{"id":29921,"date":"2019-12-28T10:06:35","date_gmt":"2019-12-28T10:06:35","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=29921"},"modified":"2020-04-22T07:34:28","modified_gmt":"2020-04-22T07:34:28","slug":"ventricular-false-tendons-in-human-hearts-an-autopsy-study-of-the-incidence-morphology-histology-and-distribution-in-basrah-city","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol12no4\/ventricular-false-tendons-in-human-hearts-an-autopsy-study-of-the-incidence-morphology-histology-and-distribution-in-basrah-city\/","title":{"rendered":"Ventricular False Tendons in Human Hearts, An Autopsy Study of the Incidence, Morphology, Histology and Distribution in Basrah City"},"content":{"rendered":"

Left ventricular false tendons (LVFTs) are isolated cordlike\u00a0 filaments of tissue\u00a0 that traverse\u00a0 the cavity of\u00a0 the\u00a0 left ventricle , they are attached to\u00a0 the ventricular septum ,\u00a0 extending from the septum to the free wall\u00a0 ,or from the septum to the papillary muscle , from a papillary muscle to the free wall ,or\u00a0 between papillary muscles\u00a0 1,2<\/sup> .<\/sup> These bands\u00a0 are not found at all\u00a0 human hearts and considered within normal anatomical variations . Many identify\u00a0 them\u00a0 as intra cavity radiations of bundle of His\u00a0 3,4.<\/sup> They are first reported by Turner at 1893 who incidentally found\u00a0 these fascinating structures\u00a0 at\u00a0 autopsy\u00a0 5<\/sup>, Later, a series of morphological\u00a0 studies have widely\u00a0 explored the anatomic criteria\u00a0 of them\u00a0 in several mammalian species 6-9<\/sup><\/p>\n

LVFTs \u00a0have various \u00a0\u00a0numbers, length and thickness, they could be\u00a0 single , multiple or branched , small multiple filaments\u00a0 at the junction of the septum with the free wall\u00a0 were considered an\u00a0 apical network \u00a010,11.<\/sup> Most of these tendons\u00a0 were fibrous, or\u00a0 fibro muscular and sometimes they contain conducting \u00a0fibers\u00a0\u00a0 12,13<\/sup> \u00a0The incidence\u00a0 of FTs in human has been rising with technical improvements,. The LVFTs\u00a0 nowadays become a common finding especially with the submission of ultrasound diagnostic instruments\u00a0 primarily with the use of routine 2-dimensional echocardiography recommended in human patients for\u00a0\u00a0\u00a0\u00a0 different\u00a0 cardiac conditions. Nishimura\u00a0 supplied\u00a0 the first paper using echocardiography to demonstrate LVFTs in 1981\u00a0 14<\/sup>.<\/p>\n

Prior to the introduction of cardiac ultrasound, FTs in humans were identified at autopsy The earliest morphological studies recorded\u00a0 rates of 0.5% whereas recent \u00a0investigations have achieved up to 78% in human and\u00a0 95% of animal hearts .Other articles describe a range in 40-60% of examined hearts 15<\/sup> .In a pathology study by Grzybiak et al\u00a0 , the prevalence was about 40% and it was similar across all age groups.16<\/sup> \u00a0Loukas et al \u00a0reported \u00a0the prevalence in a series of 200 gross pathology specimens to 62%… The results reported in\u00a0 literatures varied widely mainly because of the different methodologies and study designs ,age , race varieties, additional heart abnormalities and new equipment\u2019s\u00a0 used \u00a0.The embryogenetic origin of FTs was not fully elucidated , the most probable mechanism believed to involve displacement of conducting fibers into the LV lumen. In microscopic studies, the false bands \u00a0consist of fibrous tissue, cardiomyocytes, blood vessels; they may also contain conducting fibers pertaining to the left branch of the His bundle 17,18<\/sup><\/p>\n

