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Eur J Cardiothorac Surg 2005;27:202-209
© 2005 Elsevier Science NL

Invited paper

Architecture must document functional evidence to explain the living rhythm

^a Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Box 951741, 62-258 CHS, Los Angeles, CA 90095-1741, USA
^b Options in Bioengineering, California Institute of Technology, 1200 East California Boulevard, Mail Code 230-87, Pasadena, CA 91125, USA

Received 11 August 2004; received in revised form 1 September 2004; accepted 5 October 2004.

^* Tel.: +1 310 206 1027; fax: +1 310 825 5895. (E-mail: gbuckberg{at}mednet.ucla.edu).

The central theme of surgical procedures is to interact structure and function. Two reviews of architecture by Torrent-Guasp and Lunkenheimer provide anatomic observations, and then only deduce, rather than test and verify functional relationships. Lunkenheimer previously showed the reciprocal helical configuration of the connective tissue scaffold, a weave-like network that may be the lattice for the descending and ascending segments of Torrent-Guasp's apical loop formed from the helical band. Lunkenheimer stresses cardiac development from a blood vessel, and exposes the need to disregard heart formation by a band that develops between the pulmonary artery and aorta. Torrent-Guasp's band-like concept is confirmed by MRI and sonomicrometer measurements, together with early systolic filling by ongoing, unopposed contraction of the ascending segment of the apical loop. This muscular component contradicts conventional concepts that elastic recoil causes rapid ventricular filling. However, direct physiologic measurements show that Torrrent-Guasp's physiologic timing sequence must be revised. While presumption is an important first step, proof of the marriage of structure and function happens only with measurement, a critical step before surgical action.

Key Words: Ventricular myocardial band • Connective tissue scaffold • MRI and sonomicrometer testing • Cardiac embryology

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