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Left ventricular false tendon and aortic coarctation

Case contributed by Jose Fernando Mendoza Cuadra
Diagnosis certain

Presentation

Pediatric female with arterial hypertension diagnosed 9 months ago accompanied by occasional tachycardias.

Patient Data

Age: 15 years
Gender: Female

Left ventricle with false tendon in the middle segment from the anteroseptal to anterolateral wall and few more from the septal wall to the subvalvular cistem.

Transverse plane of the aorta shows bicuspid valve. Aortic coarctation is partially imaged. 

Left ventricle with false tendon in the middle segment from the anteroseptal to anterolateral wall (white arrows).

Aortic coarctation. Intercostal, internal mammary and collateral subcliavian arteries dilated with connection through the superior epigastric collaterals with inferior epigastric arteries and then with the external iliac arteries (Winslow pathway).

Case Discussion

Left ventricular false tendons are fibromuscular structures that arise from the inner trabeculated myocardial layer of the left ventricle. They can be found, most of the times in autopsy or incidental findings, as single or multiple structures that traverse the left ventricle.

False tendons, as in this patient, may lead to arrhythmias and also causing left ventricular hypertrophy with resultant systolic dysfunction. In some cases, they can be found in addition of others cardiac abnormalities as shown in this case.

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