# Bronchopulmonary Sequestration — GCMD Library living collection

Everything in the library about bronchopulmonary sequestration — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 97 cited statements

## Episodes
### Medical Management
- [Prenatal Management of CPAMs: Lung Lesions](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089) — video · 18:16 · [machine version](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089.md)

### Surgical Management
- [Postnatal Management of  Lung Lesions Part II: Pediatric Thoracic Surgery...](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419) — video · 25:07 · [machine version](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419.md)
- [Fetal Interventions Part II: Lung Lesions](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884) — video · 16:30 · [machine version](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=0) Anatomic Variations in Bronchopulmonary Sequestrations and Venous Drainage Patterns (Ep 1)
- [3:26](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=206) Surgical Management of Infra-diaphragmatic Sequestration with Esophageal Obstruction (Ep 1)
- [7:20](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=440) Bronchogenic Cysts and Bronchial Atresia: Pathophysiology and Surgical Approach (Ep 1)
- [10:54](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=654) Vessel Management Techniques and Pleuropulmonary Blastoma Diagnosis (Ep 1)
- [14:58](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=898) Timing of Postnatal Resection and Impact on Lung Development (Ep 1)
- [16:49](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1009) Technical Aspects: CO2 Insufflation Pressures and Single-Lung Ventilation (Ep 1)
- [20:04](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1204) Size Limitations for Thoracoscopic Resection in Premature and Small Infants (Ep 1)
- [23:12](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1392) Management of Bilobar Involvement and Incomplete Fissures (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=0) Fetal thoracic interventions: techniques and complications (Ep 2)
- [3:43](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=223) Natural history and indications for intervention (Ep 2)
- [6:05](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=365) Disappearing CCAMs and diagnostic accuracy (Ep 2)
- [7:16](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=436) Nomenclature, EXIT procedure indications, and diagnostic pitfalls (Ep 2)
- [10:07](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=607) Pleuro-amniotic shunt indications (Ep 2)
- [12:07](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=727) Referral criteria, CVR thresholds, and imaging protocols (Ep 2)
- [0:01](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1) Introduction to prenatal lung lesions and differential diagnosis (Ep 3)
- [2:42](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=162) CPAM volume ratio and natural history (Ep 3)
- [4:43](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=283) Open fetal surgery for steroid-refractory microcystic CPAM (Ep 3)
- [10:58](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658) Thoracoamniotic shunts for macrocystic CPAMs (Ep 3)
- [12:57](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=777) EXIT procedure for mixed cystic-solid CPAM (Ep 3)
- [16:13](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=973) EXIT procedure indications and challenging cases (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Infra-diaphragmatic and sub-diaphragmatic sequestrations are frequently misdiagnosed as intrathoracic lesions — Steve (clinical) [Ep 1 · 0:22](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=22)
- A new class of sequestrations exists within the leaves of the diaphragm muscle, requiring diaphragm opening for resection — Steve (clinical) [Ep 1 · 0:39](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=39)
- Sequestrations at the esophageal hiatus can cause esophageal obstructive symptomatology — Alan (clinical) [Ep 1 · 0:51](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=51)
- The majority of infra-diaphragmatic sequestrations approached abdominally extend up through the esophageal hiatus, even when not apparent on CT — Steve (clinical) [Ep 1 · 4:45](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=285)
- Intra-diaphragmatic sequestrations (between diaphragm leaves) are frequently associated with the esophageal hiatus — Alan (clinical) [Ep 1 · 6:21](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=381)
- Bronchogenic cysts can be associated with bronchial obstruction and cause hyperplastic growth of the distal lobe — Alan (clinical) [Ep 1 · 7:24](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=444)
- In cases of fetal bronchial atresia causing hydrops not responsive to steroids, fetal lobe resection may be required — Alan (clinical) [Ep 1 · 7:37](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=457)
