False tendon

Moshe Bronshtein, MD

Haifa, Israel

This is an ultrasound image and a video clip demonstrating a 15-week-old-fetus with a cardiac false tendon.



Definition: 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.

Histology: False tendons in fetal, newborn and infant hearts are made up of mainly heart muscle tissue. These false tendons are composed of muscle tissue and connective tissue in various proportions. Most of the connective tissue is observed in this age group in the area of the tendon attachment to the interventricular septum. These false tendons are  richly vascularized. In some of them, elements of the conductive system connected to the left branch of the bundle of His exist. This may confirm the role of false tendons in heart arrhythmia.(1)

Incidence: In 26-56% of patients with benign murmur (according to echocardiography findings (2,3)) and in 55% in an autopsy study (male 61% female 49%). (4)

Clinical presentation: Most of them are considered normal structures but now cardiologists are interested because of the possible association with the so-called benign murmur, and even more so for the role they can have in eliciting ventricular arrhythmia (5, 6).

Prenatal diagnosis: There is only one case report in the literature of prenatal diagnosis of false tendon (7).

Differential diagnosis: Huge “Golf Ball“ (Echogenic focus), tumors, sub aortic membranes, thrombus borders, septal hypertrophy, artifacts (reverberation), septal aneurysm, etc



1. Lotkowski D, Grzybiak M, Kozlowski D, Budzyn K, Kuta W. A microscopic view of false tendons in the left ventricle of the human heart. Folia Morphol (Warsz). 1997;56(1):31-9.

2. Kervancioglu M, Ozbag D, Kervancioglu P, Hatipoglu ES, Kilinc M, Yilmaz F, Deniz M.

3. Echocardiographic and morphologic examination of left ventricular false tendons in human and animal hearts. Clin Anat. 2003 Sep;16(5):389-95.

4. Malouf J, Gharzuddine W, Kutayli F.  A reappraisal of the prevalence and clinical importance of left ventricular false tendons in children and adults. Br Heart J. 1986 Jun;55(6):587-91.

5. Luetmer PH, Edwards WD, Seward JB, Tajik AJ. Incidence and distribution of left ventricular false tendons: an autopsy study of 483 normal human hearts. J Am Coll Cardiol. 1986 Jul;8(1):179-83.

6. Suwa M, Hirota Y, Kaku K, Yoneda Y, Nakayama A, Kawamura K, Doi K. Prevalence of the coexistence of left ventricular false tendons and premature ventricular complexes in apparently healthy subjects: a prospective study in the general population. J Am Coll Cardiol. 1988 Oct;12(4):910-4.

7. Plonska E, Wojtarowicz A, Nowicki A.Rel. False tendons in the left ventricle--an independent arrhythmogenic factor? Kardiol Pol. 1991;35(11):300-3. Polish.

8. Morin LR, Iselin M, Loisel JC, Feuilly C. Prenatal diagnosis of left ventricular false tendon. Acta Obstet Gynecol Scand. 1989;68(5):463-4

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