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J Thorac Cardiovasc Surg 2002;124:1053-1054
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Reply

Francisco Torrent-Guasp, MD, Gerald D. Buckberg, MD

UCLA Medical Center, Department of Surgery, 62-258 CHS, Los Angeles, CA 90095-1741

Reply to the Editor:

The helical concept of spatial myocardial fiber orientation has been described by Senac, Krehl, and a large spectrum of anatomists over the past 500 years.Go 1 Three missing links have been the structural origin of the helical left ventricle and septum, why there was a right angle crossing of septal fibers, and the functional meaning of this anatomic configuration.

Some background into anatomic contributions appeared in our recent manuscript,Go 2 including the enormous contributions of Pettigrew, and recognition that Greenbaum and Anderson's histologic observations further clarified the helical intraventricular formation.Go 3 We agree that the origin of the heart is from a modified blood vessel.Go 4

The helical arrangement of the heart traverses the ventricular musculature and connects with actin, myosin, tropomyosin, and calcium. Efforts to link histology with structure require a pattern of dissection that does not violate underlying structure during unfolding of the helices to prevent disruption. Consequently, fibers cut in a dissected fetus by Jouk,Go 5 in the orientation used can change the optical properties of birefringent material and not provide a pure optical method. These studies did not reconstruct the 3-dimensional fiber orientation, based on standard tomography methods, and they could not use this 2-dimensional dissection method to see the apex; the site of continuity of twist of cardiac fibers that links the septal crossing of descending and ascending segments. Some of this is recognized, as they indicate that the final model is conjectural and based on the examiners' experience with dissection slide reading. Despite this, they see the helical patterns and thus add another coiled observation to cardiac anatomy.

We agree that function is related to the muscular formation of the wrapped tube, and we also recognize that joining of form and function can produce departure between the anatomist and pathologist that observe only the nonfunctional structure, and the physiologist and surgeon that must link function with underlying form. Our recent report of sonomicrometer verification of the functional components along the band, that correlate with magnetic resonance imaging studies of contraction, indicates we must take a new look into the form/function relationship, based on spatial orientation of the ventricular muscular band.Go 6

References

  1. Robb JS, Robb RC. The normal heart: anatomy and physiology of the structural units. Am Heart J. 1942;23:455-67.
  2. Buckberg GD, Coghlan HC, Torrent-Guasp F. The structure and function of the helical heart and its buttress wrapping. V. Anatomic and physiologic considerations in the healthy and failing heart. Semin Thorac Cardiovasc Surg. 2001;13:358-85.[Medline]
  3. 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]
  4. Buckberg GD. The structure and function of the helical heart and its butrress wrapping. II. Interface between unfolded myocardial band and evolution of primitive heart. Semin Thorac Cardiovasc Surg. 2001;13:320-32.[Medline]
  5. Jouk PS, Usson Y, Michalowicz G, Grossi L. Three-dimensional cartography of the pattern of the myofibres in the second trimester fetal human heart. Anat Embryol (Berl). 2000;202:103-18.[Medline]
  6. Buckberg GD, Coghlan HC, Torrent-Guasp F. The structure and function of the helical heart and its buttress wrapping. IV. Concepts of dynamic function from the normal macroscopic helical structure. Semin Thorac Cardiovasc Surg 2001;13:342-57.[Medline]




This Article
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