Ventricular Inversion Clinical Presentation

Updated: Jan 28, 2021
  • Author: Ira H Gessner, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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History and Physical Examination


The history in patients with ventricular inversion reflects associated heart defects, including conduction abnormalities.

Most patients present in infancy with a clinically significant heart murmur.

Physical examination

Physical findings reflect the associated heart defect, if any, and its effects (eg, cyanosis, heart failure) on the patient.

The physical findings are not likely to suggest ventricular inversion if an associated defect is absent, though some subtle observations may provide a clue.

Anterior and leftward location of the ascending aorta may result in a palpable brisk systolic impulse in the second left intercostal space. Because the aorta is anterior, the aortic component of the second heart sound (S2) is louder than usual. Because the pulmonary artery is posterior, the pulmonic component of S2 is softer than usual.

Variation in the splitting interval of S2 occurs with respiration, but with a notable modification. The left ventricle is activated before the right ventricle as usual. In ventricular inversion this causes P2 to occur earlier than in a healthy, normal heart. This change is not enough to cause paradoxical splitting of S2, but it does substantially shorten the A2 -P2. interval. As a result of these phenomena, normal splitting and respiratory variation of S2 may not be detectable. Therefore, the only clue to the diagnosis of ventricular inversion may be a loud single S2 in the second left intercostal space without another reason for this finding.