients on a transplant list get better if you exercise them, largely because of skeletal muscle function and oxygen extraction improvements" (clinical) [Ep 11 · 10:36](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=636)
- "The hemodynamic response to exercise may or may not change with exercise training" (opinion) [Ep 11 · 10:51](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=651)
- "In Fontan patients, vessels themselves change in their histopathology to accommodate higher pressures, with perivenular changes in the liver and vascular adaptive responses in the SVC and IVC" (clinical) [Ep 11 · 11:15](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=675)
- "There is virtually no data in any condition suggesting that if you change vascular biology acutely, you change exercise function" (clinical) [Ep 11 · 11:38](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=698)
- "In biventricular patients, supine exercise is limited compared to upright exercise" (clinical) [Ep 11 · 13:15](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=795)
- "In Fontan patients, exercise limitation during supine exercise looks the same as in biventricular patients, with no particular advantage to swimming or other flat exercises" (clinical) [Ep 11 · 13:38](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=818)
- "Gravity affects flow patterns in Fontan patients, with very different patterns of hepatic venous flow depending on whether lying flat or standing up" (clinical) [Ep 11 · 13:48](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=828)
- "Exercise testing with venous pressure monitoring can detect occult obstructions in the Fontan circuit that may not be identified with echo and clinical assessment alone" (clinical) [Ep 11 · 14:10](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-ii-new-horizons-in-medical-894?t=850)
- "In any circulation, blood flow per unit time is dependent upon the drop in pressure across the vascular bed and the vascular resistance (Ohm's law)" — Brian Goldstein (clinical) [Ep 12 · 1:26](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=86)
- "Biventricular circulation is characterized by low right ventricular pressure, low pulmonary arterial pressure, and low pulmonary vascular resistance" — Brian Goldstein (clinical) [Ep 12 · 2:07](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=127)
- "During exercise in biventricular circulation, cardiac output can increase to approximately 5 times baseline cardiac output" — Brian Goldstein (clinical) [Ep 12 · 2:31](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=151)
- "The pulmonary vascular resistance falls characteristically during exercise in biventricular circulation, allowing for substantial augmentation of pulmonary blood flow" — Brian Goldstein (clinical) [Ep 12 · 2:41](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=161)
- "In the Fontan circuit, the pulmonary vascular resistance is typically both fixed and elevated" — Brian Goldstein (clinical) [Ep 12 · 3:01](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=181)
- "In Fontan circulation, baseline cardiac output is typically near normal but a bit reduced, 70 to 80% or so" — Brian Goldstein (clinical) [Ep 12 · 3:28](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=208)
- "Central venous pressure in Fontan patients is chronically elevated because there is no ventricle to do the work of the subpulmonary blood flow" — Brian Goldstein (clinical) [Ep 12 · 3:39](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=219)
- "At rest with zero exercise, cardiac output in typical or good Fontan patients is 70 to 80% of a normal biventricular patient" — Brian Goldstein (clinical) [Ep 12 · 4:30](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=270)
- "With augmentation of cardiac output or with stress or exercise, the difference between the Fontan patient and the biventricular patient becomes substantially increased, and identifying abnormalities or limitations in the Fontan circuit becomes quite a bit easier" — Brian Goldstein (clinical) [Ep 12 · 4:49](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=289)
- "Systolic function is typically preserved in Fontan patients, at least preserved until very late in the clinical presentation with difficulties" — Brian Goldstein (clinical) [Ep 12 · 5:28](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=328)
- "Most or all hemodynamic variables may be pretty typical or near normal at rest in Fontan patients, thus to understand limitations, one must evaluate these variables in a dynamic or stressed state" — Brian Goldstein (clinical) [Ep 12 · 5:50](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=350)
- "Pulmonary vascular resistance is elevated at rest in Fontan patients and with exercise, the pulmonary vascular resistance is quite static and does not decrease as one would expect with maximal exercise" — Brian Goldstein (clinical) [Ep 12 · 7:10](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=430)
- "In patients with biventricular circulation, pulmonary vascular resistance begins lower and falls with exercise" — Brian Goldstein (clinical) [Ep 12 · 7:21](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=441)
- "With echocardiographic assessment of diastolic function of both right and left and mixed ventricles, nearly 3/4 of Fontan patients demonstrate abnormalities of early relaxation or elevated atrial filling pressure" — Brian Goldstein (clinical) [Ep 12 · 9:03](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=543)
- "Patients with diastolic dysfunction had reduced functional capacity as measured by peak VO2 and peak work compared to those with normal diastolic function" — Brian Goldstein (clinical) [Ep 12 · 9:50](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=590)
- "Echocardiographic measures of diastolic function have not been validated in a Fontan population" — Brian Goldstein (clinical) [Ep 12 · 10:21](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=621)
- "Invasive assessment of end diastolic pressure in symptomatic Fontan patients is frequently unrevealing in the resting state" — Brian Goldstein (clinical) [Ep 12 · 10:27](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=627)
- "In a cohort of 46 Fontan patients undergoing rapid volume expansion, ventricular filling pressure (end diastolic pressure) was significantly increased after exposure to volume" — Brian Goldstein (clinical) [Ep 12 · 11:10](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=670)
- "About 35% of Fontan patients demonstrated occult diastolic dysfunction, defined as a post volume challenge end diastolic pressure of greater than or equal to 15 millimeters of mercury" — Brian Goldstein (clinical) [Ep 12 · 12:09](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=729)
