Influence of the Valsalva maneuver on cardiac hemodynamics and right to left shunt in patients with patent foramen ovale

Abstract

The purpose of this study was to investigate the influence of the Valsalva maneuver (VM) on cardiac hemodynamics in patients with patent foramen ovale (PFO). Sixty-five patients who were highly suspected to have PFO were included. The changes in E, A, E/A ratio of mitral valve blood flow, E, A, E/A ratio of tricuspid valve blood flow, left ventricular end-diastolic volume, area and right atrial area during the resting state and the strain phase of the Valsalva maneuver were observed by transthoracic echocardiography (TTE). Statistical analyses were performed using SPSS Version18.0. Compared to the resting state, mitral valve diastolic velocity E and A peaks at the strain phase of the Valsalva maneuver significantly decreased (P < 0.05), left ventricular end diastolic volume(LVEDV) and area(LVEDA) decreased significantly (P < 0.05), while E/A ratio of mitral valve, tricuspid valve systolic velocity E and A peaks and E/A ratio remained unchanged (P > 0.05). PFO hemodynamic changes mainly occurred in the left ventricle when the Valsalva maneuver was performed. The Valsalva maneuver increased pressure in the chest, then pulmonary venous return was impeded, which resulted in left ventricular limited filling, and E and A peaks decreased. The pressure of the left ventricle and atrium was lower than that of the right side, which resulted in right-to-left shunt (RLS) through PFO.

Migraine and Ischemic Stroke: Deciphering the Bidirectional Pathway

“…PFO is a common abnormality in which the primum and secundum atrial septa do not merge and closure remains incomplete . The foramen ovale might be open persistently or functionally because of abrupt changes in intrathoracic pressure from the Valsalva maneuver . The transitory change in pressure may allow the venous system to directly communicate with the arterial system, which will allow a paradoxical embolus or microbubble to traverse from the venous to the arterial system .…”

“…115 The foramen ovale might be open persistently or functionally because of abrupt changes in intrathoracic pressure from the Valsalva maneuver. 116 The transitory change in pressure may allow the venous system to directly communicate with the arterial system, which will allow a paradoxical embolus or microbubble to traverse from the venous to the arterial system. 117 Paradoxical emboli seem to have a tendency for the posterior circulation, the area in which hypoperfusion occurs during an MA attack.…”

Purtscher-like retinopathy following a bowel movement

“…When a PFO is present, Valsalva leads to increased right to left cardiac shunting which could allow microemboli to pass into the arterial circulation and lead to Purtscher-like retinopathy from a distant embolic cause. 8 Neurology and cardiology were consulted during this patient's work-up and felt that this was less likely as there was no known embolic source, no other sequelae from embolic disease, and the PFO was small. In cases where the cause or inciting factor of Purtscher-like retinopathy is unclear, a broad systemic work-up is warranted given that various life-threatening pathologies can be the cause, such as pancreatitis, pancreatic adenocarcinoma, embolism, blood dyscrasias, and renal failure.…”

Modified Method of Contrast Transthoracic Echocardiography for the Diagnosis of Patent Foramen Ovale

“…However, the traditional Valsalva maneuver is performed by expiration against a closed nose and mouth[15, 16]. Several studies have recently reported the clinical practice use of a modified Valsalva maneuver, which use a device to monitor the effectiveness of the Valsalva maneuver[12, 17–22]. At present, there are few studies comparing diagnostic sensitivity in the traditional and modified Valsalva maneuvers.…”