Aortico-right ventricular tunnel was successfully corrected in a 15-month-old child. Both the aortic and right ventricular openings were closed with pledgeted sutures. The coronary artery anatomy was normal. At 12-month follow-up the patient is in excellent clinical condition. Before surgical intervention for aortico-right ventricular tunnel is undertaken, every effort should be made to diagnose the coronary artery anatomy, because failure to do so in the case of aberrant origin of a coronary artery may prevent successful surgical correction.
Background/Objectives Progression of retinopathy of prematurity (ROP) is associated with increased retinal blood flow velocities. We investigated changes of central retinal arterial and venous blood flow after intravitreal administration of bevacizumab. Subjects/Methods Prospective observational study using serial ultrasound Doppler imaging in preterm infants with bevacizumab-treated ROP. Eyes were examined 1 [0–2] days before injection (median [interquartile range]), and at three time points after injection (1 [1–2] days, 6 [3–8] days, and 17 [9–28] days). Preterm infants with ROP stage 2 displaying spontaneous regression served as controls. Results In 21 eyes of 12 infants with bevacizumab-treated ROP, peak arterial systolic velocity declined from 13.6 [11.0-16.3] cm/s prior to intravitreal bevacizumab to 11.2 [9.4–13.9] cm/s, 10.6 [9.2–13.3] cm/s and 9.3 [8.2–11.0] cm/s at discharge ( p = .002). There was also a decline of the arterial velocity time integral (from 3.1 [2.3–3.9] cm to 2.9 [2.4–3.5], 2.7 [2.3–3.2] cm and 2.2 [2.0–2.7], p = .021) and mean velocity in the central retinal vein (from 4.5 [3.6–5.8] cm/s to 3.7 [2.6–4.1] cm/s, 3.5 [3.0–4.3] cm/s, and 3.2 [2.8–4.6] cm/s, p = .012). Arterial end-diastolic velocity and resistance index remained unchanged. Blood flow velocities in bevacizumab-treated eyes examined before injection were significantly higher than those measured in untreated eyes that ultimately showed spontaneous regression of ROP. Sequential examinations in these controls did not reveal any declines of retinal blood flow velocities. Conclusion Increased retinal arterial and venous blood flow velocities in infants with threshold ROP decline following intravitreal bevacizumab injection.
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