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Linker DT. What Is True About False Tendons? Am J Cardiol 2024; 219:116-117. [PMID: 38548011 DOI: 10.1016/j.amjcard.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Affiliation(s)
- David T Linker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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Carrasco M, Cabrito TMS, Montalbano MJ, Hołda MK, Walocha J, Tubbs RS, Loukas M. Cardiac ventricular false tendons: A meta-analysis. Clin Anat 2024; 37:114-129. [PMID: 37819143 DOI: 10.1002/ca.24116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
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Affiliation(s)
- Mark Carrasco
- Department of Family Medicine, HealthQuest, Rhinebeck, New York, USA
| | | | | | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
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Sumerkan MC, Cetin S, Helvaci FB, Yaslikaya SS, Karabay U, Hamit T, Gurdal A, Agirbasli M, Alyan O. Three-dimensional echocardiographic assessment of Chiari’s network relationship with the left ventricular false tendon. Egypt Heart J 2022; 74:49. [PMID: 35704119 PMCID: PMC9200920 DOI: 10.1186/s43044-022-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Left ventricular false tendon (LVFT) is a fibromuscular band crossing the left ventricular cavity. And Chiari’s network (CN) is a highly mobile, mesh-like, echogenic structure in right atrium. In this study, we aimed to evaluate the coexistence of LVFT in patients with CN. CN patients were examined with live/real-time three-dimensional transthoracic echocardiography (TTE) for visualization of LVFT. Results This is a single-center prospective study of 49 patients with CN. In literature studies, the average ratios of LVFT were 22% in the normal population. In our study, an increased ratio of LVFT (n = 31, 63.3%) was found in CN patients evaluated with a three-dimensional TTE (63.3% versus 22%) (p = 0.01). The interatrial septal aneurysm was found in 31 (63.3%) patients with CN. And, the positive contrast echocardiography examination was determined in 22 (61.1%) patients with CN. Conclusions Our study reveals that CN is associated with LVFT and is also associated with cardiac anomalies like an interatrial septal aneurysm, and atrial septal defect. And LVFT can be evaluated better with three-dimensional TTE than with traditional two-dimensional TTE. Patients with CN should be evaluated more carefully by three-dimensional echocardiography as they can be in synergy in terms of the cardiac pathologies they accompany. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00287-5.
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Velthuis S, Senden PJ. Left ventricular false tendons. Neth Heart J 2021; 29:419-422. [PMID: 34232482 PMCID: PMC8397804 DOI: 10.1007/s12471-021-01592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/04/2022] Open
Abstract
Left ventricular false tendons (LVFTs) are fibromuscular structures, connecting the left ventricular free wall or papillary muscle and the ventricular septum. There is some discussion about safety issues during intense exercise in athletes with LVFTs, as these bands have been associated with ventricular arrhythmias and abnormal cardiac remodelling. However, presence of LVFTs appears to be much more common than previously noted as imaging techniques have improved and the association between LVFTs and abnormal remodelling could very well be explained by better visibility in a dilated left ventricular lumen. Although LVFTs may result in electrocardiographic abnormalities and could form a substrate for ventricular arrhythmias, it should be considered as a normal anatomic variant. Persons with LVFTs do not appear to have increased risk for ventricular arrhythmias or sudden cardiac death.