LVFTs are considered by many \u00a0as \u00a0benign anatomical variants\u00a0 . Recent \u00a0\u00a0\u00a0morphologic studies have focused on the clinical importance of these bands ,several studies have indicated that they might have a pathophysiologic role in ventricular geometric anomalies. Increased prevalence of innocent precordial murmur and ventricular arrhythmias in humans, giant inverse T waves and left ventricular hypertrophy evident on resting electrocardiograms\u00a0 and pre-excitation mitral regurgitation \u00a0considered to have\u00a0 \u00a0possible relationship with \u00a0these bands \u00a0\u00a019-26.<\/sup> No previous studies on LVFTs \u00a0\u00a0in local participant of Basrah city \u00a0was done before .<\/p>\n

Aim<\/strong><\/p>\n

The present study \u00a0directed to describe \u00a0\u00a0the prevalence and characteristics of LVFs as normal anatomical variant and to estimate a prognostic significance of \u00a0these structures \u00a0and their role in clinical cardiac manifestations .<\/strong><\/p>\n

Materials and Methods<\/strong><\/p>\n

Anatomical \u00a0study <\/strong><\/p>\n

The present work was enrolled during the period extended from March 2018 –\u00a0 December\u00a0\u00a0\u00a0 2018\u00a0 at\u00a0 forensic medicine department in\u00a0 Basrah with full\u00a0 ethical approval obtained . Two hundred\u00a0 fifteen\u00a0\u00a0 human hearts were examined\u00a0 from cadavers for actual prevalence of LVFTs\u00a0 . The age ranged from 18-71yrs, gender distribution\u00a0 were 151 men (70.2%)\u00a0 \/\u00a0 64 women (29.8%) . Children , individuals \u00a0\u00a0below 18 years and those with \u00a0obvious \u00a0heart\u00a0 problems were excluded .<\/p>\n

The normal hearts were cleaned of surrounding tissue and left ventricular chamber was opened. A scalpel incision on the lateral wall of left ventricle was made \u00a0to visualize the interior and FTs. The number and\u00a0 location of these tendons were examined\u00a0 and \u00a0identified as isolated fibrous or fibromuscular bands \u00a0crossing the left ventricular cavity with no attachment to the atrioventricular valve ,they extend from a papillary muscle to the septum, or from a papillary muscle to the free wall, between papillary muscles, or from the septum to the free wall. The location of each band was described according to their\u00a0 points of attachment . The number was recorded \u00a0as \u00a0single ,multiple or branched and the type \u00a0of the band \u00a0like \u00a0\u00a0fibrous , fibromuscular or muscular is \u00a0described .<\/p>\n

Histological study\u00a0<\/strong><\/p>\n

Visible false tendons \u00a0from 10 of total 215 dissected hearts were examined \u00a0\u00a0for histopathological examination \u00a0, 2-3 mm thickness tissue samples were\u00a0 preserved \u00a0in 10% NBF and embedded in paraffin blocks .Sections of 4 micrometer thickness were stained with hematoxylin-eosin stain and examined under light microscope. A microphotographs at 10, 20, and 40 by using Elica camera were\u00a0 obtained \u00a0.Data were collected, tabulated and statistically analyzed by \u00a0a quantitative morphological assessment \u00a0using \u00a0( version 21 ,SPSS,INC., Chicago ,Illinois ,USA ) and Pearson Chi-square \u00a0\u00a0test for qualitative data verification . P\u2264 0.05 was considered\u00a0 statistically significant at \u00a0all tests<\/p>\n

Results<\/strong><\/p>\n

Morphological study<\/strong><\/p>\n

Data\u00a0 collected\u00a0 for 10 \u00a0months with\u00a0 total 215 human hearts.\u00a0 Age ranged\u00a0 from 18-71yrs \u00a0\u00a0with mean age 36 \u00a0years \u00a0\u00b1 14.9 . Male to female\u00a0 ratio was 2.4 : 1 . LVFTs found \u00a0\u00a0\u00a0in\u00a0\u00a0 62\u00a0 ( 28.8%) out of 215\u00a0 hearts . ( Table\u00a0 1 and \u00a0<\/em>Diagram 1) .<\/p>\n

