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Eur J Cardiothorac Surg 2004;25:376-386
© 2004 Elsevier Science NL
Review |
a Denia, Alicante, Spain
b Clinic for Cardiac Surgery, Institute for Cardiovascular Diseases, UC Clinical Centre of Serbia, 8th Kosta Todorovic St., 11000 Belgrade, Serbia and Montenegro
c Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
d Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
e Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
f Department of Nuclear Medicine, Hospital Sant Pau, Barcelona, Spain
g Department of Cardiology, University of Lleida, Lleida, Spain
h Department of Cardiology, Cardiac Imaging Unit, Hospital Sant Pau, Barcelona, Spain
Received 21 October 2003; received in revised form 8 December 2003; accepted 15 December 2003.
* Corresponding author. Tel.: +381-11-3670-609; fax: +381-11-3610-880
e-mail: kocica{at}sezampro.yu
The evidence of the ventricular myocardial band (VMB) has revealed unavoidable coherence and mutual coupling of form and function in the ventricular myocardium, making it possible to understand the principles governing electrical, mechanical and energetical events within the human heart.
From the earliest Erasistratus' observations, principal mechanisms responsible for the ventricular filling have still remained obscured. Contemporary experimental and clinical investigations unequivocally support the attitude that only powerful suction force, developed by the normal ventricles, would be able to produce an efficient filling of the ventricular cavities. The true origin and the precise time frame for generating such force are still controversial.
Elastic recoil and muscular contraction were the most commonly mentioned, but yet, still not clearly explained mechanisms involved in the ventricular suction. Classical concepts about timing of successive mechanical events during the cardiac cycle, also do not offer understandable insight into the mechanism of the ventricular filling. The net result is the current state of insufficient knowledge of systolic and particularly diastolic function of normal and diseased heart.
Here we summarize experimental evidence and theoretical backgrounds, which could be useful in understanding the phenomenon of the ventricular filling. Anatomy of the VMB, and recent proofs for its segmental electrical and mechanical activation, undoubtedly indicates that ventricular filling is the consequence of an active muscular contraction. Contraction of the ascendent segment of the VMB, with simultaneous shortening and rectifying of its fibers, produces the paradoxical increase of the ventricular volume and lengthening of its long axis. Specific spatial arrangement of the ascendent segment fibers, their interaction with adjacent descendent segment fibers, elastic elements and intra-cavitary blood volume (hemoskeleton), explain the physical principles involved in this action. This contraction occurs during the last part of classical systole and the first part of diastole. Therefore, the most important part of ventricular diastole (i.e. the rapid filling phase), in which it receives >70% of the stroke volume, belongs to the active muscular contraction of the ascendent segment.
We hope that these facts will give rise to new understanding of the principal mechanisms involved in normal and abnormal diastolic heart function.
Key Words: Ventricle • Myocardium • Anatomy • Physiology • Myocardial mechanics
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