# Congenital Heart Disease — GCMD Library living collection

Everything in the library about congenital heart disease — built automatically from dossiers that name it.

Updated: n/a · 6 episodes · 84 cited statements

## Episodes
### Complications
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in th](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127.md)
- [Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery...](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128.md)

### Case-Based Learning
- [EUPSA Webinar "GIANT OMPHALOCELE II"](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651) — video · 1:04:07 · [machine version](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651.md)

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

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=0) Introduction and Psychosocial Framework for Fontan Patients (Ep 1)
- [4:32](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=272) Neurodevelopmental Issues and Mental Health Prevalence (Ep 1)
- [8:21](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=501) Case Presentation: 15-Year-Old Fontan Patient Background (Ep 1)
- [14:12](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=852) Case Presentation: Evaluation Results and Diagnoses (Ep 1)
- [18:31](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1111) Care Plan, Discussion, and Clinical Recommendations (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=0) Hemodialysis Outcomes After Infant Congenital Heart Surgery (Ep 5)
- [0:45](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=45) Introduction and speaker presentations (Ep 6)
- [7:31](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=451) Non-surgical silo technique presentation by Dr. Guelfund (Ep 6)
- [19:39](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1179) European multicenter research proposal (Ep 6)
- [24:30](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1470) ERNICA guideline development overview (Ep 6)
- [27:43](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1663) Rotterdam case presentation by Dr. Langenfeld (Ep 6)
- [39:21](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2361) Technical discussion and Q&A (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Psychosocial functioning is the interplay between psychological factors (internal processes including neurocognitive functioning, cognitive and intellectual functioning, executive functioning, mood, anxiety, temperament, and personality factors) and social factors (levels of social support including family supports, school supports for children, employment, social interactions with peers, community involvement, and areas where they may feel productive in their social roles). — Stacey Morrison (clinical) [Ep 1 · 1:42](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=102)
- The presence of a congenital heart defect, especially a Fontan, often results in enormous emotional and financial strain on families, with continual effects from ongoing medical care and routine disruptions. — Stacey Morrison (clinical) [Ep 1 · 2:40](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=160)
- Early life experiences of families with Fontan patients have profound impact and these experiences resonate across a lifetime. — Stacey Morrison (clinical) [Ep 1 · 3:11](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=191)
- Children with complex CHD are at risk of neurological and cognitive impairment, and Fontan patients may be especially vulnerable. — Stacey Morrison (clinical) [Ep 1 · 3:24](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=204)
- A multidisciplinary clinic at Children's includes psychology, developmental pediatricians, cardiologists, social work, education consultant, OT, nutrition, and speech and language professionals, focusing on evaluation, consultation, and coordination of care for especially vulnerable children followed into adulthood. — Stacey Morrison (clinical) [Ep 1 · 3:34](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=214)
- As adults, Fontan patients remain at risk for significant sequelae and face significant and very unique life stressors that place them at increased risk for ongoing distress. — Stacey Morrison (clinical) [Ep 1 · 4:13](https://origin-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, impairments in expressive and receptive language skills and written expression skills (including organization and planning of expression), executive functioning deficits (behavioral and metacognitive), flexible attention shifting problems (distractibility and hyperfocus), poor planning and organization problems, difficulty with time management, diminished fine and gross motor skills, working memory issues, and slowed processing speed. — Stacey Morrison (clinical) [Ep 1 · 4:32](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=272)
- A very high number of Fontan patients are left-handed (anecdotal observation). — Stacey Morrison (clinical) [Ep 1 · 5:44](https://origin-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 1 · 6:02](https://origin-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 as well as ADHD compared with their healthy control peers. — Stacey Morrison (epidemiological) [Ep 1 · 6:13](https://origin-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 in the general population. — Stacey Morrison (epidemiological) [Ep 1 · 6:29](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=389)