Table 1 :\u00a0 LVFTs \u00a0percentage according to total number<\/strong><\/p>\n\n\n\n\n\n\n\n
\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0LVFTs<\/strong><\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nPercentage %<\/strong><\/td>\n\n

No.<\/strong><\/p>\n<\/td>\n<\/tr>\n

Negative<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0 71.2%<\/td>\n153<\/td>\n<\/tr>\n
Positive<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 28.8%<\/strong><\/td>\n62<\/td>\n<\/tr>\n
Total<\/td>\n<\/td>\n215<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\u00a0 \"Diagram<\/td>\nDiagram 1: LVFTs \u00a0\u00a0percentage<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Regarding gender \u00a0\u00a0,no of positive cases in male \u00a0was 39 ( 25.8%) \u00a0out of 151 male and in \u00a0female was \u00a023 ( 35.9%) out of 64 female , Male to female ratio was 2.4 \/ 1 . No significant\u00a0 difference was detected between M\\F.(P value \u00a0n.s (Table 2 and Diagram 2 \u00a0).<\/p>\n

Table 2 : Male to Female ratio and % of positive LVFTs<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
<\/td>\nCount<\/strong><\/td>\nPercent%<\/strong><\/td>\n<\/td>\n<\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Males<\/strong><\/td>\n151<\/strong><\/td>\n70.2%<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Females<\/strong><\/td>\n64<\/strong><\/td>\n29.8%<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n\u00a0% of positive<\/td>\nCount<\/td>\nLVFTs\u00a0\u00a0 % according\u00a0 to gender<\/td>\n%\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Total (215)<\/td>\n<\/td>\n<\/tr>\n
Males<\/td>\nPositive<\/strong><\/td>\n39<\/strong><\/td>\n25.8%<\/td>\n18.1%<\/td>\n0.135<\/td>\n<\/tr>\n
<\/td>\nNegative<\/td>\n112<\/td>\n74.2%<\/td>\n52.1%<\/td>\n<\/td>\n<\/tr>\n
Females<\/td>\nPositive<\/strong><\/td>\n23<\/strong><\/td>\n35.9%<\/td>\n10.7%<\/td>\n<\/td>\n<\/tr>\n
<\/td>\nNegative<\/td>\n41<\/td>\n64.1%<\/td>\n19.1%<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

P value = n.s.<\/p>\n\n\n\n
\"Diagram<\/td>\nDiagram 2 : LVFTs \u00a0distribution according to gender \u00a0<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Regarding number\u00a0 of bands ; the majority were single ( 53.2% )\u00a0 followed by multiple bands ( 29.% ) . Multiple branching \u00a0bands are less\u00a0 common with only 17.7% \u00a0. A\u00a0 significant difference found\u00a0\u00a0 between number\u00a0 of bands \u00a0with significant p v( 0.000\u00a0 ) (Table 3 ,Diagram \u00a03 and Figure \u00a01a, b, & c )<\/p>\n

Results showed that false tendons\u00a0\u00a0\u00a0 were located\u00a0 frequently between\u00a0 papillary muscle and the ventricular\u00a0 septum ,P-S (41.9%) ,followed by \u00a0FTs between ventricular septum and the free wall\u00a0 S-F type\u00a0 ( 24.2%) . Many\u00a0 attachments\u00a0 are combined and\u00a0 connect\u00a0 more than one point like\u00a0 papillary muscle to a papillary\u00a0 muscle to the septum\u00a0 PP-PS\u00a0 (8.1%) ,or false tendons\u00a0 from papillary muscle to ventricular septum , to the free wall or to a papillary muscle PS-,P-F,P-P, ( 6.5%) .few no\u00a0 include false tendons\u00a0 between papillary muscle to the septum to the free wall P-S,P-F( 1.6%) .Significant p-value (0.000) was detected(Table3,Diagram 4&Fig 2 a &b) .<\/p>\n

