José Manuel Rivero Carvallo (1905 – 1993) was a Mexican cardiologist.
Extensive contributions to the pathology and understanding of the tricuspid valve
Eponymously remembered for 1946 description of Rivero Carvallo manouver to accentuate clinical evaluation of tricuspid regurgitation.
- Born 1 April 1905 Tehuacán, Mexico
- 1928 – Medical school, city of Puebla
- 1932 – Doctorate, University of the Sorbonne. Thesis: ‘La pression artérielle au tours de l’anesthésie et de certaines interventions chirurgicales‘
- 1933 – Intern, Hôpital de la Pitié with Louis Henri Vaquez
- 1934 – Cardiology, Mexico’s General Hospital with Ignacio Chávez Sánchez (1897-1979) – founder of establish the first cardiology, cardiology journal, and cardiology hospital in Mexico.
- 1944 – Founding member of the National Institute of Cardiology (INC) of Mexico
- 1946 – Described intensification of tricuspid regurgitation (systolic) murmur during inspiratory apeoa.
- 1951 – Described ‘atrium papyraceum’ for thinning of the right atrial wall in patients with chrinic tricuspid stenosis.
- Died 1993
Rivero-Carvallo sign (1946)
Accentuation of the murmur of tricuspid regurgitation and tricuspid stenosis with inspiration. Auscultation is performed during post-inspiratory apnoea and the loudness of the systolic murmur is compared to its loudness during post-expiratory apnoea.
Rivero-Carvallo manouver (sign) (1946)
With the patient in a seated position, they are requested take a deep inspiration and hold breath (inspiratory apnoea) whilst the examiner listens over the tricuspid area (left lower sternal border)
Key Medical Attributions
1946 – Described intensification of tricuspid regurgitation (systolic) murmur during inspiratory apnea (Rivero-Carvallo manouver)
1951 – Noted that tricuspid stenosis murmurs may require several inspiratory efforts to accentuate the murmur in inspiration. On examining the clinical findings of tricuspid stenosis during life and comparing directly to the autopsy findings post mortem he described ‘atrium papyraceum‘ for thinning of the right atrial wall in patients with chronic tricuspid stenosis.
1962 – Described the ‘sign of the double apical thrust‘ in patients with chronic tricuspid acoustic phenomena shifted to the left. Following pathological and clinical observations he concluded that, in chronic disease, the right atrium and ventricles enlarge, rotating the heart clockwise along its longitudinal axis and counterclockwise along its transverse axis, with the right ventricle occupying the anterolateral aspect of the chest. He designed a manouver to determine the ‘true’ apex:
The patient is placed on his back and the apex area is located. The palm of the hand is placed over this area while the fingertips are placed from the fourth to the seventh intercostal spaces at the level of the left axillary line. Without separating the hand, the patient is asked to turn to his left, at which time a new apical thrust appears under the tips of the explorer’s fingers, identifying the true apex.
- Rivero-Carvallo JM. Signo para el diagnóstico de las insuficiencias tricuspídeas [A sign for the diagnosis of tricuspid insufficiency]. Arch Inst Cardiol Mex. 1946; 16: 531–540.
- Rivero-Carvallo JM. Semiología de las lesiones tricuspídeas [in Spanish]. Arch Inst Cardiol Mex. 1951; 21 567–593.
- Rivero-Carvallo JM, Garza de los Santos A. Real and apparent apical impulse in tricuspid lesions: differentiation of mitral and tricuspid murmurs and sounds. Am J Cardiol. 1959; 4 367–372.
- Rivero-Carvallo JM. El diagnóstico de la estenosis tricuspídea [in Spanish]. Arch Inst Cardiol Mex. 1950; 20 1–11.
- Rivero-Carvallo JM, Ramírez-Jaime H. El diagnóstico de la aurícula papirácea [The diagnosis of papyraceous auricle]. Arch Inst Cardiol Mex. 1966; 36: 464–482.
- Rivero-Carvallo JM, Ramírez-Jaime H. Atrium papyraceum: the clinical diagnosis of the paper-thin right atrium. Am J Cardiol. 1965; 16 369–378.
- Rivero-Carvallo JM. El signo de doble choque apexiano [in Spanish]. Arch Inst Cardiol Mex. 1962;32:387–399.
- de Micheli A. Centenary of the birth of a distinguished Mexican cardiologist, Dr. José Manuel Rivero Carvallo. Arch. Cardiol. Mex. vol.75 no.1 Mexico Jan./mar. 2005
- Soto-Perez-de-Celis E. José Manuel Rivero-Carvallo and the Tricuspid Valve. Clin Cardiol. 2011 Mar;34(3):E9-11.
- Robbins A, Zhang G. Name that murmur. LITFL 2019
the person behind the name