Which maneuver negates the effect of deep inspiration on arcuate ligament compression?

• A. Valsalva maneuver
• B. Deep expiration
• C. Standing breath-hold
• D. Hyperventilation

Answer: (A)

During deep inspiration the diaphragm moves downward and the median arcuate ligament tends to move away from the celiac trunk, reducing extrinsic compression. To negate that relief and re-create the constriction, the Valsalva maneuver is used. Forcing expiration against a closed glottis raises intrathoracic and intraabdominal pressure, drives the diaphragm upward again, and makes the ligament re-contact the aorta, restoring the compression. This is why a Valsalva maneuver is the best choice to provoke MAL-related narrowing even after deep inspiration.