This study \u00a0found \u00a0that the commonest\u00a0\u00a0 type\u00a0 was the\u00a0 fibrous\u00a0 ( 66.1%) , followed by fibro muscular type ( 33.9%)\u00a0\u00a0 while muscular type\u00a0 was uncommon . Significant P value was detected\u00a0\u00a0\u00a0 (0.000 ) (Table 3 ,Diagram 5 & Figure 3 a , b) .<\/p>\n

Table 3: % of\u00a0 LVFTs\u00a0 regarding No of bands ,site and\u00a0 type<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Characteristics <\/strong><\/td>\nFrequency %<\/strong><\/td>\nCount<\/strong><\/td>\nP-value<\/strong><\/td>\n<\/tr>\n
Number of bands<\/td>\nSingle<\/td>\n53.2%**<\/td>\n33<\/td>\n0.000<\/strong><\/td>\n<\/tr>\n
Multiple<\/td>\n29%<\/td>\n18<\/td>\n<\/tr>\n
Multiple Branched<\/td>\n17.7%<\/td>\n11<\/td>\n<\/tr>\n
Band site<\/strong><\/td>\nPS<\/td>\n41.9%**<\/td>\n26<\/td>\n0.000<\/strong><\/td>\n<\/tr>\n
SF<\/td>\n24.2%<\/td>\n15<\/td>\n<\/tr>\n
PS,SF<\/td>\n8.1%<\/td>\n5<\/td>\n<\/tr>\n
PP,PF<\/td>\n6.5%<\/td>\n4<\/td>\n<\/tr>\n
PS,PF,PP<\/td>\n4.8%<\/td>\n3<\/td>\n<\/tr>\n
PS, SF<\/td>\n3.2%<\/td>\n2<\/td>\n<\/tr>\n
PP<\/td>\n3.2%<\/td>\n2<\/td>\n<\/tr>\n
PF,PP,SF<\/td>\n3.2%<\/td>\n2<\/td>\n<\/tr>\n
PF,PP<\/td>\n3.2%<\/td>\n2<\/td>\n<\/tr>\n
PS,PF<\/td>\n1.6%<\/td>\n1<\/td>\n<\/tr>\n
Band type<\/strong><\/td>\nFibrous<\/td>\n66.1%**<\/td>\n41<\/td>\n0.000<\/strong><\/td>\n<\/tr>\n
Fibromuscular<\/td>\n33.9%<\/td>\n21<\/td>\n<\/tr>\n
Muscular<\/td>\n0%<\/td>\n0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\u00a0\"Diagram<\/td>\nDiagram 3: LVFTs in relation to number .<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 1: Number of bands . a Single. b \u00a0Multiple \u00a0& c \u00a0Multiple-branched .<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\u00a0\"Diagram<\/td>\nDiagram 4: LVFTs according to site.<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 2:\u00a0A, LVFs from papillary muscle to the septum(P-S) .B from papillary muscle to\u00a0 a papillary muscle (P-P)\u00a0 and\u00a0P value \u02c2 0.05<\/em><\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\u00a0\"Diagram<\/td>\nDiagram 5: LVFTs and type of bands<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Figure<\/td>\nFigure 3: \u00a0LVFTs ,a- Fibrous type, b- Fibromuscular type.<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Histopathological study<\/strong><\/p>\n

