I think there is a difference between putting clips across the trachea and having a complete tracheal occlusion versus having a balloon tracheal occlusion in terms of the rate of increase of the LHR, the ultimate size of the lung.
watchful waiting can be very hazardous if you wait for the mother to go into preterm labor or the fetus to evolve significant high output failure and just allow nature to take its course, and the majority of those kids will die
watchful waiting can be very hazardous if you wait for the mother to go into preterm labor or the fetus to evolve significant high output failure and just allow nature to take its course, and the majority of those kids will die
I think the future in fetal surgery are clinical trials, reduction of maternal and fetal risk, and that may make open fetal surgery obsolete in many of these anomalies
quoteyou got to give Mike credit for having, uh, real cojones to, uh, start this field↗
▶Ep 10 · 1:08
clinicalMost congenital defects are still treated by waiting and treating the neonate, with fetal intervention reserved for a very few appropriately selected cases↗
▶Ep 10 · 1:41
clinicalAccepted indications for fetal surgery include pulmonary airway malformations, bronchial atresia, CHAOS, sacrococcygeal teratoma, and myelomeningocele↗
▶Ep 10 · 2:53
clinicalThe majority of CPAM lesions regress late in gestation and do not require any fetal intervention↗
▶Ep 10 · 3:31
clinicalBronchial atresia can masquerade as microcystic CPAM but is distinguished by a dilated central bronchus or mucocele and requires documentation of contralateral lung presence↗
▶Ep 10 · 5:13
clinicalHydrops is the sole indication for consideration of open fetal surgery in CPAM↗
▶Ep 10 · 6:01
clinicalCVR (CPAM volume ratio) greater than 1.6 indicates high risk for evolution to hydrops↗
▶Ep 10 · 6:15
clinicalThe majority of high-risk CPAMs respond to a trial of maternal steroids↗
▶Ep 10 · 9:06
quoteThe key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur↗
▶Ep 10 · 10:34
epidemiologicalThoracoamniotic shunts for macrocystic CPAM have 70-75% survival↗
▶Ep 10 · 10:34
epidemiologicalOpen fetal surgery for CPAM has approximately 60% survival↗
▶Ep 10 · 10:52
epidemiologicalCHOP has treated three bronchial atresia cases by fetal intervention with one intraoperative fetal death, one hepatic necrosis death, and one ongoing NICU case↗
▶Ep 10 · 11:46
opinionBronchial atresia is a much more difficult lesion to treat than CPAMs↗
▶Ep 10 · 12:18
clinicalSCT fetal pathophysiology includes tumor vascular steal leading to high output cardiac failure↗
▶Ep 10 · 12:28
clinicalFetal SCT resection aims to interrupt arteriovenous steal from the low resistance tumor to prevent progression of high output failure↗
▶Ep 10 · 13:16
clinicalFetal SCT surgery is a quick debulking procedure to remove arteriovenous steal without coccyxectomy↗
▶Ep 10 · 15:03
quoteHer bottom's not pretty, but it's functional↗
▶Ep 10 · 15:51
clinicalWatchful waiting in SCT can be hazardous, with majority of deaths occurring between 27-32 weeks gestation↗
▶Ep 10 · 16:10
quotewatchful waiting can be very hazardous if you wait for the mother to go into preterm labor or the fetus to evolve significant high output failure and just allow nature to take its course, and the majority of those kids will die↗
▶Ep 10 · 16:33
clinicalCHOP now uses a preemptive approach for SCT, delivering patients after 27 weeks at the slightest hint of fetal or maternal decompensation↗
▶Ep 10 · 16:59
epidemiologicalFive recent SCT cases managed with early delivery protocol had good outcomes with surprisingly little prematurity morbidity↗
▶Ep 10 · 17:36
clinicalNo safe ablative technology has been identified for SCT that does not induce significant collateral injury↗
▶Ep 10 · 18:41
clinicalEssential components of EXIT procedure include maintenance of uteroplacental blood flow, complete uterine relaxation, maintenance of intrauterine volume, maternal homeostasis and hemostasis, control of membranes, and avoiding placenta and cord↗
▶Ep 10 · 19:10
clinicalEXIT procedure requires a multidisciplinary team with specific roles for each member↗
▶Ep 10 · 19:42
quoteIt's not a minor undertaking and requires a lot of coordination between services to do an optimal exit procedure↗
▶Ep 10 · 20:42
quotethere was no way that child would have survived↗
▶Ep 10 · 21:05
clinicalCHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities↗
▶Ep 10 · 21:33
clinicalCHAOS patients have to grow into their ventilatory mechanics and can have significant morbidity when treated at birth↗
▶Ep 10 · 23:57
quoteI think the future in fetal surgery are clinical trials, reduction of maternal and fetal risk, and that may make open fetal surgery obsolete in many of these anomalies↗
▶Ep 10 · 26:38
clinicalCVR is calculated by measuring CPAM in 3 dimensions, applying ellipse formula, and dividing by head circumference to standardize for gestational age↗
▶Ep 10 · 27:05
clinicalCVR has been reliable for predicting hydrops risk, determining surveillance frequency, and counseling families↗
▶Ep 10 · 27:48
clinicalFailure of steroid therapy is defined as progression of hydrops↗
▶Ep 10 · 28:05
clinicalPatients on steroids for CPAM should be monitored with ultrasound every other day or 2-3 times per week because changes can occur rapidly↗
▶Ep 10 · 29:11
