Hemodynamics of the Mueller maneuver in man: right and left heart micromanometry and Doppler echocardiography

• Published in: Circulation (New York, N.Y.) Vol. 76; no. 5; pp. 1020 - 1028
• Main Authors: CONDOS, W. R. JR, LATHAM, R. D, HOADLEY, S. D, PASIPOULARIDES, A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.11.1987
• Subjects: Adult; Biological and medical sciences; Blood Flow Velocity; Blood Pressure; Cardiac Catheterization; Cardiac Output; Cardiac Volume; Cardiovascular system; Echocardiography; Female; Heart - physiology; Hemodynamics; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Manometry; Medical sciences; Middle Aged; Pulmonary Artery - physiology; Pulmonary Wedge Pressure; Respiration; Stroke Volume; Doppler ultrasound study; Human; Echocardiography; Catheterization; Ultrasonic investigation; Cardiovascular disease; Pressure; Left heart; Inspiratory flow resisting load; Lung function; Right heart; Hemodynamics; Forced inspiration
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.76.5.1020

Ten subjects with normal hemodynamics were studied during elective cardiac catheterization with right and left heart multisensor micromanometry to assess hemodynamic responses to the Mueller maneuver. Simultaneous right and left circulatory hemodynamics and left ventricular, pulmonary arterial, and aortic pressures were recorded, in addition to pulmonary arterial and aortic flow velocities. Steady-state cardiac outputs were determined by thermal dilution. Aortic systolic and mean pressures were not significantly changed during the Mueller maneuver, in contrast to a lower diastolic (p = .019) and higher pulse pressure (p = .016). Mean right atrial pressure (+/- SE) decreased from 7 +/- 1 to -17 +/- 4 mm Hg (p = .0002) and the right atrial "x" descent was markedly accentuated. Left ventricular end-diastolic pressure decreased from 12 +/- 4 to -3 +/- 13 mm Hg (p = .0025). Systemic vascular resistance and left ventricular peak positive dP/dt were increased during the Mueller maneuver (p less than .02), cardiac output and stroke volume were reduced (p less than .05), and there was no significant change in heart rate. Right and left peak flow velocities showed a trend toward a bilateral decrease (right, p = .054; left, p greater than .1), and times to peak flow velocity were increased in the pulmonary artery (p = .007) and reduced in the aortic root (p = .03). Normal subjects were studied separately by pulsed Doppler echocardiography. During the sustained Mueller maneuver, the internal jugular and right ventricular dimensions decreased, and superior vena cava Doppler flow was reduced.