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J Thorac Cardiovasc Surg 2002;124:1053
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Spatial orientation of the ventricular muscle band

Robert H. Anderson, BSc, MD, FRCPath

Cardiac Unit, Institute of Child Health, 30 Guilford St, London WC1N 1EH, United Kingdom

To the Editor:

In the August 2001 issue of the Journal, a brief communication was published referring to the "ventricular muscle band."Go 1 Its basic premise was that the musculature of the right and left ventricles existed as a continuous band. In support of the concept, the authors cited several works previously published in Spanish and two investigations concerned only with the left ventricle. They failed to cite, however, or to discuss any of the previous investigations which, from Pettigrew onward, have shown that the musculature of the heart is arranged on the basis of a modified blood vessel, rather than in the fashion of a skeletal muscle with discrete origin and insertion.Go Go 2,3 In particular, they neglected to discuss the recent elegant work by Jouk and colleagues,Go 4 which expanded the concept of geodesic paths initially expounded by Streeter and Torrent-Guasp.Go 5 Although supporting the basic concept of a geodesic arrangement, Jouk and his colleagues were unable to provide any evidence to support the concept of a muscular band encircling the cavities of both the right and the left ventricles. There is no question but that the anatomic orientation of the muscle fibers within the left ventricular wall is of potential surgical significance. The concept, however, should not be obfuscated by slavish acceptance of a hypothesis that has yet to be confirmed histologically.

References

  1. Torrent-Guasp F, Ballester M, Buckberg GD, Carreras F, Flotats A, Carrió I, et al. Spatial orientation of the ventricular muscle band: physiologic contribution and surgical implications. J Thorac Cardiovasc Surg. 2001;122:389-92.[Free Full Text]
  2. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J. 1981;45:248-63.[Abstract/Free Full Text]
  3. Sanchez-Quintana D, Anderson RH, Ho SY. Ventricular myoarchitecture in tetralogy of Fallot. Heart. 1996;76:280-7.[Abstract/Free Full Text]
  4. Jouk PS, Usson Y, Michalowiwicz G, Grossi L. Three-dimensional cartography of the pattern of the myofibres in the second trimester fetal human heart. Anat Embryol. 2000;202:103-18.[Medline]
  5. Streeter DD, Torrent-Guasp F. Geodesic paths in the left ventricle of the mammalian heart. Circulation. 1973;48:471-7.



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