- The chronic impact over time of disruption contributes to PTSD risk, and parents early on also show signs of PTSD. — Stacey Morrison (clinical) [Ep 1 · 6:50](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=410)
- Mitigating psychosocial factors for adults with Fontan include differences in body image or perceptions of scarring, perceived health status or severity of disease, poor social support or social anxiety, performance anxiety, tendency to compare themselves and feel different than others with difficulties in social situations, communication skill deficits extending into adulthood, lack of awareness of how these factors impact self-adjustment and ability to interact with others and coping skills, perceived or real lack of independence, impulsivity or poor problem solving, ongoing difficulty maintaining employment for physical or psychological reasons, and contributing financial strain. — Stacey Morrison (clinical) [Ep 1 · 7:07](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=427)
- The case patient is a 15-year-old female with complex medical history resulting in a Fontan, who had feeding difficulties early on requiring a G-tube in early childhood. — Stacey Morrison (clinical) [Ep 1 · 8:43](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=523)
- Extra medical requirements such as G-tubes can contribute to changes in parent-child interactions and family dynamics. — Stacey Morrison (clinical) [Ep 1 · 9:06](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=546)
- The case patient has an extensive medication regimen, could verbalize her medication list, was very aware of all medications, and was reported to take them consistently; on adaptive scales, self-care and health management was really high. — Stacey Morrison (clinical) [Ep 1 · 9:16](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=556)
- Children and young adults who tend to be anxious do a really nice job of taking care of their healthcare regimen and are very hypervigilant about that area. — Stacey Morrison (clinical) [Ep 1 · 9:39](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=579)
- The case patient lives in a rural area with her mother and 16-year-old brother; parents are divorced (contentious early on), and she does not have consistent contact with her father. — Stacey Morrison (clinical) [Ep 1 · 10:05](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=605)
- The case patient had friends in school but recently moved, lost established friends, and her closest friend had moved away with no contact; the family as a whole is pretty isolated and mother is under quite a bit of stress. — Stacey Morrison (clinical) [Ep 1 · 10:21](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=621)
- The case patient just transitioned into high school with academic concerns surrounding reading comprehension, math reasoning, retention of complex academic information (especially abstract reasoning), and applied skills including written expression. — Stacey Morrison (clinical) [Ep 1 · 11:00](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=660)
- The case patient missed quite a bit of school for medical reasons (appointments and procedures), and over time there were increased days staying home because she didn't feel good, probably could have gone to school at least part of the day, which played into anxiety and comfort of being home. — Stacey Morrison (clinical) [Ep 1 · 11:09](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=669)
- Loss of school days results in losing instruction time, piled-up assignments, and missing social interaction and positive social experiences that contribute to sense of satisfaction and competency. — Stacey Morrison (clinical) [Ep 1 · 11:45](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=705)
- At presentation, the case patient was complaining of fluttering heart and a lot of somatic body pain; she denied anxiety when asked directly, but her mother reported she reported feeling panicky and was panting (significant signs of anxiety). — Stacey Morrison (clinical) [Ep 1 · 12:05](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=725)
- The case patient is described as very meek, very self-conscious, and often very keyed up or on edge; at school she would not ask for help and wanted to be under the radar if at all possible. — Stacey Morrison (clinical) [Ep 1 · 12:31](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=751)
- The case patient worried about missing assignments, which could lead to more procrastination and avoidance of school; she did not view herself as being as capable as peers, and any talk about differences led her to report feeling stupid or not smart. — Stacey Morrison (clinical) [Ep 1 · 12:44](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=764)
- During evaluation, the case patient presented as extremely polite, arrived a bit late, very cooperative, very soft-spoken, difficult to get her to engage, does not initiate; on verbal components there was a lot of query and exploring needed to get information; if not sure of an answer she was hesitant to take a guess; on nonverbal tasks her approach was disorganized; she seemed anxious and when things became more challenging she tended to shut down and become tearful, appeared embarrassed. — Stacey Morrison (clinical) [Ep 1 · 13:07](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=787)