- "Higher baseline end diastolic pressure, longer duration of Fontan circulation, and lower baseline cardiac index were associated with higher fluid challenge end diastolic pressure" — Brian Goldstein (clinical) [Ep 12 · 12:22](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=742)
- "Longer duration of Fontan circulation was associated with a greater change in filling pressure during volume challenge" — Brian Goldstein (clinical) [Ep 12 · 12:53](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=773)
- "Fontan patients can have the presence of mechanical dyssynchrony without electrical dyssynchrony" — Brian Goldstein (clinical) [Ep 12 · 14:24](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=864)
- "Reducing mechanical dyssynchrony could improve ventricular mechanics, which could improve symptomatic patients" — Brian Goldstein (opinion) [Ep 12 · 14:30](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=870)
- "BNP measurements after exercise in Fontan patients were almost universally between 15 and 40, making it difficult to identify substantive differences" — Brian Goldstein (clinical) [Ep 12 · 21:11](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=1271)
- "The easy biomarker has proved difficult to identify in Fontan patients because their end diastolic pressure is probably quite low and not straining their atrium" — Brian Goldstein (opinion) [Ep 12 · 21:34](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=1294)
- "Hideki Senzaki's group has looked at profibrotic markers in the blood in the Fontan circulation, with some patients having very high levels of circulating effectors of fibrosis" — Reddington (clinical) [Ep 12 · 21:56](https://library.globalcastmd.com/watch/case-review-dynamic-assessment-of-the-fontan-part-i-new-horizons-in-medical-895?t=1316)
- "In all reproductive age females presenting with lower abdominal pain, a pregnancy test should be checked regardless of sexual activity history" — Jennifer Dietrich (guideline) [Ep 29 · 1:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=108)
- "Ultrasound provides adequate visualization in both low and high BMI patients due to improved penetration capabilities of modern ultrasound technology, as long as the patient has a full bladder" — Jennifer Dietrich (clinical) [Ep 29 · 2:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=177)
- "Significant asymmetry between ovaries on ultrasound, particularly enlargement on the symptomatic side, raises concern for adnexal torsion" — Jennifer Dietrich (clinical) [Ep 29 · 3:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=211)
- "Complete absence of blood flow on ultrasound is the most concerning and more reliable finding for torsion; presence of blood flow is actually less reliable" — Jennifer Dietrich (clinical) [Ep 29 · 4:29](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=269)
- "Blood flow may be present in ovarian torsion because it could be just a torsed tube with preserved ovarian flow, or the torsion may be intermittent or loose rather than complete" — Jennifer Dietrich (clinical) [Ep 29 · 5:00](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=300)
- "Peripheral distribution of follicles on ultrasound suggests vascular congestion in the central ovary due to torsion, with follicles being pushed to the periphery" — Jennifer Dietrich (clinical) [Ep 29 · 7:15](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=435)
- "Lesions 5-6 centimeters or larger increase the risk of torsion in the setting of symptoms by making the ovary and tube heavy enough to twist" — Jennifer Dietrich (clinical) [Ep 29 · 8:50](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=530)
- "In prepubertal girls, normal ovaries can torse and torsion is the most common reason for gynecologic surgery in this age group" — Jennifer Dietrich (epidemiological) [Ep 29 · 9:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=571)
- "There is no specific size cutoff for torsion risk; in prepubertal children with tiny ovaries (1-1.5 cm), even a 2-3 cm cyst can cause torsion" — Jennifer Dietrich (clinical) [Ep 29 · 10:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=619)
- "Complex ultrasound features (partly cystic, partly solid), hypervascular flow on Doppler within a lesion, and elevated tumor markers raise concern for malignancy" — Jennifer Dietrich (clinical) [Ep 29 · 11:24](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=684)
- "CT is beneficial for distinguishing adnexal lesions from abscess or appendiceal pathology" — Jennifer Dietrich (clinical) [Ep 29 · 12:17](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=737)
- "MRI is useful for distinguishing torsion from Müllerian anomalies with outflow obstruction causing hematosalpinx" — Jennifer Dietrich (clinical) [Ep 29 · 12:36](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=756)
- "Pelvic exams are delayed in adolescents until later teenage years or first Pap smear at age 21, unless specific concerns arise from sexual activity or congenital issues" — Jennifer Dietrich (guideline) [Ep 29 · 13:19](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=799)
- "Tumor markers sent for complex adnexal masses include alpha-fetoprotein, quantitative beta-HCG, lactate dehydrogenase, and CA-125" — Jennifer Dietrich (clinical) [Ep 29 · 15:06](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=906)
- "At Texas Children's Hospital, three out of four tumor markers return within 1-1.5 hours, allowing results before proceeding to the operating room" — Jennifer Dietrich (clinical) [Ep 29 · 15:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=957)
- "Salvage rates for torsed ovaries are higher within the first 24-72 hours from onset of pain compared to patients presenting after one week" — Jennifer Dietrich (clinical) [Ep 29 · 17:26](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1046)
- "It is impossible to predict which patients have loose versus tight torsion; tight torsion develops ischemia more quickly" — Jennifer Dietrich (clinical) [Ep 29 · 17:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1072)
- "Ovarian torsion is a clinical diagnosis; if clinical suspicion is high, surgery should proceed regardless of ultrasound findings including presence of blood flow" — Jennifer Dietrich (guideline) [Ep 29 · 18:16](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1096)
- "In equivocal cases, brief in-hospital observation (not discharge home) is reasonable to see if the patient declares herself, potentially with repeat ultrasound" — Jennifer Dietrich (guideline) [Ep 29 · 18:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1136)
