Effects of Various Maneuvers on the Right and Left Atrial Pressures

This study aims to determine the most effective maneuver, increasing pressure gradient between the right and left atrium, using the simultaneous right and left atrial pressure records. Thirty-two coronary care unit patients, in whom a Swan-Ganz catheter was inserted because of acute left ventricular dysfunction, hypotension, sinus tachycardia with unknown cause, were included in this study. The basal values of right atrium (RA) pressure and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were trained with several trials to perform breath holding, successive three strong coughs, Valsalva maneuver, 20° head-down, respectively. In the end of these maneuvers, the highest RA pressure and PCWP were recorded simultaneously.
RESULTS
All maneuvers caused an increase in right atrial pressure. The highest mean RA pressure was obtained by means of the Valsalva maneuver (7.6±5 versus 20.4±7.6 mmHg before and after Valsalva, respectively; p<0.001). PCWP (18.8±5.9 mmHg) increased only with coughing (21.2±6.7 mmHg, p<0.01) and 20° head-down maneuver (20±5.7 mmHg, p<0.05). The highest increase in pressure gradient between mean RA pressure and PCWP was observed during the Valsalva maneuver (-11±6.6 versus 2.3±5.9 mmHg, p<0.001). The lowest increase was obtained in 20° head-down maneuver (-11±6.6 versus -8.5±5.8 mmHg, p<0.001).
CONCLUSION
The Valsalva maneuver appears to be the most effective maneuver causing increase in the pressure gradient between the right and left atrium.