- On the WISC-5 (standardized cognitive measure), the case patient's full-scale IQ is 82, which falls in the low average range when compared to other children her age. — Stacey Morrison (clinical) [Ep 1 · 14:18](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=858)
- The case patient's verbal index was in the average range, nonverbal in the low average range, and her weakest areas of performance were working memory and processing speed. — Stacey Morrison (clinical) [Ep 1 · 14:35](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=875)
- Academically, the case patient's stronger areas are basic phonetic decoding, reading accuracy, sentence completion, spelling, and numerical sequencing (basic rote skills). — Stacey Morrison (clinical) [Ep 1 · 14:57](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=897)
- The case patient has difficulty with higher-level reading comprehension, reading fluency (reads slowly, has to reread for accuracy of understanding), math calculation and reasoning, and listening recall. — Stacey Morrison (clinical) [Ep 1 · 15:10](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=910)
- In the classroom, the case patient often feels overwhelmed and very anxious, feels like she's behind the eight ball at all times, has difficult time processing what's being instructed (feels it's going too fast), doesn't ask questions, often does not bring home materials needed or actual assignment requirements because she has hard time copying from the board and keeping up with her planner. — Stacey Morrison (clinical) [Ep 1 · 15:27](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=927)
- Low-level organizational and processing issues contribute to further withdrawal and feeling of inadequacy in the case patient. — Stacey Morrison (clinical) [Ep 1 · 16:00](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=960)
- The case patient reports a high level of test anxiety, with her mind going blank and difficulty recalling any information. — Stacey Morrison (clinical) [Ep 1 · 16:11](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=971)
- Diagnostic rating scales (BRIEF - Behavior Rating Inventory of Executive Function) distributed to school personnel, mother, and patient showed significant executive dysfunction in areas of organization, planning, initiating, task persistence, and attention dysregulation. — Stacey Morrison (clinical) [Ep 1 · 16:33](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=993)
- The case patient met criteria for ADHD, predominantly inattentive presentation (not the hyperactive or impulsive components). — Stacey Morrison (clinical) [Ep 1 · 17:08](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1028)
- Additional ratings indicated significant levels of anxiety and somatic or health-related complaints, a lot of dysphoria, and sense of inadequacy, best represented with a diagnosis of generalized anxiety disorder. — Stacey Morrison (clinical) [Ep 1 · 17:17](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1037)
- The initial care plan included encouragement to pursue ongoing counseling (with the psychologist or options close to home); the family was very closed in and other than medically presenting were not really likely to come in, and despite voicing interest they did not come back for psychotherapy. — Stacey Morrison (clinical) [Ep 1 · 17:46](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1066)
- The school was willing to accommodate with a shortened school week (3 partial days per week) to allow time for medical planning and appointments while condensing core instruction time, with assistance in core instruction areas so the patient could demonstrate mastery without excessive assignments compiling. — Stacey Morrison (clinical) [Ep 1 · 18:38](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1118)
- All listed psychosocial factors (limited social support, low self-confidence and performance anxiety, isolation) are contributing factors to patient outcomes, with the relative importance dependent on where the family is at; isolation is a significant part because it plays into low sense of competency and further social withdrawal, not integrating back into the community. — Stacey Morrison (opinion) [Ep 1 · 19:48](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1188)
- Clinicians should assume that Fontan patients are going to have adjustment issues, which normalizes the challenges and gives credence to them, starting the conversation very early that emotional and mental support is a basic part of the care plan (equal opportunity, not selective for those not doing well). — Stacey Morrison (opinion) [Ep 1 · 21:08](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1268)
- Having conversations about mental health very early is important because there is still a lot of misconception about what that represents; conversations should start early with parents as well to normalize that they are juggling a lot and this disrupts work and the entire family. — Stacey Morrison (opinion) [Ep 1 · 21:48](https://origin-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 1 · 22:12](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=1332)