- When bronchogenic cysts obstruct lobar bronchi, the bronchus is typically destroyed enough that lobectomy is required rather than cyst resection alone — Alan (clinical) [Ep 1 · 8:32](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=512)
- Energy-based vessel sealers are operator-dependent because they seal as the knife advances; advancing too fast will divide the vessel before sealing — Steve (clinical) [Ep 1 · 9:49](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=589)
- Modern energy sealers now have a tone frequency that indicates when the vessel is sealed and safe to advance the blade — Alan (clinical) [Ep 1 · 10:07](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=607)
- The risk with clips on vessels is inadvertent dislodgement during dissection because they protrude past the vessel and are relatively large in small spaces — Steve (clinical) [Ep 1 · 11:50](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=710)
- Clips are safer when used as the last maneuver, such as on sequestration feeding vessels, and can be reinforced with distal ligature — Alan (clinical) [Ep 1 · 12:17](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=737)
- Thoracoscopic resection specimens provide adequate histology for diagnosis, comparable to open procedures, despite pathologist complaints about specimen quality — Alan (clinical) [Ep 1 · 14:15](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=855)
- Compensatory lung growth and alveolarization continues until age 4-6 years, so resection timing within the first few years likely does not significantly impact lung development — Alan (clinical) [Ep 1 · 16:22](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=982)
- CO2 insufflation pressure of 7 cm H2O is typically used for pediatric thoracoscopy and is well tolerated — Alan (clinical) [Ep 1 · 19:12](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1152)
- Starting CO2 pressure at 4 cm H2O is adequate if single-lung ventilation is good; pressure may need to increase to 7-8 cm H2O for lung collapse then can be reduced — Steve (clinical) [Ep 1 · 19:27](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1167)
- Main-stem intubation of the contralateral bronchus provides adequate single-lung ventilation with some overflow ventilation that is well tolerated — Steve (clinical) [Ep 1 · 19:35](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1175)
- The smallest thoracoscopic lobectomy performed was approximately 2400g, which was not significantly different technically from a term infant — Alan (clinical) [Ep 1 · 20:25](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1225)
- PDA ligations are now routinely performed thoracoscopically down to 800g, and 1000g now seems like a large space compared to a few years ago — Steve (clinical) [Ep 1 · 20:49](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1249)
- Current technology limits thoracoscopic lobectomy in small infants because 5mm clips and sealers occupy two-thirds of the chest space, making effective work difficult — Steve (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1280)
- Thoracoscopic lobectomy under 2kg is difficult with current technology — Steve (clinical) [Ep 1 · 21:50](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1310)
- Premature infants requiring CCAM resection typically have large masses impacting ventilation, which cannot be done thoracoscopically and have contralateral lung issues preventing single-lung ventilation — Alan (clinical) [Ep 1 · 21:57](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1317)
- A healthy, stable baby with a healthy contralateral lung is required for thoracoscopic lobectomy — Alan (clinical) [Ep 1 · 22:12](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1332)
- Infants with small, stable CCAM lesions can be sent home for 1-2 months to grow before returning for elective resection, making the operation easier and less stressful for parents — Steve (clinical) [Ep 1 · 22:44](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1364)
- Most CCAM lesions are removed before 3 months of age; the operation is technically easier in small infants despite the smaller working space, and children recover more quickly with shorter hospitalization — Steve (clinical) [Ep 1 · 17:38](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1058)
- Trocar setup is critical in neonatal thoracoscopy; incorrect trocar positioning will make the operation very difficult, especially in small neonates — Steve (clinical) [Ep 1 · 18:15](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1095)
- True bilobar CPAM involvement is relatively rare; most cases involve abnormal lobulation or fissure formation rather than actual involvement of two lobes — Alan (clinical) [Ep 1 · 24:07](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1447)
- When fissures are abnormal, the approach is to create a fissure in an appropriate position that preserves maximal lung parenchyma while avoiding leaving devascularized lung or lung without an airway — Alan (clinical) [Ep 1 · 24:25](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1465)
