L-Transposition and Ventricular Inversion: 2 Cases
(Case 1: Courtesy Saroja Bharati, MD, The Heart Institute for Children, Hope Children's Hospital, Palos Heights, IL.
L-Transposition and Ventricular Inversion: Case 1
This view is analogous to the conventional four-chamber view of the heart of a 10-year-old girl with complex congenital heart disease and chronic complete atrioventricular block who died suddenly at home. The malformations consist of
Right anterior oblique view of this patient's heart showing opened small left ventricle, pulmonic stenosis, pulmonary vascular hypoplasia, and VSD. Note absence of SVC and large, posteriorly directed IVC. No conclusions could be made about atrial situs due to absence of other organ clues and abnormal disposition of the two atrial appendages. Presumably upper body venous return joined the IVC through anomalous azygous networks, as no major IVC tributaries were seen above the diaphragm, nor were any extracardiac systemic-to-pulmonary vein shunts found.
Left lateral view of the same heart, showing massive, coarse trabeculation of the systemic ventricle and the flat arch of the aorta. The ligamentum arteriosum was close to the base of the left pulmonary artery branch, which passed under the aortic arch. The cardiac veins can be seen emptying separately and directly into the common atrium as they pass the AV groove.
L-Transposition and Ventricular Inversion: Case 2
These views show the heart of a 34-year-old man with right aortic arch and L-transposition with ventricular inversion. The patient had only mild exertional limitation until the last eight months of life, in which progressive systemic ventricular failure was noted. Although the patient died suddenly at rest, there was no history of AV block or bradycardia.
Right anterior oblique view of this patient's heart showing opened anatomic left ventricle with fine LV type trabeculations and thin but nondilated wall.
Left lateral view of the same heart, showing large, coarse RV type trabeculation and generalized hypertrophy. Moderator band is massive and gives rise to prominent papillary muscles.
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