The histological examination \u00a0showed cardiac \u00a0muscle tissue in different proportions ,cardiomyeocytes, ,conductive and connective tissue fibers\u00a0 \u00a0, and \u00a0abundant blood vessels\u00a0 . The fibromuscular type showed muscular \u00a0and fibrous tissue\u00a0 crossed \u00a0by small branches of coronary arteries.\u00a0 \u00a0( Fig 4 , a, b, c , & d)<\/p>\n\n\n\n
\u00a0\"Figure<\/td>\nFigure 4: (a) and (b) Cardiac muscle fibers (10x & 40x) .\u00a0 (c) \u00a0and\u00a0 (d) Blood vessels with connective &conductive \u00a0tissue (40x).<\/strong><\/p>\n

 <\/p>\n

Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion\u00a0<\/strong><\/p>\n

Various different terms have been used to describe left ventricular bands, these include; aberrant left ventricular chordae or anomalous, left ventricular chordate tendinae or tendinal cords, false chordae, \u00a0false tendons, \u00a0muscular strands, \u00a0\u00a0\u00a0anomalous left ventricular bands, moderator bands and septomarginal trabeculae\u00a0 2, 15, 26-29<\/sup>.<\/p>\n

The high incidence of LVFTs \u00a0have raised questions \u00a0about their possible role in the malfunctioning of the heart. Many\u00a0 morphologic studies indicate that there could \u00a0be a relationship between their existence and physiologic heart problems \u00a0such as heart murmurs, arrhythmias or premature ventricular complexes. False tendons can be associated also\u00a0 with ventricular septal defects, a bicuspid aortic valve and coarctation of the aorta 30,31<\/sup> \u00a0, their functional significance remain largely unexplored till the establishment of the echocardiography which focus on these structures. From embryological point of view these ventricular bands have no obvious embryology ,it may be considered as \u00a0an extension of the cardiac conduction system into the left ventricular cavity, It was found that many of these bands bear some similarity to chordae tendinae of mitral valve with similar mode of embryological origin ,the difference is they are not connected to the papillary muscles 32<\/sup>\u00a0 . From developmental point of view these\u00a0 tendons were thought to have been derived from the inner muscle layer of the primitive heart 33<\/sup> ;such a relation usually need more detailed morphological and clinical studies with more attention\u00a0 for these normal variants recently. In some of these tendons , few conductive tissue components found to be connected to the branch of bundle of His ,which support the idea of their role in the heart arrhythmias 17,26<\/sup>.<\/p>\n

Previous studies found that both pathological and echocardiographic studies have controversy about their prevalence, morphology and clinical significance . The current study is the first to be done in Basrah city and demonstrates a lower incidence of LVFTs \u00a0( 28.8%)\u00a0 and this differ s from what Luetmer et al reported,he found that\u00a0 FTs exist \u00a0in 55% of normal humans, while\u00a0\u00a0 Gerlis et al. found them in 46%. These investigators also reported that most of the bands extended between the papillary muscles and the interventricular septum., another study found left ventricular bands in 47% of the 28 human hearts examined, located primarily between the interventricular septum and free wall 34<\/sup> . In the present study the results demonstrate no significant difference between male and female while there is a significant difference found regarding the number of these bands ; majority are single, located mainly between the septum to the papillary muscle or between the septum to the free wall and usually composed of fibrous bands , this agrees with most studies done on LVFTs which emphasize on their anatomical bases . the differences detected in morphologic studies in humans could be \u00a0due to differences\u00a0 in\u00a0 the thickness criteria of these bands or may could be due to race \u00a0or methodology used 35, 36<\/sup> \u00a0, the most probable mechanism is believed to involve displacement of conducting fibers into the LV lumen ,they are considered \u00a0to be a part of the conduction system that causes excess tension in the Purkinje fibers in the septum, thus irritating arrhythmia 37,38<\/sup><\/p>\n