- The non-surgical silo technique was developed by Dr. Cristóbal Avello from Colombia approximately 20 years ago and modified by Dr. Guelfund's team starting 7 years ago — Miguel Guelfand (clinical) [Ep 6 · 8:27](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=507)
- In the series of 50 patients, 98% required only one surgery for closure — Miguel Guelfand (clinical) [Ep 6 · 11:20](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=680)
- The technique uses Duoderm hydrocolloid dressing shaped as a T, with the stem attached to the patient's skin and the flaps wrapped around the omphalocele — Miguel Guelfand (clinical) [Ep 6 · 13:00](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=780)
- The silo should be placed as soon as possible after birth to prevent the amnion from drying, which facilitates reduction — Miguel Guelfand (clinical) [Ep 6 · 12:34](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=754)
- Plastic umbilical cord clamps should be replaced with suture or elastic band, as the umbilical cord is not always the apex of the omphalocele — Miguel Guelfand (clinical) [Ep 6 · 13:59](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=839)
- The silo is reduced by 0.5 inch (1 centimeter) every day or every other day depending on the patient's respiratory condition — Miguel Guelfand (clinical) [Ep 6 · 14:53](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=893)
- In the first 2-3 years of using the protocol, patients were kept completely paralyzed and intubated; in the last 4-5 years, the protocol changed to sedation only with paralysis used only during silo reduction — Miguel Guelfand (clinical) [Ep 6 · 15:07](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=907)
- Amnion inversion is performed when the silo is completely flat, typically within 1-10 days, to test how the baby will tolerate primary closure — Miguel Guelfand (clinical) [Ep 6 · 16:07](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=967)
- In the 50-patient series, median silo reduction time was 5 days, amnion inversion time was 5 days, and time to closure was 12 days — Miguel Guelfand (clinical) [Ep 6 · 17:18](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1038)
- 95% of patients achieved anatomical closure without mesh; approximately 2-3 patients required mesh reinforcement and one required Gore-Tex mesh for closure — Miguel Guelfand (clinical) [Ep 6 · 16:48](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1008)
- Complications in the series included one hemoperitoneum (due to delayed silo placement on day 3-4 with dry amnion), three local infections treated with antibiotics, one high intra-abdominal pressure (resolved by retrieving reduction 1cm), and one central line infection — Miguel Guelfand (clinical) [Ep 6 · 17:50](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1070)
- There was no mortality related to the silo technique; four mortalities occurred related to other malformations — Miguel Guelfand (clinical) [Ep 6 · 18:24](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1104)
- The technique is a pushing mechanism, not pulling; all force goes into the abdomen rather than using traction to the ceiling — Miguel Guelfand (clinical) [Ep 6 · 43:51](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2631)
- Clinical signs are used to guide progression rather than direct intra-abdominal pressure measurement; the clinician observes the patient for 10-20 minutes after each reduction — Miguel Guelfand (clinical) [Ep 6 · 39:41](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2381)
- When progression is inadequate, complete paralysis for 24 hours over 7 days is used to facilitate reduction — Miguel Guelfand (clinical) [Ep 6 · 40:46](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2446)
- The amnion is not cleaned during dressing changes; only the skin is cleaned to ensure good traction of the Duoderm — Miguel Guelfand (clinical) [Ep 6 · 41:29](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2489)
- The silo is changed every 4-5 weeks because it loses traction as it gets wet — Miguel Guelfand (clinical) [Ep 6 · 41:29](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2489)
- Patients are not fed during the reduction phase to avoid bowel distention — Miguel Guelfand (clinical) [Ep 6 · 42:14](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2534)
- Amnion inversion should not be attempted until the silo is completely flat, as premature inversion will not be tolerated — Miguel Guelfand (clinical) [Ep 6 · 42:20](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2540)
- A protocol is being developed to use Botox from day one, and one patient has been treated with in utero Botox in Colombia — Miguel Guelfand (clinical) [Ep 6 · 42:38](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2558)
- Three patients with ruptured amnion at birth were treated by suturing the amnion and then placing the silo on top — Miguel Guelfand (clinical) [Ep 6 · 48:12](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2892)
- For narrow-neck mushroom-shaped defects, the technique can be attempted, but if no progression occurs within 7-10 days, the approach should be changed — Miguel Guelfand (clinical) [Ep 6 · 48:53](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2933)
- Component separation has been performed in 3 patients between 2 and 4 weeks of age with good results and no lateral hernias — Miguel Guelfand (clinical) [Ep 6 · 50:11](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3011)
