Editor – Dr. Hiner’s comments regarding the use of the Valsalva maneuver in the comprehensive assessment of the cardiovagal (Valsalva ratio) and adrenergic (blood pressure) functions of the autonomic nervous system are appreciated. The discussion in the article on Antonio Maria Valsalva1 was focused on the use of the Valsalva maneuver as part of the bedside technique for evaluating heart murmurs and heart failure; however, Dr. Hiner’s description of the Valsalva ratio and beat-to-beat blood pressure response in autonomic testing illustrates the laboratory applications of this technique.
In addition, the Valsalva maneuver has been used in multiple disciplines. For example, the use of the Valsalva maneuver during Doppler ultrasound examinations helps to improve the identification of patients with abnormalities such as lower extremity venous insufficiency, diastolic dysfunction, and patent foramen ovale.2 In urological examinations, the Valsalva maneuver is used to determine urethral competence (sphincter insufficiency) in patients with stress urinary incontinence3 and helps to identify varicoceles during male infertility testing.4
The Valsalva maneuver can also be used to assist in identifying lesions in the head and neck when they are not well delineated due to tumors abutting against mucosal surfaces.5 Other serious and life threatening complications have been identified by using the Valsalva maneuver. These include calvarial and upper cervical hyperpneumatization, pneumothorax, pneumomediastinum, and pneumoperitoneum, retinal, macular, and vitreous hemorrhages, and retinal vein occlusion.6 , 7 , 8
References
- 1↵Yale SH. Antonio Maria Valsalva (1666 – 1723). Clinical Medicine & Research 2005;3:35–38.
- 2↵Khouri SJ, Maly GT, Suh DD, Walsh TE. A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 2004;17:290–297.
- 3↵Daneshgari F. Valsalva leak point pressure: steps toward standardization. Curr Urol Rep 2001;2:388–391.
- 4↵Belker AM. The varicocele and male infertility. Urol Clin North Am 1981;8:41–51.
- 5↵Henrot P, Blum A, Toussaint B, Troufleau P, Stines J, Roland J. Dynamic maneuvers in local staging of head and neck malignancies with current imaging techniques: principles and clinical applications. Radiographics 2003;23:1201–1213.
- 6↵Littrell LA, Leutmer PH, Lane JI, Driscoll CL. Progressive calvarial and upper cervical pneumatization associated with habitual valsalva maneuver in a 70-year-old man. AJNR Am J Neuroradiol 2004;25:491–493.
- 7↵Chapman-Davies A, Lazarevic A. Valsalva maculopathy. Clin Exp Optom 2002;85:42–45.
- 8↵Kadrmas EF, Pach JM. Vitreous hemorrhage and retinal vein rupture. Am J Ophthalmol 1995;120:114–115.