Histopathological examination showed that\u00a0 FTs are mainly formed of cardiac muscle fibers , connective and conducting tissues, thick bands are composed of thickened endocardium with myocardial tissues that have all the features attributable to myogenic conducting tissues identical to that seen in the bundle of His . It is not clearly known whether these bands are functionally different although some studies correlate their presence with implication in cardiac arrhythmias,<\/sup> Because of the presence of muscular and conductive tissues ,it can be assumed that their contraction may effect electrophysiologic changes , this may explain their usual existence in subjects with innocent cardiac murmurs compared with normal subjects, However, such causation need further expanded clinical studies to achieve a clear understanding of a relationship between the morphology of left ventricular bands and the clinical presentation.<\/p>\n

Conclusion <\/strong><\/p>\n

This study provided suggestions that:<\/p>\n

LVFTs In Basrah population can be identified at all age groups and both genders . Majority were found between\u00a0\u00a0 interventricular septum and papillary muscles with single appearance mostly and frequently as fibrous type .<\/p>\n

LVFTs are common anatomical variants ,their prevalence is evaluated and compared with that reported in many published data of different populations .<\/p>\n

Knowledge of the morphology and existence of these bands\u00a0 may be helpful to link them \u00a0with \u00a0cardiac murmurs and arrhythmias , beside it may minimize difficulties and critical points which are faced\u00a0 while \u00a0introducing devices in the left ventricular catheterization.<\/p>\n

