Left ventricular pseudotendinous cords are derived from the endomysium of the primitive heart and are mostly dense fibrous tissue, with a few consisting of endocardium-encapsulated myocardium in varying numbers, both single and multiple, and were previously found only incidentally by autopsy. 2D echocardiography has become the method of choice for in vivo diagnosis of left ventricular pseudotendinous cords. For almost a century, left ventricular pseudotendinous cords were generally considered to be an anatomical variant of no clinical significance, and it was thought that left ventricular pseudotendinous cords might be associated with cardiac murmurs, arrhythmias, and chest pain, chest tightness, and palpitations. The pseudotendinous cords are suspended in the left ventricular cavity, and when the left ventricle contracts to eject blood rapidly, the blood flow encounters the blockage of the left ventricular pseudotendinous cords, thus creating turbulence in the left ventricle; also when the left ventricular pseudotendinous cords encounter accelerated blood flow, they cause the left ventricular pseudotendinous cords to vibrate together with the ventricular wall to which they are attached thus creating a murmur. We also observed the direction of the pseudotendinous cord and found that the closer it terminated to the left ventricular outflow tract, the more pronounced the murmur was. In a few patients, the pseudotendinous cords tightly pull the ventricular septum to form a “gourd” shape in the left ventricular cavity, which may also cause the left ventricular outflow tract to narrow. True tendons are fibrous strips of tissue that originate from the apical biceps of the left ventricular wall and insert into the left atrioventricular valve leaflets. The left ventricular pseudotendinous cord is usually located: 1. from the papillary muscle to the papillary muscle; 2. from the papillary muscle to the left ventricular wall; 3. from the left ventricular wall to the left ventricular wall; 4. from the papillary muscle to the septum, or from the left ventricular wall to the septum. The left ventricular pseudotendinous cord is often cord-like or capsule-like, its thickness is often ≥2 mm, it can be single or multiple, and a few can be small multi-stranded fiber-like meshwork. The diagnostic criteria for 2D echocardiographic pericardium are that linear strong echoes connected to the left ventricular free wall, papillary muscle, or septum can be found in at least two views, with pseudotendinous cords that vary in length, location, and thickness between each other and are not associated with other cardiac abnormalities. The left ventricular pseudotendinous cords are classified as longitudinal (≤30° and transverse or oblique >30°) according to the angle formed by the left ventricular pseudotendinous cords in the long-axis view of the parasternal left ventricle. Transverse or oblique LV pseudotendinous cords are generally considered to be prone to premature ventricular contractions. Such a wide difference in the detection rate of left ventricular pseudotendinous cords by ultrasound may be related to many factors such as the resolution of the applied instruments, the examination method and the proficiency of the examiner. Therefore, the epidemiology of left ventricular pseudotendinous cords needs further investigation. Left ventricular pseudotendinous cords are a variant of normal anatomy, and the clinical significance of their production of arrhythmias is not well understood. Moreover, premature ventricular contractions caused by left ventricular pseudotendinous cords are mostly “benign” and difficult to be controlled by antiarrhythmic drugs. Some scholars believe that surgical treatment can be used for severe symptoms: Suwa reported a case of ventricular tachycardia with left ventricular pseudotendinous cords that was difficult to be controlled by drugs, which was cured by surgical removal of the left ventricular pseudotendinous cords and condensation of the local tissue of the left ventricular free wall to which they were attached. In conclusion, the question of whether and how to treat premature ventricular contractions due to left ventricular pseudotendinous cords is still inconclusive and should be considered in the context of the clinical situation.