An asymptomatic 45-year-old man was referred to our hospital for detailed evaluation of a systolic ejection murmur. The intensity of the murmur increased on deep expiration and decreased on deep inspiration, showing so-called reversed Rivero-Carvallo's sign. Using cardiac magnetic resonance imaging, we demonstrated a characteristic respiratory-induced change in peak flow velocity in the right ventricular outflow tract, which was the basic mechanism of the reversed Rivero-Carvallo's sign in a case with straight back syndrome. Concomitant anatomical changes in the entire heart in relation to the thoracic cage were also clarified.
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