Acknowledgements<\/strong><\/p>\n

Authors are grateful \u00a0to forensic medicine department staff for their help<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Philip S, CherianKM, WuMH, LueHC. Left ventricular false tendons: Echocardiographic, morphologic, and histopathologic studies and review of the literature. Pediatr Neonatol 2011;52:279-86<\/li>\n
  2. Turner W. Another heart with moderator band in the left ventricle. J Anat Physiol, 1896 ;30:568e9.<\/li>\n
  3. Elizari MV1<\/sup>. The normal variants in the left bundle branch system; J Electrocardiol., 2017;50(4):389-399. doi: 10.1016\/j.jelectrocard.2017.03.004<\/li>\n
  4. Kosi\u0144ski A, Grzybiak M, Dubaniewicz A, et al.(2012 ).False chordae tendineae in right ventricle of adult human hearts – morphological aspects .Arch Med Sci.2012;8(5):834-840,doi:10.5114\\aoms.pubmed;23185192.<\/li>\n
  5. Turner W.A heart with moderator band in left ventricle J Anat Physiol .1893;27:19 [Abstract<\/li>\n
  6. Satish Kenchaiah, MD, MPH, Emelia J. Benjamin, MD, ScM, Jane C. Evans, DSc, Jayashri Aragam, MD, and Ramachandran S. Vasan, MD\u00a0\u00a0\u00a0 .Epidemiology of Left Ventricular False Tendons: Clinical Correlates in the Framingham Heart Study 3.\u00a0 J Am Soc Echocardiogr.; 22(6): 739\u2013745. doi:10.1016\/j.echo.2009.03.008<\/li>\n
  7. Kervancio\u011flu M, Ozba\u011f D, Kervancio\u011flu P, et al. Echocardiographic and morphologic examination of left ventricular false tendons in human and animal hearts. Clin Anat..2003; 16(5): 389\u2013395, doi:\u00a010.1002\/ca.10152, indexed in Pubmed:\u00a012903060.<\/li>\n
  8. Kimura Y1<\/sup>,\u00a0Karakama S1<\/sup>,\u00a0Kobayashi M1<\/sup>,\u00a0Machida N2<\/sup> Incidence, Distribution and Morphology of Left Ventricular False Tendons in Cat Hearts. Anat Histol Embryol.2016;45(6):490-493. doi: 10.1111\/ahe.12216. Epub 2015 Oct 26.<\/li>\n
  9. Heshmat SW Haroun. Comparative Anatomy of the Cardiac Septomarginal Trabecula (Moderator Band) , Anatomy Physiol Biochem Int J .2017 ;2(4): APBIJ.MS.ID.55595<\/li>\n
  10. Luetmer PH, Edwards WD, Seward JB, Tajik . Incidence and distribution of left ventricular false tendons: an autopsy study of 483 normal human hearts. J Am Coll Cardiol .1986;8: 179\u2013183<\/li>\n
  11. Gerlis LM, Wright HM, Wilson N, Erzengin F, Dickinson DF . Left ventricular bands: a normal anatomical feature. Br Heart J .1984;52: 641\u2013647<\/li>\n
  12. .Deniz M, Kilin\u00e7 M, Hatipoglu ES. Morphologic study of left ventricular bands. Surg Radiol Anat. 2004; 26(3): 230\u2013234, doi:\u00a0 10.1007\/s00276-003-0212-0, indexed in Pubmed:\u00a014648038<\/li>\n
  13. Loukas M, Louis RG, Black B, et al .False tendons: an endoscopic cadaveric approach. Clin Anat..2007; 20(2): 163\u2013169, doi:\u00a0 10.1002\/ca.20347, Pubmed: 16944521. 40.<\/li>\n
  14. Nishimura T, Kondo M, Umadome H, Shimono Y. Echocardiographic features of the false tendons in the left ventricle. Am J Cardiol . 1981;48:177e83<\/li>\n
  15. Loukas M, Wartmann CT, Tubbs RS, et al .Right ventricular false tendons, a cadaveric approach. Surg Radiol Anat. 2008; 30(4): 317\u2013322, doi: 10.1007\/s00276-008-0326-5, indexed in Pubmed:\u00a018283389<\/li>\n
  16. Grzybiak M, Lotkowski D, Kozlowski D .False tendons in the left ventricle of the heart in humans during pre- and postnatal periods. Folia Morphol. 1996; 55: 89\u201399.<\/li>\n
  17. Francisco Sa\u00b4nchez Ferrer,a, * Mar\u0131\u00b4a Luisa Sa\u00b4nchez Ferrer,b Mar\u0131\u00b4a Dolores Grima Murcia,c Marina Sa\u00b4nchez Ferrer,a and Francisco Sa\u00b4nchez. . Basic Study and Clinical Implications of Left Ventricular False Tendon. Is it Associated With Innocent Murmur in Children or Heart Disease Rev Esp Cardiol.2015;68(8):700\u2013705<\/li>\n
  18. Saji Philip a,b,c , Kottureth Mammen Cherian a , Mei-Hwan Wu c , Hung-Chi Lue c,d,. Left Ventricular False Tendons:, Echocardiographic Morphologic, and Histopathologic Studies and Review of the Literature Pediatrics and Neonatology (2011) 52, 279e286<\/li>\n
  19. Abdulla AK, Frustaci A, Martinez JE, Florio RA, Somerville J, Olsen EGJ Echocardiography and pathology of left ventricular \u2018\u2018false tendons.\u2019\u2019 Chest: 1990;98: 129\u2013132<\/li>\n
  20. 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 ;55:587e91<\/li>\n
  21. Bhatt MR, Alfonso CE, Bhatt AM, et al. Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy. J Thorac Cardiovasc Surg .2009;138:1123e8.<\/li>\n
