J Thorac Cardiovasc Surg 2006;132:1244-1245
© 2006 The American Association for Thoracic Surgery
Right ventricular remodeling
Robert H. Anderson, MD, BSc, FRCPatha,
Paul P. Lunkenheimer, ProfDrMedb
a Joseph Levy Foundation Professor of Paediatric Cardiac Morphology, Supported by the British Heart Foundation, Cardiac Unit, UCL Institute of Child Health, London WC1N 1EH, United Kingdom
b Klinik und Poliklinik für Thorax-, Herz- und Gefäßchirurgie, University of Münster, Münster, Germany
To the Editor:
The Pediatric Cardiac Surgical Annual for 2006 contained an article on remodeling surgery,1
in which the claim was made that the surgical concept is based "on the anatomic features described by Torrent-Guasp et al." We find this disturbing since, to the best of our knowledge, Torrent-Guasp and his colleagues have never studied the arrangement of the ventricular myocytes in the human right ventricle. Furthermore, although receiving increasing attention from surgeons working in the arena of acquired cardiac disease, their findings in animal hearts have never been validated by independent anatomic investigators. Thus, we would question the wisdom of basing surgical procedures on such a flimsy anatomic foundation. It is noteworthy that, in a recent supplement to the European Journal of Cardio-thoracic Surgery, Kocica and colleagues2 state, "Under no circumstances is the attachment of the entire ventricular mass, which extends from the pulmonary artery on the one side and to the aorta on the other, considered to perform its "'skeletal-muscle-like-contraction.'" Despite this statement, at no stage do Kocica and colleagues explain how the ventricular myocardial mass is compartmented so as to produce the "helical band." Indeed, throughout the supplement, very many authors illustrate this purported helical band, yet in our own contribution to the supplement,3 we showed how, although it is possible to unravel the ventricular myocardium in the form of the helical band, there is no orderly arrangement of the myocardial aggregates within its alleged compartments. In our opinion, therefore, it is both dangerous and foolish to propose concepts for restorative surgery on the basis of unvalidated anatomic concepts. This is more so since del Nido and associates1 chose to ignore a study specifically devoted to the orientation of the myocardial aggregates in tetralogy of Fallot,4 which lends no support to the concept of the "helical ventricular myocardial band."
References
- del Nido PJ. Surgical management of right ventricular dysfunction late after repair of tetralogy of Fallot: right ventricular remodeling surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2006;9:29-34.
- Kocica MJ, Corno AF, Carrera-Costa F, Ballester-Rodes M, Moghbel MC, Cueva CNC, et al. The helical ventricular myocardial band: global, three-dimensional, functional architecture of the ventricular myocardium. Eur J Cardiothorac Surg 2006;29(Suppl 1):S21-S40.[Abstract/Free Full Text]
- Lunkenheimer PP, Redmann K, Westermann P, Rothaus K, Cryer CW, Niederer P, et al. The myocardium and its fibrous matrix working in concert as a spatially netted mesh: a critical review of the purported tertiary structure of the ventricular mass. Eur J Cardiothorac Surg 2006;29(Suppl 1):S41-S49.[Abstract/Free Full Text]
- Sanchez-Quintana D, Anderson RH, Ho SY. Ventricular myoarchitecture in tetralogy of Fallot. Heart 1996;76:280-287.[Abstract/Free Full Text]
