Morphological Study of Left Ventricular False Tendons in Human Cadaveric Heart Specimens

Introduction: Left Ventricular False Tendons (LVFT) are normal and common anatomical variants of the left ventricle. They may be associated with findings of cardiac pathology or they may be an isolated finding from 2D echocardiogram. These structures may mimic pathologic structures, such as intraventricular chorda rupture, vegetation or thrombus, but considered as false tendon.

Aim: To study the morphology, age and gender specific proportions of false tendons in cadaveric heart specimens.

Materials and Methods: A descriptive cross-sectional study was conducted in Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from October 2015 to March 2017. A total of 100 human cadaveric heart specimens of both males (n=50) and females (n=50) aged 18-76 years were collected from Department of Anatomy and postmortem specimens from Department of Forensic Medicine. The morphology of tendons was studied regarding its location, gross appearance and parameters such as its length and width. The statistical analysis was done using Chi-square test and Analysis of Variance (ANOVA) test appropriately using the software Statistical Package for Social Service (SPSS), version 20.0 for windows.

Results: False tendons were seen in 49 of heart specimens. Total 40 of the specimens showed one LVFT and nine showed two LVFT. Out of total 44 (58.67%) specimens aged 50 years or less had false tendons, while in older specimens, only 5 (20%) were found to have false tendon (p-value <0.05). The common location of false tendons was Posteromedial Papillary Muscle (PMPM) to mid interventricular septum 11 (18.9%), followed by PMPM to free wall 9 (15.5%). The tendons were fibrous in 53 (91.4%), fibromuscular in 4 (6.9%) and 1 (1.7%) was muscular in nature. Out of 50 female and 50 male heart specimens, 24 and 25 had LVFT, respectively (p-value=0.891).

Conclusion: Sound knowledge of heart morphology can avoid false diagnosis in patients with false tendon, as it can simulate other pathological murmurs and structural heart disease in echocardiography.