Detection of left ventricular false tendons by two-dimensional echocardiography

In a prospective series of 300 consecutive patients referred for a two-dimensional echocardiogram, the presence of left ventricular false tendons was searched. The diagnosis of a false tendon was made when a clear linear echo was continuously observed within the left ventricular cavity from the septum to the free wall or to a papillary muscle. Using this criterion, a false tendon was detected in 9 of the 300 patients (incidence of 3%), frequently from an apical position. The precise sites of attachment of the false tendons were observed by slight rotation and/or angulation of the transducer from the classic views: the septum and the lateral papillary muscle were the most frequent sites of attachment. Associated congenital heart disease was present in only 1 patient. Most patients had moderate symptoms and a soft musical systolic murmur. Three patients had premature ventricular contractions disappearing with exercise. The possible relations of LV false tendons with a musical murmur, arrhythmia or abnormal LV geometry are discussed.