Morphology and Morphometry of Right Ventricular False Tendons
Abstract
An anatomical and morphometric investigation of right ventricular false tendons in formalin-fixed human hearts, expanding the existing five-type classification and describing six additional morphological patterns.
False tendons are fibrous or fibromuscular structures that traverse the ventricular cavity without attachment to valvular cusps. Although left ventricular false tendons are well documented, right ventricular false tendons remain less well characterised. Their morphology may be relevant to cardiac imaging, catheter-based procedures and interpretation of right ventricular anatomy.
Sixty-eight formalin-fixed human hearts from the Department of Human Anatomy, University of Nairobi were examined. Right ventricular false tendons were identified, classified and measured from origin to insertion using a digital Vernier caliper. Data were analysed using SPSS Version 25.0. Prevalence estimates were reported with 95% Wilson confidence intervals, while differences in length were assessed using Kruskal-Wallis and Mann-Whitney U tests.
Right ventricular false tendons were identified in 43 of 68 hearts (63.2%), and 122 individual false tendons were documented. Six novel types were identified in addition to the five conventionally defined types. Type 1 was the most prevalent classic type at 18.9%, while Type 11 had the highest cumulative prevalence when all 11 types were considered, accounting for 54.1% of all false tendons.
Mean false tendon length was 14.6 ± 7.1 mm, with a range of 1–34 mm. Type 3 was the longest at 25.5 ± 6.4 mm, whereas Type 9 was the shortest at 8.0 mm. False tendon length differed significantly across morphological types.
Right ventricular false tendons are common anatomical variations with greater morphological diversity than previously documented. The findings provide an anatomical reference that may assist interpretation of cardiac imaging and procedural planning during right-sided cardiac interventions.
Formalin-fixed human cadaveric hearts.
63.2% of examined hearts.
Individual RFTs characterised.
Five classic plus six newly described types.
RFTs Present in 63.2% of Hearts
Right ventricular false tendons were identified in 43 of the 68 examined hearts, supporting their recognition as common anatomical variants of right ventricular morphology.
Six Additional Types Identified
Beyond the five conventionally recognised right ventricular false tendon types, the study identified six additional morphological patterns classified as Types 6–11.
Type 1 Was the Most Common Classic Type
Type 1, connecting the ventricular septum to the anterior papillary muscle, was the most prevalent of the five conventionally defined types, accounting for 18.9% of all false tendons.
Type 11 Accounted for 54.1%
When all 11 morphological types were considered, Type 11 had the highest cumulative prevalence, representing 66 of the 122 documented false tendons.
Septal Leaflet-to-Septum Was Most Common
Within Type 11, tendons extending from the septal leaflet of the tricuspid valve to the ventricular septum were the most common subtype, accounting for 33.6% of all identified false tendons.
Mean Length 14.6 ± 7.1 mm
Across all 122 false tendons, mean length was 14.6 ± 7.1 mm, with measurements ranging from 1 mm to 34 mm.
Type 3: 25.5 ± 6.4 mm
Type 3, connecting the anterior tricuspid leaflet to the right ventricular free wall, was the longest morphological type observed in the study.
Type 9: 8.0 mm
Type 9, connecting the ventricular septum to the moderator band, was the shortest type observed, although this category was represented by a single specimen and should be interpreted descriptively.
Length Varied Significantly Across Types
The Kruskal-Wallis test demonstrated significant global heterogeneity in false tendon length across morphological groups with sufficient observations (H = 19.847; p = 0.006).
Septum-Attached Tendons Were Longer
Septum-attached tendons had a mean length of 15.6 mm compared with 12.5 mm for non-septum-attached tendons, a statistically significant difference (p = 0.048).
Excellent Observer Agreement
Measurement repeatability was high, with intra-observer ICC of 0.94 and inter-observer ICC of 0.91, supporting the reliability of the morphometric measurements.
Imaging & Right-Heart Procedures
Greater awareness of RFT morphology may help distinguish false tendons from structures such as mural thrombi or flail valve chordae and may assist procedural planning for right-sided cardiac interventions.
Potential Entanglement Considerations
Certain RFT configurations may provide an anatomical basis for previously reported catheter entanglement during right-sided cardiac procedures, although the present study did not directly evaluate procedural complications.
Clinical Significance Remains Unconfirmed
Some RFT locations correspond anatomically to areas containing conduction tissue; however, histology was not performed and the arrhythmogenic potential of the newly identified variants remains speculative.
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Original Anatomical Research
A cadaveric morphological and morphometric study examining right ventricular false tendons and expanding the previously described classification of these structures.
68 Formalin-Fixed Human Hearts
All available eligible hearts from the cadaveric repository of the Department of Human Anatomy, University of Nairobi were consecutively screened for inclusion.
Two Experienced Anatomists
False tendons were identified and classified by two experienced anatomists. Six additional categories were defined for structures that could not be accommodated within the established five-type classification.
Digital Vernier Caliper
False tendon lengths were measured twice from origin to insertion using a digital Vernier caliper accurate to 0.01 cm, with the mean of the two measurements recorded.
ICC 0.94 & 0.91
Intra-observer repeatability was excellent (ICC 0.94; 95% CI 0.88–0.97), as was inter-observer reliability (ICC 0.91; 95% CI 0.84–0.95).
Non-Parametric Comparison
Prevalence was reported with Wilson 95% confidence intervals. Kruskal-Wallis tests assessed differences across morphological types, while Mann-Whitney U tests compared selected anatomical groups.
Types 6–11
The study describes six additional configurations: interpapillary connections; septum-to-posterior ventricular wall; septum-to-septal papillary muscle; septum-to-moderator band; septal papillary muscle-to-moderator band; and tricuspid-leaflet connections represented within Type 11.
Anatomical Reference, Not Causal Evidence
The anatomical findings may improve recognition of RFTs during cardiac imaging and right-heart procedures. The study does not establish that individual RFT variants cause arrhythmias, valve dysfunction or procedural complications.
Not Performed
No histological examination was undertaken. Accordingly, claims regarding conduction tissue or arrhythmogenic potential of the newly described RFT variants remain speculative and require further investigation.
Repository & Classification Limitations
Cadaver age, sex, ethnicity and cause of death were unavailable. Formalin fixation may have affected measurements, and the proposed new categories were derived from a single population and require independent external validation.
HAMP BAUEC/2018/266
Ethical approval was obtained from the Departmental Ethics
and Research Committee, Department of Human Anatomy and
Physiology, University of Nairobi.
Approval date: 28 March 2018.
CRediT Contributions
VK:
Project protocol development, data collection and analysis,
and manuscript writing.
CK, TC & MO:
Project protocol development and manuscript editing.
SM:
Data analysis and manuscript editing.
MM, JM & BO:
Data management and manuscript editing.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
This research did not receive any specific grant from
funding agencies in the public, commercial or not-for-profit
sectors.
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DOI: 10.64573/torgj2605009
Volume 2 · Issue 2 · Special Issue · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Original Research.
DOI: 10.64573/torgj2605009.
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