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ARTICLE:
Sandra Herr, Mary C. Pierce, Rachel P. Berger, Henri Ford, and Raymond D. Pitetti
Does Valsalva Retinopathy Occur in Infants? An Initial Investigation in Infants With Vomiting Caused by Pyloric Stenosis
Pediatrics 2004; 113: 1658-1661 [Abstract] [Full text] [PDF]
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[Read eLetters] HPS Unlikely Model for Valsalva Retinopathy
Anthony Shaw   (19 May 2005)

HPS Unlikely Model for Valsalva Retinopathy 19 May 2005
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Anthony Shaw,
pediatric surgeon
emeritus prof UCLA

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Re: HPS Unlikely Model for Valsalva Retinopathy

shawpas{at}pacbell.net Anthony Shaw

Herr, et al report the absence of retinal hemorrhage in a series of 100 infants with vomiting caused by hypertrophic pyloric stenosis (HPS) and conclude that "Valsalva retinopathy does not occur in infants". In my experience as a pediatric surgeon, I have observed many babies with HPS and it seems to me that their projectile vomiting does not involve a Valsalva maneuver, but rather is the consequence of retrograde ejection of gastric contents generated by the compressive force of their hypertrophic, hyperperistaltic stomachs against a chronically obstructed pylorus - an action that does not call into play the abdominal and thoracic muscles employed in the Valsalva maneuver. Although the authors' data may support a hypothesis that infants with HPS are unlikely to have retinal hemorrhage, their conclusion that "Valsalva retinopathy does not occur in infants" cannot be drawn from this patient population in my opinion.

Conflict of Interest:

None declared