  22. Kareem H, et al. Case Rep .A dancing ball in the heart\u2019: false tendon of the left ventricle simulating a mass lesion BMJ .2013;doi:10.1136\/bcr-2013-201115<\/li>\n
  23. Mehul R. Bhatt, MD, Carlos E. Alfonso, MD, Amar M. Bhatt, BS, Sangmin Lee, MD, Alexandre C. Ferreira, MD, Tomas A. Salerno, MD, and Eduardo de Marchena, MD .Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy .The Journal of Thoracic and Cardiovascular Surgery .2015; Volume 138, Number 5 1123<\/li>\n
  24. Yuan Liu1, Ning Mi2, Yiming Zhou3, Peng An4 , Yongyi Bai1 , Yifang Guo5 , Changming Hong1 , Zhixin Ji6 , Ping Ye1 , Caie Wu1. Transverse False Tendons in the Left Ventricular Cavity are associated with Early Repolarization * PLOS ONE | .2015; DOI:10.1371\/journal.pone.0125173<\/li>\n
  25. Suwa M, Hirota Y, Kaku K, Yoneda Y, Nakayama A, Kawamura K, Dio 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;12: 910\u2013914 17.<\/li>\n
  26. Suwa M, Hirato Y, Nagao H, Kino M, Kawamura K .Incidence of the coexistence of left ventricular false tendons and premature ventricular contractions in apparently healthy subjects. Circulation.1984; 70: 793\u2013798<\/li>\n
  27. Boyd MB, Seward JB, Tajik AJ, Edwards WD. Frequency and location of prominent left ventricular trabeculations at autopsy in 474 normal human hearts: implications for evaluation of mural thrombi by two dimensional echocardiography. J Am Coll Cardiol 1987;9:323e6.<\/li>\n
  28. Martins L, Van Zeller P, Rocha-Goncalves F, Ramalhao C, Cerqueira-Gomes M. Morphology, prevalence and clinical significance of left ventricular false tendons in adults. Acta Cardiol 1988;43:245e9.<\/li>\n
  29. Choo MH, Chia BL, Wu DC, Tan AT, Ee BK. Anomalous chordae tendinae. A source of echocardiographic confusion. Angiology 1982;33:756e67.<\/li>\n
  30. Kudoh Y, Hiraga Y, Imura O. Benign ventricular tachycardia in systemic sarcoidosis- a case of the false tendon. Jpn Circ J 1988;52:385e9<\/li>\n
  31. Ker J. Subaortic tendon induced ST-segment elevationda new echo-electrocardiographic phenomenon? Cardiovasc Ultrasound 2009;24:7e13.-32<\/li>\n
  32. Elizari MV1 <\/sup>The normal variants in the left bundle branch system.J Electrocardiol.\u00a02017 Jul – Aug;50(4):389-399. doi: 10.1016\/j.jelectrocard.2017.03.004. Epub 2017 Mar 14.<\/li>\n
  33. Perry LW, Ruckman RN, Shapiro SR, Kuehl KS, Galioto Jr FM, Scott LP. Left ventricular false tendons in children: prevalence as detected by 2-dimensional echocardiography and clinical significance. Am J Cardiol 1983;52:1264e6<\/li>\n
  34. Deniz M. Kilinc\u00b8 E.M , Hatipoglu E. S. .Morphologic study of left ventricular bands .Surg Radiol Anat (2004) 26: 230\u2013234<\/li>\n
  35. Chaudhary S, Bharti RK, Deshpande H. A large morphological variant trifurcated septal band in right ventricle in middle east population: a case report. J. Evolution Med. Dent. Sci. 2016;5(58):4042-4043,<\/li>\n
  36. Pisiak, K. Dorniak, M. Hellmann, D. Rawicz-Zegrzda, M. W\u0119sierska, M. Dudziak .. Left ventricular false tendons: echocardiographic characteristics in the Polish population .Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Poland .2015<\/li>\n
  37. Tamborini G, Pepi M, Celeste F, Muratori M, Susini F, Maltagliati A, Veglia F Incidence and characteristics of left ventricular false tendons and trabeculations in the normal and pathologic heart by second harmonic echocardiography. J Am Soc Echocardiogr, 2004;17: 367\u2013374.<\/li>\n
  38. Weir RA, Dargie HJ, Findlay IN .Arrhythmogenic left ventricular false tendon. Med J Aust,.2007; 187: 591.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Left ventricular false tendons (LVFTs) are isolated cordlike\u00a0 filaments of […]<\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[73],"tags":[],"class_list":["post-29921","post","type-post","status-publish","format-standard","hentry","category-vol12no4"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/29921","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=29921"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/29921\/revisions"}],"predecessor-version":[{"id":31868,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/29921\/revisions\/31868"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=29921"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=29921"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=29921"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}