- "Classic presentation of torsion includes acute onset abdominal pain after physical activity (gymnastics, cartwheels, banana boat riding), with persistent pain, nausea, vomiting, and asymmetric ovarian enlargement on ultrasound" — Jennifer Dietrich (clinical) [Ep 29 · 19:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1192)
- "Hemorrhagic ovarian cysts are more likely in menstruating females; menstrual history including regularity and timing of last cycle helps distinguish hemorrhagic cyst from torsion" — Jennifer Dietrich (clinical) [Ep 29 · 21:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1282)
- "In hemorrhagic cysts, Doppler shows no flow within the cyst itself but preserved flow peripheral to the cyst, which can help differentiate from torsion" — Jennifer Dietrich (clinical) [Ep 29 · 22:09](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1329)
- "Surgical management of torsion involves detorsing the ovary and removing any causative lesion (peritubal or ovarian cyst) via cystectomy rather than simple drainage" — Jennifer Dietrich (clinical) [Ep 29 · 22:51](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1371)
- "Even purple, black and blue ovaries can recover over time after detorsion; oophorectomy should be avoided unless the ovary is literally falling apart during manipulation" — Jennifer Dietrich (clinical) [Ep 29 · 23:35](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1415)
- "Follow-up studies show return of ovarian function and evidence of follicles even in ovaries that appeared necrotic at surgery, though recovery may take several months" — Jennifer Dietrich (clinical) [Ep 29 · 26:47](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1607)
- "Peritubal cysts will recur if not completely resected; the cyst wall must be removed by opening the mesosalpinx beneath the splayed fallopian tube" — Jennifer Dietrich (clinical) [Ep 29 · 24:08](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1448)
- "For hemorrhagic cysts, if the cyst wall is not completely removed during surgery, the cyst may continue to bleed" — Jennifer Dietrich (clinical) [Ep 29 · 25:21](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1521)
- "The bivalve procedure involves making an incision into the ovarian cortex after detorsion to release pressure in cases of severe edema, similar to treating compartment syndrome" — Jennifer Dietrich (clinical) [Ep 29 · 27:56](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1676)
- "Bivalving is indicated when the ovary remains severely edematous after detorsion and cyst removal, or when a normal ovary has torsed and remains bulky with no lesion to remove" — Jennifer Dietrich (clinical) [Ep 29 · 28:48](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1728)
- "If bivalving does not adequately decompress the ovary, debulking via biopsy may be necessary to remove bulky tissue that could cause recurrent torsion" — Jennifer Dietrich (clinical) [Ep 29 · 29:23](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1763)
- "Oophoropexy is considered in cases of recurrent torsion, when a patient has lost the contralateral ovary, or when there is concern for re-torsion due to persistent edema" — Jennifer Dietrich (clinical) [Ep 29 · 30:53](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1853)
- "Oophoropexy changes the position of the ovary which may affect future fertility, but preserving the ovary is better than losing it; egg retrieval for IVF remains possible" — Jennifer Dietrich (clinical) [Ep 29 · 31:18](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1878)
- "Absorbable suture for oophoropexy holds the adnexa still for 4-6 weeks during inflammation resolution, then dissolves to minimize long-term fertility impact" — Jennifer Dietrich (clinical) [Ep 29 · 31:54](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1914)
- "Clipping the utero-ovarian ligament does not reliably prevent torsion because the ovary can still twist on either the utero-ovarian ligament or the infundibulopelvic ligament" — Jennifer Dietrich (clinical) [Ep 29 · 32:37](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1957)
- "Oophoropexy techniques include shortening the utero-ovarian ligament by plicating it, pexing to the pelvic sidewall (avoiding ureters), or pexing to the posterior uterus" — Jennifer Dietrich (clinical) [Ep 29 · 33:10](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=1990)
- "Tubo-ovarian abscess should be treated with antibiotics rather than surgical drainage unless the patient is clinically unstable, to avoid seeding infection to other pelvic structures" — Jennifer Dietrich (guideline) [Ep 29 · 35:14](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2114)
- "Ectopic pregnancy can present similarly to torsion with acute pain and adnexal mass; ultrasound may not visualize early pregnancy with transabdominal probe, especially in children's hospitals without transvaginal capability" — Jennifer Dietrich (clinical) [Ep 29 · 35:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2157)
- "Ectopic pregnancy is managed by salpingostomy (longitudinal incision in fallopian tube) to remove the pregnancy; the tube is not sutured closed as pelvic structures heal well without suturing and suturing may cause stricture" — Jennifer Dietrich (clinical) [Ep 29 · 38:07](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2287)
- "Endometriosis in adolescents presents with atypical lesions: clear vesicular lesions or red hyperemic-appearing lesions rather than the classic blue-black lesions seen in adults" — Jennifer Dietrich (clinical) [Ep 29 · 39:57](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2397)
- "The underwater examination technique involves filling the pelvis with crystalloid and submerging the camera to better visualize clear endometriosis lesions in the cul-de-sac" — Jennifer Dietrich (clinical) [Ep 29 · 40:55](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2455)
- "Endometriosis lesions should be excised with cold scissors when overlying critical structures like ureter or bowel, rather than using energy devices" — Jennifer Dietrich (clinical) [Ep 29 · 41:52](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2512)
- "Patients can be discharged within hours after laparoscopic surgery for torsion if they meet postoperative milestones, with activity restriction for 4-6 weeks to allow incision healing and prevent hernia" — Jennifer Dietrich (guideline) [Ep 29 · 42:22](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2542)
- "Oral contraceptives can prevent recurrent functional cysts in pubertal females but do not prevent torsion from dermoid cysts or peritubal cysts" — Jennifer Dietrich (clinical) [Ep 29 · 43:31](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2611)
