Ventricular Inversion Differential Diagnoses

Updated: Jan 28, 2021
  • Author: Ira H Gessner, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Diagnostic Considerations

Important considerations

A potential problem is the failure of the primary care physician to identify an abnormal cardiac finding on physical examination of a patient with ventricular inversion who also has a clinically significant associated defect that creates observable findings.

Surgery or cardiac catheterization may raise medicolegal concerns, especially if the operator is inexperienced in caring for patients with complex congenital heart defects.

The patient's family and, if appropriate, the patient should be fully informed regarding the increased risks of evaluating and treating ventricular inversion.

Special concerns

Pregnancy can be accomplished successfully in many women who have ventricular inversion. Such patients should undergo careful evaluation by a cardiologist with expertise in both congenital heart disease and high-risk pregnancies. If right ventricular function is satisfactory, no significant tricuspid-valve regurgitation is present, and no major associated heart defects are present, the pregnancy can occur safely under careful guidance and management. The risk of the baby having congenital heart disease is approximately 5% provided that no close relatives of either parent have another congenital heart defect.

The presence of tricuspid regurgitation with any evidence of right ventricular dysfunction substantially increases the risk for the mother. Other associated factors can also include the risk of pregnancy risks in a patient with ventricular inversion.

Other problems to be considered

Identification of ventricular inversion is most difficult and, perhaps, most controversial in hearts with clinically significant positional abnormality. For example, when the cardiac mass is oriented primarily to a person's right, establishing that neither asplenia nor polysplenia are present is essential because these conditions, especially asplenia, prevent precise determination of left and right ventricular chambers.

In a heart with a rotational abnormality of the ventricular mass to the right (ie, dextroversion) the incidence of a congenital heart defect is high, and ventricular inversion is one of the most common types. Another rare and interesting anomaly is the corollary (ie, situs inversus with levoversion). In this situation, ventricular inversion frequently occurs.

The specific abnormality dictates the differential diagnosis of an associated congenital heart defect of any type.