[Echocardiographic features of false tendons: with special reference to phonocardiographic significance (author's...

Echocardiographic features consistent with the findings of false tendons (FTs) were described in five out of 1,000 consecutive cases, and they were studied in order to determine whether FT was responsible for the systolic murmurs. Three had heart diseases including aortic regurgitation, 3 degrees AV-block with aortic regurgitation, and pericarditis and mitral stenosis, and the remainder cases had no heart disease. M-mode echocardiograms showed abnormal linear echoes in the outflow tract of the left ventricle in three cases, and in the left ventricle toward the apex in another two cases. Two-dimensional echocardiograms revealed long string-like echoes stretching from the upper parts of the interventricular septum across the ventricular cavity to the lateral wall of the left ventricle in three cases in the long and short axis views or four chamber view. In another two cases, there were long slender echoes binding the lower parts of the interventricular septum and the left ventricle in the apical view. These string-like echoes seemed to represent FTs reported previously in autopsy cases. Phonocardiography with pharmacological study (amyl nitrite and methoxamine) showed no significant systolic murmur, for which Fts had been considered to be responsible, even in a dilated left ventricle. We conclude that (1) M-mode and two-dimensional echocardiograms can demonstrate the presence of FTs, (2) two-dimensional echocardiograms might be utilized in differentiating FTs from other abnormal linear echoes in the outflow tract of the left ventricle seen in M-mode echograms, and (3) FTs do not necessarily cause systolic murmur.