- "Surveillance ultrasound is performed at 3 months postoperatively to allow inflammation to resolve, then repeated at 3-6 months if recovery is ongoing, then annually" — Jennifer Dietrich (guideline) [Ep 29 · 44:32](https://library.globalcastmd.com/watch/ovarian-torsion-with-dr-jennifer-dietrich-306?t=2672)
- "The patient underwent coarctation repair and PA banding at 2 days of life via end-to-end anastomotic repair after resection of coarc segment plus left carotid to left subclavian artery side-to-side anastomosis" — Anisa Chowdhury (clinical) [Ep 7 · 0:46](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=46)
- "Fontan pressures were 12 mmHg and left ventricular end-diastolic pressure was 5 mmHg on 2006 catheterization, both normal" — Anisa Chowdhury (clinical) [Ep 7 · 1:22](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=82)
- "The patient had three prior miscarriages" — Anisa Chowdhury (clinical) [Ep 7 · 1:58](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=118)
- "The patient was prescribed Depo-Provera contraception but only received one injection in the past 3-4 years" — Anisa Chowdhury (clinical) [Ep 7 · 2:02](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=122)
- "The patient had NYHA class 2-3 dyspneic symptoms at baseline (short of breath climbing one flight of stairs or walking 2 blocks) with no change during first couple trimesters of pregnancy" — Anisa Chowdhury (clinical) [Ep 7 · 2:08](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=128)
- "Echocardiogram showed mildly reduced left ventricular systolic function with estimated LVEF 45-50%" — Anisa Chowdhury (clinical) [Ep 7 · 3:20](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=200)
- "The patient was classified as WHO class 3 risk, indicating significantly elevated risk of maternal morbidity and mortality during peripartum period" — Anisa Chowdhury (clinical) [Ep 7 · 4:43](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=283)
- "Management included aspirin 162 mg daily; stronger anticoagulation was not pursued because thrombophilia profile was not elevated" — Anisa Chowdhury (clinical) [Ep 7 · 5:06](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=306)
- "ACE inhibitor was discontinued due to teratogenicity" — Anisa Chowdhury (clinical) [Ep 7 · 5:18](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=318)
- "Normal pregnancy involves decreased systemic vascular resistance, decreased PVR, increased heart rate, drop in blood pressure mid-pregnancy that rises again, and increase in cardiac output by about 50% and blood volume by 25%" — Nicole Brown (clinical) [Ep 7 · 7:11](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=431)
- "Risk of thrombosis is about 6 times normal during pregnancy and as high as 11 times normal in the first 6 weeks postpartum" — Nicole Brown (clinical) [Ep 7 · 7:33](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=453)
- "During labor without analgesia, cardiac output may increase by about 30% during each contraction" — Nicole Brown (clinical) [Ep 7 · 7:53](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=473)
- "Regional analgesia mitigates the cardiac output increase during contractions to some degree" — Nicole Brown (clinical) [Ep 7 · 8:00](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=480)
- "It takes about 6 months for cardiac output to return to non-pregnant levels postpartum" — Nicole Brown (clinical) [Ep 7 · 8:26](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=506)
- "Miscarriage rate among Fontan single ventricle patients is about 46%" — Nicole Brown (epidemiological) [Ep 7 · 8:45](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=525)
- "In a systematic review of about 198 pregnancies in 110 Fontan women, there were no maternal deaths" — Nicole Brown (epidemiological) [Ep 7 · 9:05](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=545)
- "SVT occurs in about 8.9% of pregnant Fontan patients" — Nicole Brown (epidemiological) [Ep 7 · 9:22](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=562)
- "Heart failure occurs in about 5% of pregnant Fontan patients, with wide range among studies" — Nicole Brown (epidemiological) [Ep 7 · 9:22](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=562)
- "Most Fontan women deliver between 26 and 36 weeks gestation, not making it to term (37 weeks)" — Nicole Brown (epidemiological) [Ep 7 · 9:40](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=580)
- "Risk of congenital heart disease in the fetus of a Fontan patient is probably between 3-10%" — Nicole Brown (epidemiological) [Ep 7 · 9:56](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=596)
- "Fontan patients fall in WHO class 3, indicating significantly increased risk of maternal mortality or severe morbidity; in this population it is more the morbidity that is concerning, not the mortality" — Nicole Brown (clinical) [Ep 7 · 10:11](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=611)
- "Fontan patients at higher risk for pregnancy complications include those with significant NYHA functional class deterioration, residual cyanosis, pulmonary hypertension, arrhythmias, multi-organ failure, or protein losing enteropathy; these would be classified as class 4 and advised against pregnancy" — Nicole Brown (clinical) [Ep 7 · 11:20](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=680)
- "Aspirin seems reasonable for most pregnant Fontan patients" — Nicole Brown (guideline) [Ep 7 · 13:46](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=826)
- "For Fontan patients at higher thrombotic risk (arrhythmias, prior clot, low cardiac output), therapeutic anticoagulation should be considered" — Nicole Brown (guideline) [Ep 7 · 13:51](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=831)
- "For moderate-risk pregnant Fontan patients, prophylactic dose low molecular weight heparin should be considered" — Nicole Brown (guideline) [Ep 7 · 14:02](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=842)
- "Delivery should be at a tertiary care center where the highest level of cardiac, OB, anesthesia, and neonatal care is available" — Nicole Brown (guideline) [Ep 7 · 14:27](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=867)
- "Left lateral decubitus position improves systemic venous return in pregnant Fontan patients" — Nicole Brown (clinical) [Ep 7 · 14:50](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=890)
- "Vaginal delivery with epidural is the preferred method for most Fontan women from a cardiovascular perspective" — Nicole Brown (guideline) [Ep 7 · 15:10](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=910)
- "Pregnant Fontan patients should stay in hospital for up to about a week postpartum because that is how long it takes for hemodynamics to settle back out" — Nicole Brown (guideline) [Ep 7 · 15:32](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=932)
