Dynamic left ventricular outflow tract obstruction as a complication of severe kyphosis: Jeopardy of the excessive thoracic kyphosis

摘要

Hyperkyphosis is a commonly recognized clinical finding in the aging population. This disorder may be independently associated with an increased risk for adverse health outcomes, including impaired pulmonary function, decreased physical function capabilities, and future fractures. We recently met a patient who had a dynamic left ventricular outflow tract (LVOT) obstruction as a complication of severe kyphosis. A 58-year-old woman with kyphosis presented with dyspnea which was gradually worsened after diarrhea and poor diet She had tachycardia, tachypnea, and an early systolic murmur. Chest x-ray showed extreme foreshortening and widening of the cardiac silhouette (Fig. 1A). Severe kyphosis was identified by spine films (Fig. IB). Her spine films showed an exaggerated thoracic kyphosis with anterior wedging of the thoracic vertebrae. Transthoracic echocardiography showed systolic anterior motion (SAM) of a mitral valve with LVOT obstruction (Fig. 1C and Videos 1 -3). The peak pressure gradient recorded with continuous-wave Doppler was80mmHg(Fig.lD).