- Following anatomic boundaries properly makes residual cystic lesions requiring re-resection rare; speaker has had only one case requiring return for further resection — Alan (clinical) [Ep 1 · 24:50](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=1490)
- Radiofrequency ablation for vessel occlusion in fetal bronchopulmonary sequestrations was a disaster and is not recommended. — Jack (clinical) [Ep 2 · 1:27](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=87)
- Coils were used for vessel occlusion with initial success, but the fetus died about a week later for unclear reasons. — Jack (clinical) [Ep 2 · 1:33](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=93)
- Alcohol injection for vessel occlusion can travel through the vasculature and cause thrombosis in the systemic circulation, including thrombi in the heart chambers. — Alan (clinical) [Ep 2 · 1:52](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=112)
- The effects of systemic alcohol injection on fetal neural development and other organ development have not been studied experimentally, even in sheep models. — Alan (clinical) [Ep 2 · 2:29](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=149)
- Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage. — Alan (clinical) [Ep 2 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=180)
- In a laboratory study, a radiofrequency ablation probe placed in one side of a resected fetal teratoma caused the other side to boil when activated. — Alan (clinical) [Ep 2 · 3:12](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=192)
- Probably 95% of CCAMs are now prenatally diagnosed. (epidemiological) [Ep 2 · 3:46](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=226)
- Almost none of prenatally diagnosed lung lesions require prenatal intervention, and very few require intervention the day the child is born. (clinical) [Ep 2 · 3:52](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=232)
- Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions because the numbers are so small. (opinion) [Ep 2 · 4:09](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=249)
- Many lung lesions have been referred after a recommendation for termination by people who don't understand the natural history. — Alan (clinical) [Ep 2 · 5:20](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=320)
- Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions. — Alan (clinical) [Ep 2 · 5:31](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=331)
- The garden variety postnatal CCAM is very different than some prenatal CCAMs. — Alan (clinical) [Ep 2 · 5:44](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=344)
- True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan a month after birth. — Alan (clinical) [Ep 2 · 6:43](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=403)
- Some lesions that look like CCAMs in utero, such as segmental bronchial stenosis, can be minimally apparent or non-apparent after birth. — Alan (clinical) [Ep 2 · 6:13](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=373)
- Prenatal lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring a specimen. — Jean Martin (clinical) [Ep 2 · 7:45](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=465)
- Many tertiary centers have the capacity to perform EXIT procedures with a huge team approach and leadership. — Jean Martin (clinical) [Ep 2 · 8:17](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=497)
- Lung agenesis can be misdiagnosed as a microcystic CCAM with mediastinal shift on prenatal imaging. — Alan (clinical) [Ep 2 · 9:33](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=573)
- EXIT procedures are more invasive than regular C-sections for the mother. — Jean Martin (clinical) [Ep 2 · 9:59](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=599)
- Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops. — Alan (clinical) [Ep 2 · 11:08](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=668)
- Hydrops requires pleural effusion, pericardial effusion, and skin or scalp edema; pure ascites alone is not necessarily hydrops. — Alan (clinical) [Ep 2 · 11:18](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=678)
- Pure ascites can be related to mediastinal shift and hepatic venous return rather than true hydrops. — Alan (clinical) [Ep 2 · 11:27](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=687)
- Pleuro-amniotic shunts are not placed prophylactically; large macrocystic lesions may be tapped just prior to delivery to improve ventilation. — Alan (clinical) [Ep 2 · 11:48](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=708)
- A CVR cutoff of 1.6 is used; if a CCAM presents with CVR less than 1.6, the likelihood of evolving hydrops is about 3-5%. — Alan (clinical) [Ep 2 · 13:33](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=813)
- CVR greater than 1.6 requires close watching with much higher likelihood of evolving into hydrops. — Alan (clinical) [Ep 2 · 14:11](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=851)
- Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6. — Alan (clinical) [Ep 2 · 14:18](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=858)
- MRI is better for some fetal anomalies and not as good for others; it depends on the specific anomaly. — Alan (clinical) [Ep 2 · 15:55](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=955)
- There is no registry for fetal surgery or EXIT procedures similar to the ECMO registry. — Alan (clinical) [Ep 2 · 16:17](https://origin-library.globalcastmd.com/watch/fetal-interventions-part-ii-lung-lesions-884?t=977)
- Prenatal diagnosis has had a tremendous impact on the understanding and management of lung lesions. (opinion) [Ep 3 · 0:06](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=6)
- Right CDHs are frequently misdiagnosed as CPAMs and vice versa because of the similar echogenicity of the liver and the right chest. (clinical) [Ep 3 · 1:09](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=69)
- Steroids have reduced the need for surgical fetal intervention to almost zero in most fetal centers over the past 4-7 years for microcystic CPAMs when hydrops is threatened. (clinical) [Ep 3 · 1:52](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=112)
- The CCAM volume ratio (CVR) is the volume of an ellipse (three dimensional volume of the CPAM) over the head circumference to standardize for gestational age. (clinical) [Ep 3 · 2:59](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=179)
- CVR has proven to be probably the most valuable prognostic indicator for CPAMs both retrospectively and prospectively. (clinical) [Ep 3 · 3:11](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=191)
- CPAMs typically grow up until about 25 to 28 weeks when they tend to plateau, and then they'll actually regress in size very often. (clinical) [Ep 3 · 3:27](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=207)
- If the CVR is less than 1.6 with a solid lesion at presentation, there's less than a 3% chance of that lesion progressing to hydrops. (clinical) [Ep 3 · 3:46](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=226)
- CVR of greater than 1.6 has a very high likelihood of developing hydrops, as high as 75%. (clinical) [Ep 3 · 4:10](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=250)
- At the speaker's center, lesions with CVR greater than 1.6 are treated with steroids prophylactically to try to avoid heart failure. (clinical) [Ep 3 · 4:24](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=264)
- The presented case is probably the only case in the last 5 years of a microcystic CPAM that didn't respond to steroids at the speaker's center. (clinical) [Ep 3 · 4:51](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=291)
- Complete uterine relaxation with deep inhalational anesthetic is required before touching the uterus in fetal surgery. (clinical) [Ep 3 · 5:44](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=344)
- If there is an anterior placenta, a posterior uterine incision is required, which necessitates dividing the rectus muscle and doing a bigger abdominal incision. (clinical) [Ep 3 · 7:27](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=447)
- IV access is extremely important in fetal surgery to allow resuscitation, transfusions, and other interventions. (clinical) [Ep 3 · 8:00](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=480)
- Continuous echocardiographic monitoring of the fetal heart by a scrubbed cardiologist is an invaluable component of fetal surgery. (clinical) [Ep 3 · 8:17](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=497)
- When tumors are decompressed out of the chest during fetal surgery, the fetus can become bradycardic due to loss of preload on the heart. (clinical) [Ep 3 · 8:40](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=520)
- Fetuses are usually preloaded via IV before chest decompression to prevent bradycardia. (clinical) [Ep 3 · 8:49](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=529)
- Amniotic fluid is replaced with warm lactated Ringer solution during fetal surgery. (clinical) [Ep 3 · 9:05](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=545)
- A three-layer closure of the uterus is performed after fetal surgery to prevent amniotic fluid leakage and control the membranes. (clinical) [Ep 3 · 9:36](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=576)
- Open fetal surgery is required very rarely for lung lesions. (clinical) [Ep 3 · 9:48](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=588)
- The fetus in the presented case was delivered at 35 weeks without ventilation required and showed good compensatory lung growth at 3.5 weeks post-op. (clinical) [Ep 3 · 9:58](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=598)
- At CHOP, overall survival for open fetal surgery for lung lesions is around 60%, consistent over all years. (epidemiological) [Ep 3 · 10:20](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=620)