- "Estrogen-containing contraceptives should be avoided in Fontan women because of increased thrombogenicity" — Nicole Brown (guideline) [Ep 7 · 15:58](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=958)
- "Pneumoperitoneum required for laparoscopic tubal ligation may be detrimental for Fontan patients" — Nicole Brown (clinical) [Ep 7 · 16:10](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=970)
- "Subdermal contraceptive implants are the lowest risk option, requiring only local anesthesia" — Nicole Brown (guideline) [Ep 7 · 16:23](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=983)
- "The aspirin dose of 162 mg in this patient was based on aspirin resistance testing" — Veldman (clinical) [Ep 7 · 18:06](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=1086)
- "Many centers use full anticoagulation in pregnant Fontan patients by definition, but this is associated with risk of antepartum and postpartum hemorrhage" — Veldman (clinical) [Ep 7 · 18:14](https://library.globalcastmd.com/watch/pregnancy-in-a-fontan-patient-new-horizons-in-medical-and-surgical-fontan-887?t=1094)
- "Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period" — Marc Levitt (clinical) [Ep 19 · 2:57](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=177)
- "Males with perineal fistula may pass meconium and the malformation goes unnoticed, typically presenting in the first year of life with severe constipation" — Marc Levitt (clinical) [Ep 19 · 3:06](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=186)
- "A newborn anus should accept a size 12 Hagar dilator and a one-year-old should accept size 15" — Marc Levitt (clinical) [Ep 19 · 6:16](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=376)
- "Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation" — Marc Levitt (clinical) [Ep 19 · 4:54](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=294)
- "Patients with uncorrected perineal fistula will soil with loose stool or athletic activity because they cannot completely close the hole when squeezing sphincters" — Marc Levitt (clinical) [Ep 19 · 5:40](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=340)
- "A bucket handle skin tag is consistent with a perineal fistula even if the fistula itself is not visible" — Marc Levitt (clinical) [Ep 19 · 6:42](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=402)
- "Perineal fistula in females is probably the most confounding diagnostic challenge in pediatric colorectal surgery, with both missed diagnoses and overdiagnosis occurring" — Marc Levitt (opinion) [Ep 19 · 7:33](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=453)
- "If the anal opening in a female is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, no surgery is needed as the perineal body will lengthen with growth" — Marc Levitt (clinical) [Ep 19 · 8:47](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=527)
- "Commercial muscle stimulators costing $15,000 can be replaced by anesthesia nerve stimulators costing $150 with appropriate needle attachments" — Marc Levitt (clinical) [Ep 19 · 10:52](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=652)
- "In rectourethral fistula, the rectum could be at bladder neck, prostatic, or bulbar level, and attempting to find it without knowing the level risks finding urinary tract structures instead" — Marc Levitt (clinical) [Ep 19 · 12:45](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=765)
- "Rectourethral fistulas should be managed with colostomy and distal colostogram rather than primary repair, except in exceedingly rare cases where cross-table lateral at 20 hours shows very low rectum" — Marc Levitt (guideline) [Ep 19 · 13:20](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=800)
- "The standard of not checking rectal temperature in newborns makes it easier to miss anorectal malformations" — Marc Levitt (opinion) [Ep 19 · 4:25](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=265)
- "Cloaca is distinguished from urogenital sinus with virilization by the absence of a normal anus; cloaca patients have no anus while urogenital sinus patients have completely normal anus" — Marc Levitt (clinical) [Ep 19 · 15:49](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=949)
- "The most common colostomy error is opening too distal in the sigmoid, which restricts the ultimate pull-through" — Marc Levitt (clinical) [Ep 19 · 17:18](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1038)
- "Incompletely diverting loop colostomies allow stool to spill across and contaminate the distal segment, leading to urinary tract infections" — Marc Levitt (clinical) [Ep 19 · 17:45](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1065)
- "Transverse colostomies can cause acidosis when large rectourethral fistulas allow the left colon to absorb urine" — Marc Levitt (clinical) [Ep 19 · 18:38](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1118)
- "Prolapse risk depends on colostomy location: mid-transverse can prolapse both sides, hepatic flexure only distal, proximal sigmoid only distal because left colon is fixed to retroperitoneum" — Marc Levitt (clinical) [Ep 19 · 19:58](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1198)
- "Marking the anoplasty location on the skin surface before making the incision prevents getting lost when looking at stimulated jumping muscles" — Marc Levitt (clinical) [Ep 19 · 21:30](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1290)
- "A properly done distal colostogram requires enough contrast and pressure to overcome the PC line (puborectalis compression), otherwise it gives false impression of high rectum or absent fistula" — Marc Levitt (clinical) [Ep 19 · 24:11](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1451)
- "The urethra can be visualized as a reverse C or elbow; fistula at or below the elbow is bulbar, above the elbow is prostatic, at bladder neck is bladder neck fistula" — Marc Levitt (clinical) [Ep 19 · 25:23](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1523)
- "Bulbous rectums are more easily approached posterior sagittally while tapered rectums are better suited for laparoscopy" — Marc Levitt (clinical) [Ep 19 · 25:55](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1555)
- "Opening posterior sagittally without knowing rectum location risks finding and potentially mobilizing bladder neck instead of rectum" — Marc Levitt (clinical) [Ep 19 · 27:00](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1620)
- "Bulbar and low prostatic fistulas are found right under or distal to the coccyx; bladder neck fistulas are not reachable through posterior sagittal approach" — Marc Levitt (clinical) [Ep 19 · 27:36](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1656)