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Affiliation(s)
- S Velthuis
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
| | - P J Senden
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
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Kim MJ. False Tendon in Cardiovascular Diseases: Friend, Foe, or Bystander? J Cardiovasc Imaging 2021; 29:57-59. [PMID: 33511801 PMCID: PMC7847795 DOI: 10.4250/jcvi.2020.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mi Jeong Kim
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
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Lo Presti S, Baruqui DL, Perez J, Vadasseril BJ, Escolar E, Horvath SA, Mihos CG. The Role of False Tendons in Left Ventricular Remodeling and Secondary Mitral Regurgitation After Acute Myocardial Infarction. J Cardiovasc Imaging 2021; 29:46-56. [PMID: 33511800 PMCID: PMC7847792 DOI: 10.4250/jcvi.2020.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Left ventricular false tendons (LVFT) are common structures visualized on transthoracic echocardiography (TTE). The present study tested the hypothesis that LVFT, via a possible 'constraint' mechanism, attenuate left ventricular (LV) remodeling and secondary mitral regurgitation after acute myocardial infarction. METHODS Seventy-one patients admitted to the Coronary Care Unit following an ST-elevation (n = 63) or non-ST-elevation (n = 8) myocardial infarction were analyzed; 29 (41%) had LVFT, and 42 (59%) did not (no-LVFT). All had a TTE and at least 1 follow-up study after revascularization. The χ² analysis, Student's t-test, and Mann Whitney U test were used for the statistical analyses. RESULTS The mean age (64 vs. 66 years), left ventricular ejection fraction (LVEF) (41% vs. 39%), left ventricular end-diastolic diameter (LVEDd) index (23 mm/m² for both), and prevalence of ≥ moderate secondary/functional mitral regurgitation (MR) (17% vs. 14%) were similar between the LVFT and no-LVFT groups. At 1-year follow-up, there was no significant difference in chamber remodeling amongst the LVFT versus no-LVFT group when assessed by: 1) ≥ 10% decrease in the relative LVEF (24% vs. 26%; p = 0.83); 2) ≥ 10% increase in the LVEDd index (41% vs. 38%, p = 0.98); and, 3) ≥ 10% increase in the LV mass index (48% vs. 41%, p = 0.68). There was no difference in the prevalence of ≥ moderate secondary/functional MR (17% vs. 12%, p = 0.77). Outcomes remained similar when stratifying by LVFT morphology or ischemic territory. CONCLUSIONS In patients with mild to moderate LV dysfunction and normal chamber size, LVFT do not affect the development of LV remodeling or secondary/functional MR post-myocardial infarction.
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Affiliation(s)
- Saberio Lo Presti
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Diego Lugo Baruqui
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Jorge Perez
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ben Johns Vadasseril
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Coronary Care Unit, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Sofia A Horvath
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Echocardiography Laboratory, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL, USA
- Echocardiography Laboratory, Mount Sinai Medical Center, Miami Beach, FL, USA. ,
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Sah A, Elkattawy S, Posimreddy S, Elkattawy O, Habib M. Ruptured Left Ventricular False Tendon Mimicking a Mural Vegetation. Cureus 2020; 12:e11885. [PMID: 33415038 PMCID: PMC7781780 DOI: 10.7759/cureus.11885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Left ventricular false tendons are cord like structures that traverse the left ventricular cavity. They are found in approximately half of the human hearts examined at autopsy and have no clinical or prognostic significance. They have been well described and usually pose no diagnostic dilemma. We present the first case of a partially ruptured false tendon mimicking mural vegetation in an 80-year-old male with extended-spectrum beta-lactamase Escherichia coli bacteremia.
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Resembling Left Ventricular False Tendon in a Father and His Daughter. Case Rep Cardiol 2019; 2018:9543098. [PMID: 30627451 PMCID: PMC6304888 DOI: 10.1155/2018/9543098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/07/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022] Open
Abstract
Left ventricular false tendons (LVFTs) are linear fibrous or fibromuscular bands stretching across left ventricular cavity. Although LVFTs have been associated with various heart pathologies and investigated embryologically and histologically, there is only one report in the literature connoting possible hereditary transmission of this entity. We reported a father and his daughter having similar types of LVFTs with regard to location and thickness. With this report, we will contribute in the literature in respect to potential genetic inherence of LVFTs.
