A 33 years asymptomatic hypertensive male underwent a routine color echocardiography for assessment of overall cardiac anatomy, left ventricle (LV) regional wall motion abnormality , LV wall thickness, systolic and diastolic functions. A striking echodense vertical band was visualized in the LV while visualizing the apical two, three and four chamber views. Nevertheless, despite its anatomic location, there was no evidence that the anamolous mitral valve chordae tendineae was causing any regurgitation of mitral valve or obstruction to left ventricular outflow tract (LVOT). To the best of our knowledge this is the first case report of chordae attachment to the LV apex. 

Keywords: Aberrant mitral valve chordae tendineae, abnormal mitral valve apparatus, 4D X Strain Echocardiography.

1. Cittadini Francesca and Vincenzo L et al., Sudden Cardiac Death Due to an Anomalous Posterior Papillary Muscle. The American Journal of Forensic Medicine and Pathology 2011; 32: 239-241.
2. Liu Y, Mi N, Zhou Y, An P, Bai Y and Guo Y et al., Transverse False Tendons in the Left Ventricular Cavity Are Associated with Early Repolarization. PLoS ONE 2015; 10: 1-9.
3. Rovner A, Thanigaraj S and Perez JE, Accessory mitral valve tissue in an adult population: the role of echocardiography in diagnosis and management. Journal of the American Society of Echocardiography 2005; 18: 494-8.
4. Bouchachi AA, Folliguet T, Hebert JL, Zeghidi B, Legendre A, Drissi L, et al. A severe restrictive aortic regurgitation resulting from valve tenting by unusual aortic chordae tendineae strands. Circulation 2012; 126: e139-41.
5. Geindreau D,Pabari P, Cole G, Anderson J, Gopalan D, Ariff B. Aortic valve chordae tendineae causing aortic insufficiency and mimicking an aortic root dissection flap. J Cardiovasc Comput Tomogr 2018; 12: e11-2.
6. Esteve-Ruiz I, Lopez-Pardo F, Lagos-Degrande O, Lopez-Haldon JE, Urbano-Moral JA. Severe restrictive aortic regurgi-tation due to aortic fibrous strand. Eur Heart J Cardiovasc Imaging 2015; 16: 465.
7. Abdelaziz MM, Martinelli G, Luckraz H. Chordae tendineae of the aortic valve. J Card Surg 2016; 31: 328-9.
8. Toofaninejad N, Borjian S, Hosseinsabet A, Bozorgi A. Aberrant Chordae Attached to the interventricular Septum and the Aortic Valve. J Cardiovasc Echogr. 2021; 31: 255-256.
9. Hyun Suk Yang, Kwan S. Lee, Hari P. Chaliki, Henry D. Tazelaar, Joan L. Lusk, KrishnaswamyChandrasekaran, A. Jamil Tajik. Anomalous insertion of the papillary muscle causing left ventricular outflow obstruction: visualization by real-time three-dimensional echocardiography, European Journal of Echocardiography. 2008; 9: 855-860.
10. Yoshimura N, Yamaguchi M and Oshima Y et al., Clinical and pathological features of accessory valve tissue, Annals of Thoracic Surgery 2000; 69: 1205-8.
11. Dearani JA, Ommen SR, Gersh BJ, Schaff HV, Danielson GK. Surgery Insight: septal myectomy for obstructive hypertrophic cardiomyopathy—the Mayo Clinic experience. Nature Clinical Practice Cardiovascular Medicine 2007; 4: 503-12.
12. Oosthoek PW, Wenink AC and Wisse LJ et al., Development of the papillary muscles of the mitral valve: morphogenetic background of parachute-like asymmetric mitral valves and other mitral valve anomalies. Journal of Thoracic and Cardiovascular Surgery 1998; 116: 36—46.

Akhil Mehrotra

Prakash Heart Station, D-16, Nirala Nagar, Lucknow, India