- "Laparoscopy replaces laparotomy, not PSARP; a mini-PSARP should still be done with laparoscopy for safe entry and prolapse prevention" — Marc Levitt (opinion) [Ep 19 · 31:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=1908)
- "Rectal prolapse occurs in about 3% of cases, particularly in patients without great muscles" — Marc Levitt (epidemiological) [Ep 19 · 33:33](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2013)
- "Rectal prolapse greater than 3 millimeters should be treated because it causes bleeding, mucus, and can inhibit bowel control even in patients with good muscles" — Marc Levitt (clinical) [Ep 19 · 34:14](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2054)
- "Circumferential prolapse can be repaired in two stages (half circumference each) in ambulatory settings, avoiding hospitalization and eliminating need for dilation since half remains untouched" — Marc Levitt (clinical) [Ep 19 · 34:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2088)
- "Perineal body dehiscence is the most common cause of reoperation in female ARM repairs" — Marc Levitt (epidemiological) [Ep 19 · 36:03](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2163)
- "Proper anterior rectal wall mobilization to the areolar plane between rectum and vagina is essential to prevent tension and subsequent perineal body dehiscence" — Marc Levitt (clinical) [Ep 19 · 35:41](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2141)
- "Clear liquids only for one week postoperatively prevents hard stool formation while allowing more stool volume, showing good perineal body healing results" — Marc Levitt (clinical) [Ep 19 · 36:45](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2205)
- "Early perineal body dehiscence detected on days 5-8 can be salvaged by taking patient back to OR for re-suturing" — Marc Levitt (clinical) [Ep 19 · 37:48](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2268)
- "Attempting laparoscopic dissection of rectum that is too low risks leaving behind remnant of original fistula (distal rectum) or getting too close to urinary tract" — Marc Levitt (clinical) [Ep 19 · 38:36](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2316)
- "For high rectums, especially bladder neck fistulas, the IMA must be preserved because prior colostomy may have disrupted collaterals down the left colic, making rectum completely dependent on IMA" — Marc Levitt (clinical) [Ep 19 · 39:33](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2373)
- "The ARM continence index uses three factors to predict continence potential: original malformation type, sacral ratio, and spine quality" — Marc Levitt (clinical) [Ep 19 · 42:23](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2543)
- "A bulbar fistula with sacral ratio of 1 and normal spine should absolutely have bowel control" — Marc Levitt (clinical) [Ep 19 · 43:19](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2599)
- "A bladder neck fistula with sacral ratio of 0.4 and tethered cord or myelomeningocele has no real chance of good bowel control" — Marc Levitt (clinical) [Ep 19 · 43:29](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2609)
- "The unique challenge of ARM surgery is that technical errors may not become apparent for several years, unlike most surgical procedures where problems are immediately evident" — Marc Levitt (opinion) [Ep 19 · 46:25](https://library.globalcastmd.com/watch/complications-of-anorectal-malformations-with-dr-marc-levitt-951?t=2785)
- "6-40% of prenatally diagnosed lung lesions regress with time and may appear to completely disappear" — Steven Rothenberg (epidemiological) [Ep 20 · 5:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=343)
- "Fetal intervention for lung lesions is extremely rare; CHOP performs open fetal surgery less than once every couple of years" — Steven Rothenberg (epidemiological) [Ep 20 · 6:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=371)
- "Cyst volume ratio (CVR) greater than 2 has an extremely bad prognosis for fetal lung lesions" — Steven Rothenberg (clinical) [Ep 20 · 7:54](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=474)
- "Hybrid lesions showing features of both CPAM and sequestration are not uncommon on pathology" — Steven Rothenberg (clinical) [Ep 20 · 9:09](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=549)
- "Intralobar sequestration shares a common pleura with the lobe, usually the lower lobe" — Steven Rothenberg (clinical) [Ep 20 · 9:48](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=588)
- "Extralobar sequestration has its own pleural lining and is 90% separate from the lobe" — Steven Rothenberg (clinical) [Ep 20 · 9:52](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=592)
- "Sequestrations are defined by having a systemic artery coming directly off the aorta" — Steven Rothenberg (clinical) [Ep 20 · 10:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=602)
- "Systemic vessels to sequestrations can come off the abdominal aorta and pass through the diaphragm" — Steven Rothenberg (clinical) [Ep 20 · 10:14](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=614)
- "CPAM type 3 lesions are more solid and have the worst prognosis" — Steven Rothenberg (clinical) [Ep 20 · 10:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=640)
- "Chest X-ray alone is not adequate to ensure there is no residual lung lesion after prenatal diagnosis" — Steven Rothenberg (clinical) [Ep 20 · 14:50](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=890)
- "20-40% of untreated congenital lung lesions will develop significant infection at some point" — Steven Rothenberg (epidemiological) [Ep 20 · 15:47](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=947)
- "The incidence of malignancy in untreated congenital lung lesions is over 1% in Rothenberg's series" — Steven Rothenberg (epidemiological) [Ep 20 · 16:58](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1018)
- "Operating by 3 months of age avoids pneumonia or severe respiratory infection before surgery" — Steven Rothenberg (opinion) [Ep 20 · 18:04](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1084)
- "Surgery is technically easier in younger infants because vessels are smaller and anatomy is fresh" — Steven Rothenberg (opinion) [Ep 20 · 18:20](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1100)
- "Even asymptomatic patients often have enlarged lymph nodes and inflammation in fissures by one year of age" — Steven Rothenberg (clinical) [Ep 20 · 18:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?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 20 · 19:32](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1172)