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Hall ME, Halinski JA, Skelton TN, Campbell WF, McMullan MR, Long RC, Alexander MN, Pollard JD, Hall JE, Fox ER, Winniford MD, Kamimura D. Left Ventricular False Tendons are Associated With Left Ventricular Dilation and Impaired Systolic and Diastolic Function. Am J Med Sci 2017; 354:278-284. [PMID: 28918835 DOI: 10.1016/j.amjms.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Left ventricular false tendons (LVFTs) are chord-like structures that traverse the LV cavity and are generally considered to be benign. However, they have been associated with arrhythmias, LV hypertrophy and LV dilation in some small studies. We hypothesize that LVFTs are associated with LV structural and functional changes assessed by echocardiography. METHODS We retrospectively evaluated echocardiographic and clinical parameters of 126 patients identified as having LVFTs within the past 2 years and compared them to 85 age-matched controls without LVFTs. RESULTS There were no significant differences in age (52 ± 18 versus 54 ± 18 years, P = 0.37), sex (55% versus 59% men, P = 0.49), race (36% versus 23% white, P = 0.07), systolic blood pressure (131 ± 22 versus 132 ± 23mmHg, P = 0.76) or body mass index (BMI, 31 ± 8 versus 29 ± 10kg/m2, P = 0.07) between controls and patients with LVFTs, respectively. Patients with LVFTs had more prevalent heart failure (43% versus 21%, P = 0.001). Patients with LVFTs had more LV dilation, were 2.5 times more likely to have moderate-to-severe mitral regurgitation, had more severe diastolic dysfunction and reduced LV systolic function (18% lower) compared with controls (all P < 0.05). After adjustment for covariates, basal and middle LVFT locations were associated with reduced LV systolic function (P < 0.01), and middle LVFTs were associated with LV dilation (P < 0.01). CONCLUSIONS Our findings suggest that LVFTs may not be benign variants, and basal and middle LVFTs may have more deleterious effects. Further prospective studies should be performed to determine their pathophysiological significance and whether they play a causal role in LV dysfunction.
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Affiliation(s)
- Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson, Mississippi; Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Joseph A Halinski
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Thomas N Skelton
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - William F Campbell
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael R McMullan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Robert C Long
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Myrna N Alexander
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - James D Pollard
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - John E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael D Winniford
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Daisuke Kamimura
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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MEKHDIEVA K, BLYAKHMAN F. IMPACT OF LEFT VENTRICULAR FALSE TENDONS ON YOUNG ATHLETES’ CARDIOVASCULAR ADAPTATION TO EXERCISE LOADS. J MECH MED BIOL 2017. [DOI: 10.1142/s021951941750066x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
False tendons (FT) are additional chord-like structures in left ventricle (LV) cavity considered as a phenotypic feature of the connective tissue dysplasia (CTD) syndrome. The search for a range of heart adaptability to exercise loads of young athletes with FT in LV is the aim of the proposed study. Sixty six members of student basketball and indoor soccer teams (mean age: 19.8[Formula: see text][Formula: see text][Formula: see text]3.9 years) underwent treadmill stress-test and heart ultrasound transthoracic examination. Further, image processing to perform the tendons mapping within LV 3D-reconstructed model was applied. The number of FT located in different parts of LV varied from 1 to 6 units per LV. Based on the comparative and correlation analyses of data obtained, we found that the more the number of FT per LV, the less is a range of the heart adaptation to increased exercise loads. In accordance with the results of two-way multivariate analysis of variance, we concluded that the FT, located in basal and median LV zones, connecting interventricular septum and posterior-lateral parts of LV wall mainly affect the ability of the heart to adapt to exercise loads. Therefore, athletes with certain number and types of FT in the LV critically need individual prescription for exercise loads.
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Affiliation(s)
- K. MEKHDIEVA
- Sports and Health Technologies Laboratory, Institute of Physical Education, Sports and Youth Policy, Ural Federal University, Yekaterinburg 620078, Russian Federation
| | - F. BLYAKHMAN
- Biomedical Physics Department, Ural State Medical University, Yekaterinburg 620028, Russian Federation
- Physics Department, Ural Federal University, Yekaterinburg 620083, Russian Federation
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11
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A rare asymptomatic false tendon crossing left atrium and ventricle assessed by echocardiography. Int J Cardiol 2016; 223:779-780. [DOI: 10.1016/j.ijcard.2016.08.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
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12
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Lazarevic Z, Ciminelli E, Quaranta F, Sperandii F, Guerra E, Pigozzi F, Borrione P. Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects. World J Cardiol 2016; 8:590-595. [PMID: 27847560 PMCID: PMC5088365 DOI: 10.4330/wjc.v8.i10.590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/26/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes.
METHODS Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard pre-participation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram (ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured.
RESULTS Twenty-one of the 316 subjects (6.9%) showed false tendons in the left ventricle. The majority of false tendons (52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects (52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise.