- The first component separation cases were performed with a plastic surgeon experienced in the technique in larger patients — Miguel Guelfand (clinical) [Ep 6 · 50:48](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3048)
- For patients with severe pulmonary hypoplasia or cardiac conditions, the silo can be placed but reduction delayed for 5-7 days until the patient stabilizes, then progression is very slow and gentle — Miguel Guelfand (clinical) [Ep 6 · 52:24](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3144)
- Reduction rate varies by patient: some can tolerate 2 centimeters per day, others only 1 centimeter per week, depending on comorbidities and development of pulmonary hypertension — Miguel Guelfand (clinical) [Ep 6 · 54:28](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3268)
- Without sedation, the baby will continue putting pressure on the silo, and if feeding is started, bowel distention will occur, making the process take years rather than weeks — Miguel Guelfand (clinical) [Ep 6 · 58:49](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3529)
- The technique requires thoughtful discussion with NICU doctors and nurses about goals and time frames; if no progress occurs within 7 days, the approach should be changed — Miguel Guelfand (clinical) [Ep 6 · 47:20](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2840)
- Two centers in the US (Boston and Nationwide) have adopted the technique over the last 2 years with good results after virtual consultation for initial cases — Miguel Guelfand (clinical) [Ep 6 · 62:51](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3771)
- The Rotterdam case was a 35-week, 2400g female with giant omphalocele (8cm) containing liver, stomach, and small bowel, plus cardiac defect — Hester Langenfeld (clinical) [Ep 6 · 29:30](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1770)
- In the Rotterdam case, bladder pressure was 17 with some urination beside the catheter, and there was bulging of the Duoderm on the side — Hester Langenfeld (clinical) [Ep 6 · 31:42](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1902)
- The spatula moved upward on the liver side because tape at the ends caused the middle to distend when pressed — Hester Langenfeld (clinical) [Ep 6 · 32:13](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1933)
- On day 5, the omphalocele had yellow appearance but did not look infected; cultures were negative initially — Hester Langenfeld (clinical) [Ep 6 · 33:08](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=1988)
- The amnion leaked fluid, but cultures remained negative until later in the course — Hester Langenfeld (clinical) [Ep 6 · 34:00](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2040)
- Enteral feeding via nasogastric tube was started on day 12 while the defect was still large — Hester Langenfeld (clinical) [Ep 6 · 35:20](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2120)
- Botox was administered on day 15 due to concerns about achieving primary closure — Hester Langenfeld (clinical) [Ep 6 · 35:43](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2143)
- The patient was ventilated but not paralyzed throughout treatment, with CO2 consistently high at 8-10 — Hester Langenfeld (clinical) [Ep 6 · 35:59](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2159)
- Serratia infection occurred on the skin/sac but the patient was not systemically ill and did not receive antibiotics — Hester Langenfeld (clinical) [Ep 6 · 36:18](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2178)
- Attempted amnion inversion on days 23-30 resulted in blue legs, tachycardia, and CO2 rising to 12, requiring abandonment of closure attempt — Hester Langenfeld (clinical) [Ep 6 · 36:44](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2204)
- The patient had lung hypoplasia contributing to inability to tolerate closure — Hester Langenfeld (clinical) [Ep 6 · 37:08](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2228)
- On day 30, treatment was switched to Mepitel (silicone dressing), after which the patient was extubated 10 days later (day 40) — Hester Langenfeld (clinical) [Ep 6 · 37:18](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2238)
- By day 45, the patient was on Optiflow, drinking 20mL per feeding three times daily, with chronic hypercapnia (CO2 of 8) — Hester Langenfeld (clinical) [Ep 6 · 37:47](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=2267)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Stacey Morrison is a clinical psychologist working in adult congenital heart disease and the Fontan Clinic. — The host summarizes what Dr. Stacey Morrison said [Ep 1 · 0:03](https://origin-library.globalcastmd.com/watch/psychosocial-outcomes-new-horizons-in-medical-and-surgical-fontan-management-888?t=3)
- 1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 2 · 0:07](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=7)
- For infants that needed hemodialysis after congenital heart surgery, one-year survival was 46% — Lizzie Lee summarizing a resource [Ep 2 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=14)
- For infants that did not need hemodialysis after congenital heart surgery, one-year survival was 94% — Lizzie Lee summarizing a resource [Ep 2 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=14)
- Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis — Lizzie Lee summarizing a resource [Ep 2 · 0:23](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=23)
- Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 2 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=33)
- Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 2 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=33)
- Dialysis after infant heart surgery is rare — Lizzie Lee summarizing a resource [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=39)
- Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis — Lizzie Lee summarizing a resource [Ep 2 · 0:44](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12114?t=44)
- 1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 3 · 0:07](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=7)
- For infants needing hemodialysis after congenital heart surgery, one-year survival was 46% — Lizzie Lee summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=14)
- For infants not needing hemodialysis after congenital heart surgery, one-year survival was 94% — Lizzie Lee summarizing a resource [Ep 3 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=14)
- Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis — Lizzie Lee summarizing a resource [Ep 3 · 0:23](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=23)
- Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 3 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=33)
- Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 3 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=33)
- Dialysis after infant heart surgery is rare — Lizzie Lee summarizing a resource [Ep 3 · 0:39](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=39)
- Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis — Lizzie Lee summarizing a resource [Ep 3 · 0:44](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12117?t=44)
- 1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 4 · 0:07](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=7)
- For infants needing hemodialysis after congenital heart surgery, one-year survival was 46% — Lizzie Lee summarizing a resource [Ep 4 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=14)
- For infants not needing hemodialysis after congenital heart surgery, one-year survival was 94% — Lizzie Lee summarizing a resource [Ep 4 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=14)
- Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis — Lizzie Lee summarizing a resource [Ep 4 · 0:23](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=23)
- Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 4 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=33)
- Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 4 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=33)
- Dialysis after infant heart surgery is rare — Lizzie Lee summarizing a resource [Ep 4 · 0:39](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=39)
- Outcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis — Lizzie Lee summarizing a resource [Ep 4 · 0:44](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12127?t=44)
- 1% of infants develop severe acute kidney injury requiring dialysis after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 5 · 0:07](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=7)
- One-year survival for infants requiring hemodialysis after congenital heart surgery is 46% — Lizzie Lee summarizing a resource [Ep 5 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=14)
- One-year survival for infants not requiring hemodialysis after congenital heart surgery is 94% — Lizzie Lee summarizing a resource [Ep 5 · 0:14](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=14)
- Most infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis — Lizzie Lee summarizing a resource [Ep 5 · 0:23](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=23)
- Hospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 5 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=33)
- Hospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery — Lizzie Lee summarizing a resource [Ep 5 · 0:33](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=33)
- Dialysis after infant heart surgery is rare — Lizzie Lee summarizing a resource [Ep 5 · 0:39](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=39)
- Outcomes for infants requiring dialysis after heart surgery may improve when treated at centers with more experience in using dialysis — Lizzie Lee summarizing a resource [Ep 5 · 0:44](https://origin-library.globalcastmd.com/watch/practice-patterns-and-outcomes-of-hemodialysis-in-infants-undergoing-congenital-12128?t=44)
- According to literature, patients with giant omphalocele and lung hypoplasia requiring long-term ventilation have a median ventilation time of 100 days — Martin summarizing the discussion [Ep 6 · 53:43](https://origin-library.globalcastmd.com/watch/eupsa-webinar-giant-omphalocele-ii-13651?t=3223)

## Changelog
- Sep 26: 1 item added automatically
- Sep 8: 1 item added automatically
- Sep 7: Published again automatically — condition is back above threshold
- Sep 7: 1 item no longer name congenital heart disease
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 5 items added automatically

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