Feasibility of party balloon inflation manoeuvre for haemodynamic provocation: a pilot study in healthy volunteers

TL;DR

A new maneuver using a party balloon is tested as a better alternative to the Valsalva maneuver for diagnosing heart conditions.

Contribution

The party balloon inflation maneuver is proposed as a more effective diagnostic tool for HOCM and PFO compared to the Valsalva maneuver.

Findings

PBIM significantly reduced left ventricular diastolic dimension compared to VM, indicating greater LVOT obstruction provocation.

PBIM increased right ventricular inflow velocity-time integral, suggesting enhanced right-to-left shunting.

Abstract

Left ventricular outflow tract (LVOT) obstruction is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), whereas patent foramen ovale (PFO) obstruction is associated with cryptogenic stroke and other conditions. The Valsalva manoeuvre (VM) is a standard technique for diagnosing these conditions; however, its inconsistent execution can limit diagnostic accuracy. We aimed to evaluate the party balloon inflation manoeuvre (PBIM) as an alternative to VM for diagnosing HOCM and PFO by comparing their haemodynamic effects.

In this single-centre pilot study, we conducted in vitro and in vivo experiments. The pressure characteristics of the two balloon sizes were measured in the in vitro experiment. In the in vivo study, we assessed haemodynamic changes in 25 healthy volunteers using transthoracic echocardiography. The endpoints included the left ventricular diastolic dimension (LVDd) for HOCM and the right ventricular inflow velocity-time integral (RV inflow-VTI) for PFO. PBIM significantly reduced LVDd compared with VM, indicating greater LVOT obstruction provocation (P < 0.01). The RV inflow-VTI was also significantly higher with PBIM, suggesting increased venous return and enhanced right-to-left shunting (P < 0.01). The heart rate and perceived exertion scores were higher with the PBIM, reflecting a greater physiological load.

PBIM is a simple, effective, and reliable alternative to VM for diagnosing HOCM and PFO, offering clear visual feedback and improved diagnostic performance. Further research in patient populations is required to confirm these findings.

Trial registration number: UMIN000054423.

(https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000062098&type=summary&language=J).

Graphical Abstract

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