CONCLUSION Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.
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Abstract
A case of an asymptomatic child presenting with persistent systolic ejection click and found to have an unusual left ventricular false tendon attached to aortic valve that has not been described previously and may be responsible for the click.
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14
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Irie T, Kurosawa K, Kaneko Y, Nakajima T, Tateno R, Kurabayashi M. Left intraventricular dyssynchrony caused by a false tendon. J Arrhythm 2015; 31:163-6. [PMID: 26336551 DOI: 10.1016/j.joa.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/02/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
Left ventricular (LV) false tendons are usually benign, intraventricular myocardial structures, which may cause functional malfunction or deformation of the LV cavity due to mechanical stretching and dilatation of the LV wall. We present a case of non-ischemic cardiomyopathy complicated with intraventricular dyssynchrony that was caused by complete left bundle branch block and the mechanical pressure exerted by the stiff false tendon on the weakened mid-septum during systole.
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Affiliation(s)
- Tadanobu Irie
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Koji Kurosawa
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tadashi Nakajima
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Rieko Tateno
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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15
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Left Ventricular Noncompaction: Imaging Findings and Diagnostic Criteria. AJR Am J Roentgenol 2015; 204:W519-30. [DOI: 10.2214/ajr.13.12326] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Liu Y, Mi N, Zhou Y, An P, Bai Y, Guo Y, Hong C, Ji Z, Ye P, Wu C. Transverse false tendons in the left ventricular cavity are associated with early repolarization. PLoS One 2015; 10:e0125173. [PMID: 25933440 PMCID: PMC4416704 DOI: 10.1371/journal.pone.0125173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Left ventricular false tendons (LVFTs) are related to precordial murmurs, ventricular arrhythmias and some repolarization abnormalities. Early repolarization (ER) is a specific type of repolarization abnormality. OBJECTIVE The aim of the present study was to investigate the relationship between LVFTs and ER. METHODS This study retrospectively included 99 consecutive healthy subjects and 33 patients with ER. Early repolarization was defined as an elevation of the QRS-ST junction of >0.1 mV from baseline in at least 2 inferior or lateral leads, manifested as QRS slurring or notching. Each participant was examined using echocardiography with second harmonic imaging, and the attachments of the LVFTs were recorded. RESULTS A total of 93 LVFTs were present in 82 (83%) of the 99 healthy subjects. Of these 93 LVFTs, the majority (79/93, or 84.9%) were longitudinal-type LVFTs, which originated from the basal interventricular septum (IVS) and progressed toward the apical segment of the left ventricular free wall. There were significant differences in the positioning of the LVFTs between the ER patients and control (P < 0.0001). LVFTs between mid-IVS to the middle of the LV free wall were found more common in patients with ER compared with control subjects (47.5% vs. 6.5%, P < 0.0001). In the ER group, LVFTs between the basal IVS to the apical segment of LV free wall were only identified in 21% of the LVFTs, compared to a value of 84.9% for the control group (P < 0.0001). The distribution of LVFT trends in the ER group was also significantly different from that in the control group (P < 0.05). CONCLUSIONS LVFTs are commonly visualized using echocardiography. An LVFT from the basal IVS to the apical segment of the left ventricular free wall may be a normal anatomical structure in the left ventricular cavity. On the contrary, transverse false tendons in the left ventricular cavity may be associated with ER.
