Kyphoscoliosis: angiocardiographic findings.

Abstract

The deformities of the spine and thoracic cage in kyphoscoliosis are evident by conventional roentgenography. The distortion of the cardiac silhouette is also frequently pronounced, but without the aid of angiocardiography it is difficult to identify specific chambers or vessels. Angiocardiography in several cases of severe kyphoscoliosis clearly revealed the anatomical changes. In persons with severe kyphoscoliosis, pulmono-cardiac failure usually develops. This condition is a distinct entity, not to be confused with the congenital heart disease often associated with scoliosis. Right heart failure occurs secondary to the pulmonary and cardiac changes brought about by the thoracic deformity. In kyphoscoliosis, the principal changes in the lungs are areas of compression and emphysema and decreased lung volume due to the misshapen thorax. In addition, probably because of interference with lung drainage due to the distorted bronchi and limitation of costal movement, recurrent pulmonary infections are common. At postmortem examination the typical changes of cor pulmonale, i.e., right ventricular dilatation and hypertrophy and pulmonary artery enlargement, have been reported in 75 per cent of cases of severe kyphoscoliosis (1, 2, 3). It has been suggested that kinking or twisting of the great vessels may also be responsible for certain signs and symptoms (4). In conventional roentgenography typical changes in the cardiac silhouette have been noted (4). Cardiac displacement to the left is common in right scoliosis. There are often a prominent pulmonary artery segment and lack of prominence of the aortic knob. The variations in the silhouette are many, and in many instances it is not possible to identify clearly the specific mediastinal structures. Angiocardiographic Findings Angiocardiographic examination in four patients with severe kyphoscoliosis revealed bizarre cardiovascular configurations which varied from case to case. As a rule, the cardiovascular structures accommodated to the deformity of the thorax. The cardiac chambers and great vessels were tipped and rotated but not apparently compressed. Decrease in the vertical diameter of the thorax may cause the apex of the heart to be tipped upward and the base depressed. In extreme cases, the heart may lie in an almost horizontal position (Fig. 2). Our cases all exhibited kyphoscoliosis with a convexity to the right (the most frequent type of deformity). This thoracic configuration caused the heart to rotate, so that it resembled the projection usually seen in the right anterior oblique position (Fig. 1). In one case (5) the base of the heart was displaced to the right, and the apex was elevated and pointed to the left. The heart was also rotated to the right anterior oblique position. This caused the left atrium to be displaced to the right in relation to the left ventricle in the frontal projection.