- Survivors of open fetal surgery have good quality of life outcomes with no major neurologic sequelae or other bad quality of life impacts. (clinical) [Ep 3 · 10:30](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=630)
- Losses in open fetal surgery are usually kids that have gone too far with their hydrops and can't tolerate the procedure or have early preterm labor. (clinical) [Ep 3 · 10:44](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=644)
- Macrocystic CPAMs are less predictable, and even patients with CVR less than 1.6 will occasionally grow rapidly and induce hydrops. (clinical) [Ep 3 · 10:58](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=658)
- In the presented macrocystic CPAM case, a thoracoamniotic shunt converted CVR from 3.6 to 0.8 and reversed the associated hydrops. (clinical) [Ep 3 · 11:18](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=678)
- Many CPAMs have a large solid component, and the shunt can't entirely decompress that, but can still reverse the hydrops. (clinical) [Ep 3 · 11:43](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=703)
- The shunt experience has been about 70% survival. (epidemiological) [Ep 3 · 11:53](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=713)
- Losses after shunt placement are usually due to early delivery and associated prematurity, inadequate compensatory lung growth, or sometimes residual mass effect requiring invasive treatment. (clinical) [Ep 3 · 11:57](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=717)
- Marked chest wall deformity can occur if shunts are placed for giant macrocystic CPAMs early in gestation, most prominent when shunts are done at 18 to 20 weeks. (clinical) [Ep 3 · 12:13](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=733)
- Chest wall deformity from early shunt placement is related to collapse of the chest wall as opposed to the harpoon placement of the shunt. (opinion) [Ep 3 · 12:34](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=754)
- Chest wall deformity from shunt placement becomes less pronounced over time, and thus far affected children haven't required chest reconstructive procedures. (clinical) [Ep 3 · 12:41](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=761)
- CPAMs with multiple macrocysts generally communicate, so placement of a shunt can decompress those lesions dramatically. (clinical) [Ep 3 · 13:09](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=789)
- Ascites alone is not considered hydrops. (clinical) [Ep 3 · 13:28](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=808)
- The EXIT procedure is designed to maintain uteroplacental blood flow during delivery and resection of the mass. (clinical) [Ep 3 · 13:56](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=836)
- Infants can be maintained with normal blood gases for an hour and a half by a well-performed EXIT procedure. (clinical) [Ep 3 · 15:36](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=936)
- CHOP has performed 16 EXIT procedures for lung lesions, with 4 requiring ECMO and 15 survivors. (epidemiological) [Ep 3 · 15:44](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=944)
- ECMO is a very unusual requirement for lung lesions because of their late enlargement, so they don't have the same effect on lung hypoplasia as CDH. (clinical) [Ep 3 · 15:49](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=949)
- Fetal intervention with twins is generally considered a contraindication. (clinical) [Ep 3 · 16:19](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=979)
- EXIT procedures are much trickier when you have twin gestations. (opinion) [Ep 3 · 16:27](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=987)
- The majority of kids with large CPAMs at birth don't need EXIT procedures and can be managed with C-section and immediate resection. (clinical) [Ep 3 · 17:48](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1068)
- EXIT procedures are reserved for kids where you see mass effect with diaphragmatic aversion, can't visualize the opposite lung easily, or have dramatic mediastinal shift. (clinical) [Ep 3 · 18:01](https://origin-library.globalcastmd.com/watch/prenatal-management-of-cpams-lung-lesions-1089?t=1081)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A recent JPS study comparing early (approximately 3 months) versus later (approximately 18 months) CCAM resection found increased risk of complications like infection with delayed resection but no difference in long-term pulmonary function outcomes — Alan summarizing the discussion [Ep 1 · 15:33](https://origin-library.globalcastmd.com/watch/postnatal-management-of-lung-lesions-part-ii-pediatric-thoracic-surgery-419?t=933)

## Changelog
- Sep 9: 1 item added automatically
- Sep 9: 1 item no longer name bronchopulmonary sequestration
- Sep 8: 1 item added automatically
- Sep 8: 1 item no longer name bronchopulmonary sequestration
- Sep 7: 3 items added automatically

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