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Affiliation(s)
- Yuan Liu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Ning Mi
- Clinical medicine department of Bethune medical profession sergeant school, Shijiazhuang, China
| | - Yiming Zhou
- Department of liver disease, Beijing General Hospital of Beijing Military Command, Beijing, China
| | - Peng An
- Department of internal medicine, the First People’s Hospital of Qujing, Qujing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yifang Guo
- Department of Geriatric Cardiology, Hebei Provincial People’s Hospital, Shijiazhuang, Hebei Province, China
| | - Changming Hong
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Zhixin Ji
- Medical Administration, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Caie Wu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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MEKHDIEVA K, TIMOKHINA V, SOKOLOV SYU, BLYAKHMAN FA. CARDIAC REGIONAL FUNCTION OF YOUNG SPORTSMEN WITH FALSE TENDONS IN THE LEFT VENTRICLE. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study is to evaluate cardiac regional function of young athletes with false tendons (FT) in the left ventricle (LV). The focus was on mechanical asynchrony in LV wall. Forty-seven young athletes (mean age 20.2 ± 2.9 years) with connective tissue dysplasia syndrome underwent transthoracic echocardiography. To formalize FT topology, the 3D-model of LV geometry was reconstructed based on three short-axis sections and one long-axis section of LV. On average, 4.0 ± 1.0 FT with different localization and orientation in LV were determined. Cardiac function was estimated in 12 regions at LV long-axis section in the course of complete heart cycle. RMS variations of the regional systolic function duration (dT) and the variation coefficient of regional ejection fraction (Cv r-EF) for 12 regions served as measures of the mechanical asynchrony. Wide variety of asynchrony parameters was obtained. The value of dT varied from 24.2 to 84.1 ms (40.4 ± 27.8 ms); Cv r-EF — from 8.0% to 42.0% (20.83 ± 8.35%). Significant correlations between total number of FT per heart and dT (r = 0.396; P < 0.01) and between median transverse FT (connect interventricular septum and lateral LV wall) and Cv r-EF (r = 0.301; P < 0.05) were found. Detailed analyses of FT morphology with respect of LV regional function peculiarities showed that higher extent of asynchrony associates with the transverse and oblique FT mainly located at basal and/or medial portions of LV chamber.
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Affiliation(s)
- K. MEKHDIEVA
- Sports and Health-Improving Technologies Lab., Ural Federal University named after the first President of Russia B.N.Yeltsyn, Yekaterinburg 620078, Russian Federation
| | - V. TIMOKHINA
- Pediatric Dept., Ural State Medical University, Yekaterinburg 620028, Russian Federation
| | - S. YU. SOKOLOV
- Biomedical Physics Dept., Ural State Medical University, Yekaterinburg 620028, Russian Federation
- Physics Department, Ural Federal University named after the first President of Russia B.N.Yeltsyn, Yekaterinburg 620083, Russian Federation
| | - F. A. BLYAKHMAN
- Biomedical Physics Dept., Ural State Medical University, Yekaterinburg 620028, Russian Federation
- Physics Department, Ural Federal University named after the first President of Russia B.N.Yeltsyn, Yekaterinburg 620083, Russian Federation
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Stöllberger C, Finsterer J. Diagnostic Problem of LV Hypertrabeculation/Noncompaction? JACC Cardiovasc Imaging 2014; 7:532-3. [DOI: 10.1016/j.jcmg.2013.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 11/29/2022]
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Gerstman E, Murtaza G, Rashid ZA, Pagel PS. Left Ventricular “Masses” in a Patient With Protein S Deficiency and a Recent Myocardial Infarction: Evidence of Intraventricular Thrombi or a Benign Observation? J Cardiothorac Vasc Anesth 2014; 28:430-2. [DOI: 10.1053/j.jvca.2013.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 12/26/2022]
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Altug N, Danisman AN. Echogenic focus in the fetal left ventricular cavity: is it a false tendon? Early Hum Dev 2013; 89:479-82. [PMID: 23639508 DOI: 10.1016/j.earlhumdev.2013.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 02/27/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To draw attention to the left ventricular false tendon which can be misinterpreted as echogenic focus in the fetus. METHODS The study group consisted of 9 fetuses out of the 161 who had been misdiagnosed for left ventricular false tendon as echogenic focus by obstetricians. Fetal echocardiography and 2-D color Doppler echocardiography were performed in the pre-postnatal period. The standard fetal echocardiographic views (4,5 chamber views, long axis view of the left ventricle, short axis view of the ventricles and great arteries, three vessels and trachea view, long axis views of the duct and aortic arch) were obtained for each case. RESULTS Of the 161 fetuses with echogenic focus in the left ventricle which underwent fetal echocardiography, 9 (5.6%) were diagnosed with false tendons present in the left ventricular cavity with no other cardiovascular anomaly. Six out of 9 patients underwent amniocentesis as follows: for age of over 35 years (two patients), abnormal double-triple screening tests plus echogenic focus (two patients) and soft ultrasonographic markers including echogenic focus (two patients). These fetuses revealed no cardiovascular and other systemic pathology or dysmorphism except for false tendons in the left ventricular cavity. CONCLUSION False tendon should be taken into account as differential diagnosis of left ventricular echogenic focus in the fetus. Misinterpretation of false tendon as echogenic focus may cause unnecessary fetal invasive approach and maternal anxiety, especially when it arises with a background of borderline fetal findings and knowledge.
