The effects of the Valsalva-like maneuver upon the circulation in normal individuals and patients with mitral stenosis.

A Valsalva-like maneuver was performed during cardiac catheterization by a normal group of individuals and a group of patients with acoustic evidence of mitral stenosis. The latter group was subdivided according to its response to the maneuver. The mild group, like the normal group, showed an "overshoot" of blood pressure and a bradyeardia in the post-straining period, whereas the severe mitral stenosis group did not. The relatively undisturbed dynamics of the mild mitral stenosis group, in contrast to the marked disturbance in the severe group. was felt to be due to the amount of obstruction at the mitral valve. Additional data from the cardiac catheterizations of these patients is presented to substantiate this concept. This simple maneuver may prove to be a bedside method for the evaluation of the dynamic significance of mitral stenosis. T HE DYNAMIC effects of mitral stenosis have been the subject of many investigations. The circulatory disturbances produced by it have long been known, chiefly through animal experimentation.', 2 Recently, data accumulated by means of right heart catheterization have confirmed and expanded these observations.3-' Clinically, patients with mitral stenosis may be seen with little, if any, changes in their cardiovascular systems. With the possibility of surgical intervention, the need of assaying the magnitude of the stenosis has become obvious recently. This was recognized some years ago, when it was pointed out that the mitral valve area must be reduced at least 50 per cent in animals before its diverse effects upon the systemic circulation become evident.' Attempts have been made in man by elaborate formulas to arrive at a similar judgment .8 The simple method of measuring the stenotic index suggested by this department for pulmonary stenosis' may also be applied to mitral stenosis. In the course of a recent investigation of the relationship of respiration to cardiovascular dynamics, we studied the effects of a Valsalva-(l1 21SC). 38 like maneuver upon the circulation. The response in patients with dynamically significant mitral stenosis was distinctly different from the response in patients with lesions of little or no dynamic significance and in normal individuals. These observations suggest that this Valsalva-like maneuver with certain simple measurements might be a useful adjunct in establishing the dynamic significance of a deformed mitral valve. The present report bears on this promising lead. MATERIAL The individuals comprising this study were selected from the Cardiac Clinic and Meledical Wards of the Michael Reese Hospital. …