- "Most infants undergoing early lobectomy are discharged within 48 hours" — Steven Rothenberg (clinical) [Ep 20 · 19:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1186)
- "By one month post-op, chest X-ray shows no evidence of prior surgery due to compensatory lung growth" — Steven Rothenberg (clinical) [Ep 20 · 19:46](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1186)
- "Most asymptomatic infants will tolerate single lung ventilation without problem" — Steven Rothenberg (clinical) [Ep 20 · 23:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1418)
- "Babies initially desaturate after lung collapse but saturations improve once they stop shunting blood to the collapsed lung" — Steven Rothenberg (clinical) [Ep 20 · 26:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1562)
- "End-tidal CO2 in the mid-40s during thoracoscopy does not cause significant acidosis or deleterious effects" — Steven Rothenberg (clinical) [Ep 20 · 27:41](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1661)
- "Standing at the patient's front provides more room from the chest wall to the hilum than standing at the back" — Steven Rothenberg (opinion) [Ep 20 · 30:02](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1802)
- "The camera port should be anterior to the tip of the scapula in the mid-axillary line to allow working from front to back" — Steven Rothenberg (opinion) [Ep 20 · 30:39](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1839)
- "A 4mm scope provides a more wide-angle view comparable to a 5mm scope compared to a 3mm scope" — Steven Rothenberg (opinion) [Ep 20 · 33:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=1981)
- "Short scopes (20cm) allow the surgeon to get close to the patient without the assistant getting in the way" — Steven Rothenberg (opinion) [Ep 20 · 33:22](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2002)
- "3mm vessel sealing devices can seal vessels up to 5mm in diameter" — Steven Rothenberg (clinical) [Ep 20 · 35:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2101)
- "Making two separate seals 4-5mm apart on vessels and cutting between them maximizes safety" — Steven Rothenberg (opinion) [Ep 20 · 35:15](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2115)
- "Cutting partway through a sealed vessel until seeing the lumen allows detection of bleeding while maintaining control" — Steven Rothenberg (opinion) [Ep 20 · 36:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2171)
- "Clips on vessels can be knocked off and are less reliable than vessel sealing" — Steven Rothenberg (opinion) [Ep 20 · 36:50](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2210)
- "Using energy devices that seal and cut simultaneously is a mistake that sets up the surgeon for trouble" — Steven Rothenberg (opinion) [Ep 20 · 37:44](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2264)
- "Every sealing device can fail at some point, so techniques should allow for recovery" — Steven Rothenberg (opinion) [Ep 20 · 38:30](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2310)
- "The inferior pulmonary ligament should be taken down first to check energy source function and identify systemic vessels" — Steven Rothenberg (opinion) [Ep 20 · 42:01](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2521)
- "Systemic vessels to sequestrations can be missed on CT scan and should be actively looked for during surgery" — Steven Rothenberg (clinical) [Ep 20 · 42:24](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2544)
- "Incomplete fissures can be completed by working through tissue layer by layer, similar to finger fracturing in liver surgery" — Steven Rothenberg (opinion) [Ep 20 · 43:13](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2593)
- "The bronchus sits directly underneath the pulmonary artery and can be felt to aid dissection" — Steven Rothenberg (clinical) [Ep 20 · 45:20](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2720)
- "The pulmonary vein is directly behind the bronchus in the same plane as the fissure dissection" — Steven Rothenberg (clinical) [Ep 20 · 48:31](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2911)
- "A 5mm stapler is inadequate for bronchus or vessels in children over 10 kg" — Steven Rothenberg (clinical) [Ep 20 · 49:11](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=2951)
- "The pulmonary vein trunk must never be taken near the pericardium because retraction into the pericardium after device failure causes fatal hemorrhage" — Steven Rothenberg (clinical) [Ep 20 · 50:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3033)
- "Middle lobe vessels come off just above the right lower lobe pulmonary artery and can be damaged if dissection migrates too cephalad" — Steven Rothenberg (clinical) [Ep 20 · 51:10](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3070)
- "Large cysts should be decompressed with the sealing device at the beginning of the procedure to improve visualization and lung manipulation" — Steven Rothenberg (opinion) [Ep 20 · 57:38](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3458)
- "Systemic vessels to sequestrations can number up to 6 and range from small to 15mm in diameter" — Steven Rothenberg (clinical) [Ep 20 · 58:40](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3520)
- "Using both sealing technology and clips on the same vessel risks delayed bleeding as the vessel changes nature and clips lose secure footing" — Steven Rothenberg (clinical) [Ep 20 · 59:55](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3595)
- "Systemic vessels to sequestrations have higher pressure from the aorta compared to low-pressure pulmonary vessels" — Steven Rothenberg (clinical) [Ep 20 · 60:43](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3643)
- "Extralobar sequestrations become infected and can cause problems even if malignant potential is uncertain" — Steven Rothenberg (clinical) [Ep 20 · 61:07](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3667)
- "Embolization of sequestrations requires general anesthesia and significant arterial intervention with no advantage over thoracoscopic resection" — Steven Rothenberg (opinion) [Ep 20 · 61:23](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3683)
- "Extralobar sequestration resection does not require a chest tube and patients go home the next day" — Steven Rothenberg (clinical) [Ep 20 · 61:35](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3695)
- "Segmentectomy is feasible when disease is confined to the superior segment of lower lobe or lingula with favorable anatomy" — Steven Rothenberg (opinion) [Ep 20 · 63:48](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3828)
