[Left ventricular false tendon: the most frequent cause of "innocent" murmur in childhood?]

BACKGROUND

The left ventricular false tendon (FT) is an anomalous fibrous or fibromuscular band stretching across the left ventricle. The false tendons extend from the septum to the left ventricular free wall or, more rarely, from the septum to a papillary muscle. The association between FT and innocent cardiac murmur has been pointed out. The aim of the present study was to assess the incidence of FTs in children with a murmur classified as innocent.

METHODS

Two groups of subjects were selected. Group A consisted of 253 children with: 1) systolic ejection murmur; 2) normal electrocardiogram and 3) absence of clinical data suggesting cardiac disease. Group B consisted of 240 children clinically free of cardiac disease, and without any cardiac murmur. A FT was diagnosed by means of 2D echocardiogram whenever a linear band stretching across the left ventricular chamber was evident in at least two sections.

RESULTS

One hundred and sixty-one children of group A (63.6%) reflected a left ventricular FT; only in 3 patients out of 161 the FT was associated with a small ventricular septal defect, whereas in 158 children the FT was the only abnormal finding. A normal echocardiogram was observed in 71 children (28.1%) of group A; whereas in 21 patients (8.3%) a congenital heart disease was diagnosed. In group B, only 33 subjects (13.8%) had a FT. The different incidence of FT in the two groups (63.6% versus 13.8%) was statistically significant (p less than 0.01).

CONCLUSIONS

The study shows that about two thirds of children with innocent heart murmur reflect a left ventricular FT. Furthermore, FT is far more common in subjects with innocent cardiac murmur than in normal subjects. The relationship between FT and murmur thus appears very likely, although not definitely proven.

Prevalence of predisposing factors for endocarditis among an elderly institutionalized population

The charts of 100 nursing home patients in a Veterans Affairs skilled nursing facility were reviewed to identify the need for endocarditis prevention prior to dental procedures. Forty-two (42%) had identifiable needs. Systolic murmurs, documented in 38% of the residents, were the most prevalent abnormality. Five patients had other indications for antibiotic coverage (history of rheumatic heart disease, previous endocarditis, artificial heart valve), which added four unique patients (those not already identified by murmurs) to the total. The dental implications of these findings are discussed.