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Eur J Cardiothorac Surg 2004;26:663-664
© 2004 Elsevier Science NL

Letter to the Editor

Reply to Lunkenheimer

Francisco Torrent-Guaspa, Mladen J. Kocicab*,1, Antonio Cornoc, Francesc Carreras-Costad

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 Cardiology, Cardiac Imaging Unit, Hospital Sant Pau, Barcelona, Spain

Received 15 May 2004; accepted 18 May 2004.

* Corresponding author. Tel.: +381-11-3670609; fax: +381-11-3610880
e-mail: kocica{at}sezampro.yu

Key Words: Ventricle • Anatomy • Myocardium • Physiology

It was a real pleasure to see your Letter to the Editor, because of many reasons. First, it is always good to know that our work [1] is attracting your interest so strongly. We thank you. Then, it is very interesting to follow your evolution [2], switching from the valuable participation in a development of the ventricular myocardial band concept, to the position of its passionate critic. Finally, it is again pleasure to find out, that your calls for denial of such concept, do not always find a ‘desirable’ echo in a scientific world [3].

Examining elctrophysiological and functional data, in order to test the hypothesis of activation sequence in the ventricular myocardium, James Cox (coauthor) and his associates, calculated the delivery of the impulse throughout the ventricular band. They have very carefully plotted out how the electrical impulse is delivered to the myocardium, by the specialized conduction system, and correlated those findings with the velocities of conduction in thin and thick areas of the heart. It came out that impulse delivery precisely mimicked predicted sequence of activation. The same was true for other researchers applying different investigational methods, mentioned in our article (i.e. Fourier analyses of ventricular MUGA scans, MRI-based mathematical modeling) [1]. The results obtained from those studies, initiated by the evidence of the ventricular myocardial band, not only provided a solid experimental ground for present publication [1], but also for many other researches derived from this new morpho-functional concept [3].

Careful readers may also find a precise concordance between the context and references cited in our article [1]. Thus, they can notice, for example, that some conclusions given by Henein and Gibson are not interpreted, but transferred from the their valuable original work on ventricular long axis [4]. It is not our misunderstanding, but our disagreement with proposed influence of the atrial muscle on generating ventricular suction force, by abrupt upward movement of the entire ventricular base. The same is true for the excellent Brutsaert's review [5]. There is no such place in our article [1] arguing with Brutsaert's explanations of different loading conditions influence on isolated myocardial fiber activation. On the contrary, we have emphasized this well-known fact several times, explaining dynamic changes of the ‘hemoskeleton’ and their significant influences on the ventricular performance. Therefore, the sources of your conclusion about "delayed shortening activity as a typical behaviour of the ascending limb" would remain a secret for us, but definitively, they do not belong to our article [1].

Beyond your personal, undoubtedly benevolent, concerns, the readers may also be aware of the some other opinions, declaring that: "This model is an example of an emphasis that relates fiber architecture to chamber shape and mechanics and has implications for improved understanding of electrical, electromechanical and mechanical determinants of cardiac function" [3].

We are quite confident that you had carefully read our article [1], but if you could, in addition, participate on the NIH-NHLBI 2002 Workshop: ‘Form and Function: New Views on Development, Diseases and Therapies for the Heart’, you probably wouldn't miss some important facts.

Footnotes

1 URL: www.ctsnet.org/home/mkocica Back

References

  1. Torrent-Guasp F., Kocica M.J., Corno A., Komeda M., Cox J., Flotats A., Ballester-Rodes M., Carreras-Costa F. Systolic ventricular filling. Eur J Cardiothorac Surg 2004;25:376-386.[Abstract/Free Full Text]
  2. Torrent-Guasp F., Zarco P., Lunkenheimer P.P., Aragoncillo P., Farina J., Streeter D.D., Ramon C. Nuevos conceptos sobre la estructura miocardica ventricular. In: Torrent-Guasp F., Zarco P., Lunkenheimer P.P., Aragoncillo P., Farina J., Streeter D.D., Ramon C., eds. Estructura y mecanica del corazon. Barcelona: Grass Ediciones, 1987:34-87.
  3. Buckberg G.D., Weisfeldt M.L., Ballester M., Beyar R., Burkhoff D., Coghlan H.C., Doyle M., Epstein N.D., Gharib M., Ideker R.E., Ingels N.B., LeWinter M.M., McCulloch A.D., Pohost G.M., Reinlib R.J., Sahn D.J., Spinale F.G., Spotnitz H.M., Sopko G., Torrent-Guasp F., Shapiro E.P. Left ventricular form and function: scientific priorities and strategic planning for development of new views of disease. Circulation 2004.
  4. Henein M.J., Gibson D.G. Long-axis function in disease. Heart 1999;81:229-231.[Free Full Text]
  5. Brutsaert D.L., Sys S.U. Relaxation and diastole of the heart. Physiol Rev 1989;69:1228-1315.[Abstract/Free Full Text]




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