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Re: [echocardiography] false tendons

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  • Natraj Ballal
    In fetus it may suggest chromosomal abnormalities. ( ? Down s syn.) ... From: Daniel Shindler To: echocardiography@egroups.com
    Message 1 of 1 , Apr 29, 2000
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      In fetus it may suggest chromosomal abnormalities. ( ? Down's syn.)

      -----Original Message-----
      From: Daniel Shindler <shindler@...>
      To: echocardiography@egroups.com <echocardiography@egroups.com>
      Date: Saturday, April 29, 2000 12:46 PM
      Subject: [echocardiography] false tendons

      >Left ventricular false tendons are fibrous or
      >fibromuscular bands that stretch across the
      >left ventricle from the septum to the free
      >wall. They can also tether to a papillary
      >muscle, but unlike the chordae tendineae,
      >do not connect to the mitral leaflets. They are
      >anatomic variants that should not be mistaken
      >for abnormalities such as tumors, subaortic
      >membranes, thrombus borders, septal
      >hypertrophy. They have been noted in patients
      >with murmurs and arrhythmias.
      >References at the end.
      >Dan Shindler MD
      >Elton Aguilar, BS RDCS wrote:
      >Is it me or are we also seeing more false
      >chords in the LV apex? I've also
      >heard this structure referred to as
      >"false tendons" or "heart strings".
      >What is the significance of these
      >structures? What happens to these chords
      >in a dilated heart?
      >Elton Aguilar, BS RDCS
      >Portland Cardiovascular Institute
      >Badano L, Piazza R, Bisignani G, Nicolosi GL.
      >Echocardiographic features of left ventricular
      >aneurysm and false tendon in a patient with
      >postinfarction pseudoaneurysm after aneurysmectomy.
      >G Ital Cardiol 1993 Mar;23(3):295-9
      >Three years after the repair of a true left ventricular
      >aneurysm, a 62-year-old man was admitted with angina
      >and heart failure.
      >The two-dimensional echocardiogram revealed a uniformly
      >dilated left ventricle with a large apical aneurysm,
      >in which a thin, continuous, band-like echogenic
      >structure, extending from the interventricular
      >septum to the antero-lateral wall could be
      >visualized. That structure was initially interpreted
      >as a left ventricular false tendon . Color Doppler
      >flow imaging, however, showed a continuous, phasic
      >flow crossing the band-like structure. Thus, the
      >diagnosis of a huge apical pseudoaneurysm was
      >made and subsequently confirmed by angiographic
      >Calabro MP, De Luca F, Consolo S, Falcone G, Oreto G.
      >Left ventricular false tendon: the most frequent cause of
      >innocent murmur in childhood?
      >G Ital Cardiol 1992 Jan;22(1):19-24
      >To assess the incidence of false tendons in children
      >with a murmur classified as innocent 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. One hundred and sixty-one children of group A
      >(63.6%) had a left ventricular false tendon. Three out
      >of the 161 had a small ventricular septal defect (the
      >false tendon was the only abnormal finding in 158 of
      >the children). Seventy one (28.1%) of group A had an normal
      >echocardiogram; 21 (8.3%) had congenital heart disease.
      >In group B, only 33 subjects (13.8%) had a false tendon.
      >The different incidence of false tendons in the two groups
      >(63.6% versus 13.8%) was statistically significant
      >(p less than 0.01).
      >Goicolea FJ et al. False tendon rupture simulating chordal
      >rupture after percutaneous mitral balloon dilation.
      >A report of two cases.
      >Eur Heart J 1991 Jul;12(7):829-31.
      >Two cases of ruptured false tendons following percutaneous
      >balloon dilation of the mitral valve in one case, and combined
      >mitral and aortic balloon valvotomy in the other. No
      >adverse effects were noted following this complication.
      >Morin LR et al. Prenatal diagnosis of left ventricular false tendon.
      >Acta Obstet Gynecol Scand 1989;68(5):463-4
      >Kudoh Y, Hiraga Y, Iimura O. Benign ventricular tachycardia in
      >systemic sarcoidosis--a case of false tendon. Jpn Circ J 1988
      >A 22-year-old female patient was diagnosed as having systemic
      >sarcoidosis with pulmonary, skin and ocular lesions, and
      >ventricular tachycardia in resting ECG. Although cardiac
      >sarcoidosis was strongly suspected at diagnosis, no
      >clinical symptom such as palpitation or syncope developed
      >during the three year observation period. Cardiac
      >silhouette was unchanged in chest X-ray and 201thallium
      >myocardial scintigraphy revealed no abnormality. Ventricular
      >complex was suppressed by exercise or tachycardia. Two-dimensional
      >echocardiogram showed abnormal fascicular bands attached
      >from the mid-septum to the apex (false tendon). Therefore,
      >it was concluded that this benign form of ventricular
      >tachycardia might be due to the false tendon,
      >rather than to the cardiac involvement of sarcoidosis.
      >The cause of arrhythmia is important when evaluating
      >the prognosis of a patient with a systemic disease.
      >Okamoto M et al. Visualization of the false tendon in the left
      >ventricle with echocardiography and its clinical significance.
      >J Cardiogr 1981 Mar;11(1):265-70.
      >False tendons were best detected in the apical long axis view
      >in 61 of 132 consecutive patients. The incidence did not seem to
      >be related to the underlying conditions. The false tendon was
      >usually a string, a few millimeters in width, crossing
      >the ventricular cavity from the vicinity of the papillary
      >muscles to the interventricular septum. In a few patients
      >it looked as Y-figure and net like. Sometimes, several
      >sticks of the false tendon were detected. It was observed
      >to be stretched in diastole and relaxed in
      >systole. On the M-mode echocardiogram the false tendon
      >was displayed as a linear echo moving with heart beat. False
      >tendons seen near the interventricular septum, exhibited
      >a motion so similar to that of the interventricular septum
      >that they should be carefully differentiated from the echo
      >of the left ventricular surface of the septum. In 2 patients
      >with valvular heart disease, the false tendon was observed
      >to be fluttering in diastole. Echocardiography was more
      >useful in detecting false tendons than left ventriculography.
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