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J Thorac Cardiovasc Surg 2008;136:10-18
© 2008 The American Association for Thoracic Surgery

Point/Counterpoint

Structural–functional correlates of the 3-dimensional arrangement of the myocytes making up the ventricular walls

^a Cardiac Unit, Institute of Child Health, University College, London, United Kingdom
^b Department of Anatomy, Universidad de Extramadura, Badajoz, Spain
^c Institute of Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
^d Experimental Thoraco-, Heart and Vascular Surgery, University Hospital, Munster, Germany

Received for publication September 10, 2007; accepted for publication September 25, 2007.

^_* Address for reprints: Robert H. Anderson, BSc, MD, FRCPath, Cardiac Unit, Institute of Child Health, 30 Guilford St, London WC1N 1EH, United Kingdom. (Email: r.anderson@ich.ucl.ac.uk).

The first 300 words of the full text of this article appear below.

	Introduction

 

See related article on page 19.

 

"There is always an easy solution to every human problem—neat, plausible and wrong."

—Henry Louis Mencken. New York Evening Mail; November 16, 1917; later published in Prejudices: Second Series (1920), and A Mencken Chrestomathy (1949)

The aphorism from Mencken, which we have chosen as the header for our review, is particularly pertinent to the ongoing controversies regarding the anatomic arrangements of the myocytes that make up the ventricular mass. The 3-dimensional architecture of these cells has fascinated anatomists for centuries. Despite multiple investigations, it has proved difficult to relate the presumed anatomic arrangements to function so as to adequately explain the contractions that produce the forces driving the systemic and pulmonary circulations. In particular, it has been difficult to explain why, although the individual myocytes thicken by only one sixth as they shorten, the ventricular walls made up of the aggregated myocytes thicken by an appreciably greater proportion during systole. Most anatomic investigations, exemplified perhaps by the detailed study of Pettigrew,¹ have shown that the long axis of the aggregated myocytes changes in angulation relative to the ventricular equator at different depths within the ventricular walls. In recent years, at least 2 alternative concepts of myocytic aggregation have come to the fore, although neither has been substantiated by independent anatomic investigation. One of these concepts is based on the premise that radial fibrous lamellas interpose between ordered layers of myocytes, permitting them to slide between each other during the process of systolic thickening of the ventricular walls.^2,3 A cartoon used to illustrate this concept, however, shows the lamellas extending uniformly from the epicardium to the endocardium.¹ Any examination of a histologic section across the thickness of the ventricular wall is sufficient to show that there is no support for this particular notion. . . . [Full Text of this Article]

Related Article

Cardiac structure/function relationships: Reality or deduction?

Gerald Buckberg
J. Thorac. Cardiovasc. Surg. 2008 136: 19-20. [Extract] [Full Text] [PDF]