Left ventricular anomalous chords (LVAC) are picked up surprisingly often in children, usually as a "by-the-way" finding on echocardiography, yet we still don't fully understand what they mean for the child's future health. The main unresolved question is whether these structures are just harmless anatomical quirks or whether, in some children, they help create an arrhythmogenic substrate, especially when they coexist with undifferentiated connective tissue dysplasia (CTD) and a history of perinatal stress. In this article, we pull together current data on how common LVAC are, how they are shaped and located, and how they appear on echocardiography, and we look more closely at the mechanisms that have been proposed to link them with repolarization changes, conduction disturbances, and ventricular arrhythmias. CTD is treated as a systemic "background condition" that may favor the formation of aberrant chords and subtle myocardial remodeling, making the ventricular myocardium electrically more vulnerable, at least in a subset of patients. We also consider how adverse perinatal factors such as intrauterine hypoxia, infection, or prematurity might nudge myocardial maturation and autonomic regulation in an unhealthy direction. On this basis, we outline an integrative, and admittedly still evolving, approach to risk stratification that combines chordal characteristics, clinical markers of CTD, perinatal history, and documented rhythm disturbances to plan more individualized follow-up rather than assuming that all LVAC can be safely dismissed as benign.

Left ventricular false chords, minor cardiac developmental anomalies, undifferentiated connective tissue dysplasia, arrhythmias, WPW syndrome

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