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J Thorac Cardiovasc Surg 2008;136:578-589
© 2008 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Structure and function relationships of the helical ventricular myocardial band

^a Option on Bioengineering, California Institute of Technology, Pasadena, Calif
^b Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif
^c Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif
^d Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif
^e Department of Pediatrics and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, Calif
^f Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Ala

Received for publication June 29, 2007; revisions received August 29, 2007; accepted for publication October 19, 2007.

^_* Address for reprints: Gerald Buckberg, MD, UCLA Medical Center, Department of Cardiothoracic Surgery, Rm 62-258 CHS, Box 951741, Los Angeles, CA 90095-1741.

Objective: Understanding cardiac function requires knowledge of the architecture responsible for the normal actions of emptying and filling. Newer imaging methods are surveyed to characterize directional (narrowing, shortening, lengthening, and widening) and twisting motions.

Methods: These movements are defined and then compared with a spectrum of models to introduce a useful "functional anatomy" that explains cardiac spatial and temporal relationships. The sequential nature of normal contraction differs from a synchronous beat.

Results: The prior concept of constriction is replaced by understanding that clockwise and counterclockwise helical motions are necessary to cause the predominant twisting motion. The helical ventricular myocardial band model of Torrent-Guasp fulfills the architectural structure to define normal function. Expansion of information from this model allows novel understanding of mechanisms that explains why a component of ventricular suction involves a systolic event, clarifies septum function, determines diastolic dysfunction, introduces new treatments, shows how knowledge of the helical structure influences understanding of atrioventricular and biventricular pacing, and creates novel methods for introducing septal pacing stimuli.

Conclusion: Further testing of these spatial anatomic concepts is needed to create a more accurate understanding of the architectural mechanisms that underlie cardiac dynamics to address future problems in unhealthy hearts.