José Manuel Rivero-Carvallo

José Manuel Rivero Carvallo

José Manuel Rivero Carvallo (1905-1993) was a Mexican cardiologist.

Rivero-Carvallo dedicated his life to the study of the tricuspid valve and made significant contributions to it’s pathology and mechanics.

Rivero-Carvallo is eponymously remembered for his 1946 description of the Rivero Carvallo manouver to assist in the clinical evaluation of tricuspid stenosis and regurgitation.

  • Born on April 1, 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 apneoa.
  • 1951 – Described ‘atrium papyraceum‘ for thinning of the right atrial wall in patients with chronic tricuspid stenosis.
  • Died 1993

Medical Eponyms
Rivero-Carvallo manouver / 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.

The murmur of tricuspid insufficiency is a holosystolic murmur which increases in intensity with inspiration. When listening to the murmur you will notice the variation of the intensity of the murmur, the moment it is intensified is during the inspiration, as in inspiration there is a greater return of volume to the right cavities which increases the intensity of the murmur. Luis Lasso Rodríguez

1946 – Described intensification of tricuspid regurgitation (systolic) murmur during inspiratory apnea and published Signo para el diagnóstico de las insuficiencias tricuspídeas

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 – Rivero-Carvallo 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.

Major Publications



Eponymous terms


BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

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