Left Ventricular False Tendons: A Morphological Study by Echocardiography

Abstract

Purpose: This is a prospective study aimed to investigate the morphology of left ventricular false tendons (LVFTs) using echocardiography and explore its associations with age, sex, body mass index (BMI), congenital heart structural abnormalities, and premature ventricular contractions (PVCs).

Methods and results: We analyzed data from 889 individuals who underwent consecutive echocardiograms at our ultrasound department between December 2023 and February 2024. Routine echocardiograms were performed to detect congenital structural abnormalities, with a focus on identifying LVFT. We examined the prevalence, number, and distribution of LVFTs, as well as their correlation with age, sex, BMI, and congenital heart structural abnormalities. LVFTs were detected in 460 of 889 cases (51.74%), totaling 672 LVFTs. LVFT prevalence significantly differed not only between sexes but also between ages. LVFT prevalence was higher in individuals with lower BMI. There was no significant difference in congenital heart structural abnormalities between the groups, but the composition of distinct types of structural abnormalities differed between the groups. The incidence of PVCs in the LVFT-positive group was significantly higher than in the LVFT-negative group.

Conclusions: The prevalence of LVFTs is notably higher in males than females and tends to decrease with advancing age and increasing BMI. LVFTs display diverse morphological features and may interact synergistically with certain congenital heart structural abnormalities. LVFTs can easily lead to PVCs in healthy people, but the risk of leading to malignant PVCs does not seem to be high. Correctly recognizing the morphological characteristics of LVFTs helps to distinguish similar ultrasonic images of different diseases, thus avoiding missed diagnoses and misdiagnoses in ultrasound work and clinical practice.

Keywords: congenital heart anomalies; echocardiography; left ventricular false tendons; premature ventricular contractions.

FIGURE 1

Left ventricular false tendon with both ends in the interventricular septum (arrow). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; IVS, interventricular septum.

FIGURE 2

Representative case with one of the chordae tendineae of the mitral valve merged with the left ventricular false tendon at the base of papillary muscles (arrow). AML, anterior mitral leaflet; IVS, interventricular septum；Ao, aorta; LA, left atrium; LV, left ventricle; PPM, posterior papillary muscle; RV, right ventricle.