clinicalSteroids have had a dramatic impact on reducing the number of open fetal surgeries for microcystic CPAM↗
▶Ep 10 · 29:23
clinicalMacrocystic CPAMs and bronchial atresia do not respond as well to steroids as microcystic CPAMs↗
quoteyou got to give Mike credit for having, uh, real cojones to, uh, start this field↗
▶Ep 9 · 1:08
clinicalMost congenital defects are still treated by waiting and treating the neonate, with fetal intervention reserved for a very few appropriately selected cases↗
▶Ep 9 · 1:41
clinicalAccepted indications for fetal surgery include pulmonary airway malformations, bronchial atresia, CHAOS, sacrococcygeal teratoma, and myelomeningocele↗
▶Ep 9 · 2:53
clinicalThe majority of CPAM lesions regress late in gestation and do not require any fetal intervention↗
▶Ep 9 · 3:31
clinicalBronchial atresia can masquerade as microcystic CPAM but is distinguished by a dilated central bronchus or mucocele and requires documentation of contralateral lung presence↗
▶Ep 9 · 5:13
clinicalHydrops is the sole indication for consideration of open fetal surgery in CPAM↗
▶Ep 9 · 6:01
clinicalCVR (CPAM volume ratio) greater than 1.6 indicates high risk for evolution to hydrops↗
▶Ep 9 · 6:15
clinicalThe majority of high-risk CPAMs respond to a trial of maternal steroids↗
▶Ep 9 · 9:06
quoteThe key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur↗
▶Ep 9 · 10:34
epidemiologicalOpen fetal surgery for CPAM has approximately 60% survival↗
▶Ep 9 · 10:34
epidemiologicalThoracoamniotic shunts for macrocystic CPAM have 70-75% survival↗
▶Ep 9 · 10:52
epidemiologicalCHOP has treated three bronchial atresia cases by fetal intervention with one intraoperative fetal death, one hepatic necrosis death, and one ongoing NICU case↗
▶Ep 9 · 11:46
opinionBronchial atresia is a much more difficult lesion to treat than CPAMs↗
▶Ep 9 · 12:18
clinicalSCT fetal pathophysiology includes tumor vascular steal leading to high output cardiac failure↗
▶Ep 9 · 12:28
clinicalFetal SCT resection aims to interrupt arteriovenous steal from the low resistance tumor to prevent progression of high output failure↗
▶Ep 9 · 13:16
clinicalFetal SCT surgery is a quick debulking procedure to remove arteriovenous steal without coccyxectomy↗
▶Ep 9 · 15:03
quoteHer bottom's not pretty, but it's functional↗
▶Ep 9 · 15:51
clinicalWatchful waiting in SCT can be hazardous, with majority of deaths occurring between 27-32 weeks gestation↗
▶Ep 9 · 16:10
quotewatchful waiting can be very hazardous if you wait for the mother to go into preterm labor or the fetus to evolve significant high output failure and just allow nature to take its course, and the majority of those kids will die↗
▶Ep 9 · 16:33
clinicalCHOP now uses a preemptive approach for SCT, delivering patients after 27 weeks at the slightest hint of fetal or maternal decompensation↗
▶Ep 9 · 16:59
epidemiologicalFive recent SCT cases managed with early delivery protocol had good outcomes with surprisingly little prematurity morbidity↗
▶Ep 9 · 17:36
clinicalNo safe ablative technology has been identified for SCT that does not induce significant collateral injury↗
▶Ep 9 · 18:41
clinicalEssential components of EXIT procedure include maintenance of uteroplacental blood flow, complete uterine relaxation, maintenance of intrauterine volume, maternal homeostasis and hemostasis, control of membranes, and avoiding placenta and cord↗
▶Ep 9 · 19:10
clinicalEXIT procedure requires a multidisciplinary team with specific roles for each member↗
▶Ep 9 · 19:42
quoteIt's not a minor undertaking and requires a lot of coordination between services to do an optimal exit procedure↗
▶Ep 9 · 20:42
quotethere was no way that child would have survived↗
▶Ep 9 · 21:05
clinicalCHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities↗
▶Ep 9 · 21:33
clinicalCHAOS patients have to grow into their ventilatory mechanics and can have significant morbidity when treated at birth↗
▶Ep 9 · 23:57
quoteI think the future in fetal surgery are clinical trials, reduction of maternal and fetal risk, and that may make open fetal surgery obsolete in many of these anomalies↗
▶Ep 9 · 26:38
clinicalCVR is calculated by measuring CPAM in 3 dimensions, applying ellipse formula, and dividing by head circumference to standardize for gestational age↗
▶Ep 9 · 27:05
clinicalCVR has been reliable for predicting hydrops risk, determining surveillance frequency, and counseling families↗
▶Ep 9 · 27:48
clinicalFailure of steroid therapy is defined as progression of hydrops↗
▶Ep 9 · 28:05
clinicalPatients on steroids for CPAM should be monitored with ultrasound every other day or 2-3 times per week because changes can occur rapidly↗
▶Ep 9 · 29:11
clinicalSteroids have had a dramatic impact on reducing the number of open fetal surgeries for microcystic CPAM↗
▶Ep 9 · 29:23
clinicalMacrocystic CPAMs and bronchial atresia do not respond as well to steroids as microcystic CPAMs↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 10 · 56:19
quoteI think there is a difference between putting clips across the trachea and having a complete tracheal occlusion versus having a balloon tracheal occlusion in terms of the rate of increase of the LHR, the ultimate size of the lung.↗
▶Ep 10 · 1:00:26
quoteThese procedures should not be done unless you're in a startup phase and a learning phase outside of a clinical trial. We need to learn from the cases that are done.↗