- "Average length of stay for lobectomy in patients coming in the morning is about 2.5 days" — Steven Rothenberg (clinical) [Ep 20 · 65:33](https://library.globalcastmd.com/watch/neonatal-lung-lesions-with-dr-steven-rothenberg-948?t=3933)
- "The paper examined 98 patients who had severe tracheomalacia with posterior membranous intrusion" — Ian Glenn (clinical) [Ep 1 · 0:28](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=28)
- "All patients underwent bronchoscopy showing the trachea tended to collapse inward from the posterior aspect" — Ian Glenn (clinical) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=35)
- "Anterior compression is from the aortic arch, while posterior compression is from collapse" — Ian Glenn (clinical) [Ep 1 · 0:44](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=44)
- "Posterior tracheopexy uses pledgeted sutures to sew the posterior wall of the trachea to the anterior longitudinal ligament of the spine" — Ian Glenn (clinical) [Ep 1 · 0:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=54)
- "88% of the 98 patients had esophageal atresia with or without TEF" — Ian Glenn (epidemiological) [Ep 1 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=65)
- "Patients were followed anywhere from 1 week to 36 months" — Ian Glenn (clinical) [Ep 1 · 1:05](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=65)
- "Clinical symptoms improved across the board, including cough, barking cough, noisy breathing, and infections" — Ian Glenn (clinical) [Ep 1 · 1:15](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=75)
- "Patients improved on bronchoscopic evaluation" — Ian Glenn (clinical) [Ep 1 · 1:25](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=85)
- "Exercise tolerance did not improve statistically but showed a trend towards improvement" — Ian Glenn (clinical) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=90)
- "Tracheomalacia is not one homogeneous disease" — Ian Glenn (opinion) [Ep 1 · 1:35](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=95)
- "Systematic bronchoscopic evaluation is important for tracheomalacia" — Ian Glenn (opinion) [Ep 1 · 1:41](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=101)
- "Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both" — Ian Glenn (clinical) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=105)
- "Approximately 20% of patients in the study required both posterior tracheopexy and aortopexy" — Ian Glenn (clinical) [Ep 1 · 1:54](https://library.globalcastmd.com/watch/posterior-tracheopexy-for-severe-tracheomalacia-320?t=114)
- "Esophagogastric dissociation was historically thought of as a last resort operation when a Nissen won't work" — Todd Ponsky (clinical) [Ep 23 · 0:14](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=14)
- "Esophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients who have severe neurologic impairment" — Todd Ponsky (clinical) [Ep 23 · 0:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=24)
- "The study compared patients with severe GERD who were neurologically disabled, half undergoing esophagogastric dissociation and half undergoing laparoscopic Nissen" — Ian Glenn (clinical) [Ep 23 · 0:48](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=48)
- "Primary outcome was operative failure, defined as either recurrence of preoperative reflux symptoms or requirement of additional anti-reflux surgery" — Ian Glenn (clinical) [Ep 23 · 1:01](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=61)
- "There was a 4% failure rate in the esophagogastric dissociation group" — Ian Glenn (clinical) [Ep 23 · 1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=73)
- "There was a 21% failure rate in the Nissen group" — Ian Glenn (clinical) [Ep 23 · 1:13](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=73)
- "The difference in failure rates between esophagogastric dissociation and Nissen was not statistically significant" — Ian Glenn (clinical) [Ep 23 · 1:21](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=81)
- "17% of patients in the esophagogastric dissociation group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [Ep 23 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "54% of patients in the Nissen group continued to require anti-reflux medications after surgery" — Ian Glenn (clinical) [Ep 23 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "The difference in continued medication requirement between groups was statistically significant" — Ian Glenn (clinical) [Ep 23 · 1:29](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=89)
- "Caregiver-evaluated quality of life and symptom scores were the same between the two groups with no statistically significant difference" — Ian Glenn (clinical) [Ep 23 · 1:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=99)
- "The lack of statistical significance in failure rates could potentially be a type 2 error where there was actually a difference but the sample size was too small to detect it" — Ian Glenn (opinion) [Ep 23 · 2:03](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=123)
- "A multi-center study will probably be needed to really understand the difference between these procedures" — Todd Ponsky (opinion) [Ep 23 · 2:12](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=132)
- "The study did not adequately look at complication rates such as leaks and strictures" — Todd Ponsky (clinical) [Ep 23 · 2:16](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=136)
- "Leaks and strictures are the main concern of why most surgeons don't do esophagogastric dissociation" — Todd Ponsky (opinion) [Ep 23 · 2:18](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=138)
- "Esophagogastric dissociation is a much bigger surgery than Nissen fundoplication" — Ian Glenn (clinical) [Ep 23 · 2:24](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=144)
- "The study examined perioperative factors including time in the OR, length of hospital stay, need for ICU stay, and time to full feeds, with statistically significant differences following expected trends" — Ian Glenn (clinical) [Ep 23 · 2:26](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=146)
- "The study did not report on leaks, strictures, or long-term requirement for additional surgeries other than anti-reflux operations" — Ian Glenn (clinical) [Ep 23 · 2:39](https://library.globalcastmd.com/watch/esophagogastric-dissociation-for-gerd-in-severe-neurodisability-962?t=159)

## Changelog
- Aug 31: 23 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 30: 23 doctors auto-found from episode dossiers
- Aug 29: 23 doctors auto-found from episode dossiers
- Aug 29: 23 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 37 items, 34 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 35 items, 34 dossiers, summaries for 3 audience(s)

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