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Affiliation(s)
- Nahide Altug
- Zekai Tahir Burak Maternity Teaching Hospital, Ped. Cardiology Unit, Ankara, Turkey.
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Herzgeräusche bei Kindern. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Silbiger JJ. Left ventricular false tendons: anatomic, echocardiographic, and pathophysiologic insights. J Am Soc Echocardiogr 2013; 26:582-8. [PMID: 23602169 DOI: 10.1016/j.echo.2013.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Indexed: 01/12/2023]
Abstract
Left ventricular (LV) false tendons are chordlike structures that traverse the LV cavity. They attach to the septum, to the papillary muscles, or to the free wall of the ventricle but not to the mitral valve. They are found in approximately half of human hearts examined at autopsy. Although it has been more than 100 years since their initial description, the functional significance of these structures remains largely unexplored. It has been suggested that they retard LV remodeling by tethering the walls to which they are attached, but there are few data to substantiate this. Some studies have suggested that false tendons reduce the severity of functional mitral regurgitation by stabilizing the position of the papillary muscles as the left ventricle enlarges. LV false tendons may also have deleterious effects and have been implicated in promoting membrane formation in discrete subaortic stenosis. This article reviews current understanding of the anatomy, echocardiographic characteristics, and pathophysiology of these structures.
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Nakagawa M, Ezaki K, Miyazaki H, Wakisaka O, Shinohara T, Teshima Y, Yufu K, Takahashi N, Saikawa T. Electrocardiographic characteristics of patients with false tendon: Possible association of false tendon with J waves. Heart Rhythm 2012; 9:782-8. [DOI: 10.1016/j.hrthm.2011.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Indexed: 10/14/2022]
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Gilbert M, Ionescu A. Unusual mobile structure in the left ventricular outflow tract leading to re-exploration after elective aortic valve replacement. J Cardiothorac Vasc Anesth 2012; 27:406-9. [PMID: 22521405 DOI: 10.1053/j.jvca.2012.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Gilbert
- Department of Anaesthetics, Morriston Cardiac Centre, Swansea, United Kingdom.
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BETSUYAKU TETSUO, MUTO HARUTATSU, SUGIYAMA EITARO, MINOSHIMA AKIHO, SATO MINORU. False Tendon-Related Polymorphic Ventricular Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:e341-4. [DOI: 10.1111/j.1540-8159.2011.03160.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Left ventricular false tendons are thin, fibromuscular structures which traverse the left ventricular cavity. They are thought to be intracavitary radiations of the bundle of His. Usually these tendons span between the interventricular septum and the lateral wall or a papillary muscle. They have been known to be a source of innocent and musical murmurs. In this case report a peculiar left ventricular false tendon is shown—one extending between the two papillary muscles, giving the appearance of a musical note. During ventricular diastole the tendon is pulled taut between the two heads of the papillary muscles and during ventricular systole the tendon relaxes. The echocardiographic characteristics and possible long term implications are discussed.
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Affiliation(s)
- James Ker
- Department of Physiology, University of Pretoria, Pretoria, South Africa
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Ker J. The violin heart. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2010; 4:49-51. [PMID: 20859528 PMCID: PMC2941135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Left ventricular false tendons are thin, fibromuscular structures which traverse the left ventricular cavity. They are thought to be intracavitary radiations of the bundle of His. Usually these tendons span between the interventricular septum and the lateral wall or a papillary muscle. They have been known to be a source of innocent and musical murmurs.In this case report a peculiar left ventricular false tendon is shown-one extending between the two papillary muscles, giving the appearance of a musical note. During ventricular diastole the tendon is pulled taut between the two heads of the papillary muscles and during ventricular systole the tendon relaxes. The echocardiographic characteristics and possible long term implications are discussed.
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