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Eur J Cardiothorac Surg 2005;28:364-365
© 2005 Elsevier Science NL
Letter to the Editor |
a David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA 90095-1741, USA
b Option on Bioengineering, California Institute of Technology, 1200 East California Blvd., Pasadena, CA 91105, USA
Received 29 March 2005; accepted 22 April 2005.
* Address: David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los Angeles, CA 90095-1741, USA. Tel.: +1 310 206 1027; fax: +1 310 825 5895. (Email: gbuckberg{at}mednet.ucla.edu).
Key Words: Myocardial fold • Helical heart • Cardiac structure • Isovolumetric contraction • Ventricular systolic filling
I borrowed my response title ‘Nature is simple, but scientists are complicated’ from Dr Francisco (Paco) Torrent-Guasp, whose lifetime work addressed the myocardial band. Unfortunately, this remarkable innovator has just passed away, but his legacy will be eternal. The aforementioned Editorial provides a bioengineering ‘hero list’, but the authors must study the 1942 Robb and Robb report [1], listing 58 anatomists during the past 500 years who could not unfold the ‘Gordian knot’ structure of the human heart; a feat that Torrent-Guasp has accomplished by discovering the myocardial fold.
The world is sometimes blessed with the opportunity to grow by learning and addressing visions that evolve through revolutionary concepts. Perhaps, the highest form of power is to create something that changes thinking. Paco Torrent-Guasp has achieved this unique goal, and I believe that his scientific contribution will likely exceed that of William Harvey in altering universal knowledge of the circulatory system.
Confirmation of the band is codified by Gorodkov's [2] corrosion casts documenting the spiral trabeculae of descending loop markings on cavity blood, and Hennig's [3] MRI spiral velocity evidence of strain formation. Their opposition to ventricular myocardial band ‘systolic filling hypotheses’ [4] should be balanced with (a) observation of co-contraction of the descending and ascending loops during ejection, (b) ongoing contraction of ascending loop during ‘isovolumetric contraction’, showing the misnomer of ‘isovolumetric relaxation’ [5], (c) rapid MRI [6] untwisting during suction; a dynamic and potential inotropic drug stimulated muscular event during rapid filling and (d) our capacity to undo this altered pathway during stunning by altering calcium dynamics with Sodium Hydrogen exchange pathway inhibitors.
Torrent-Guasp‘s unraveling of structure has opened pathways towards a revolution that will allow others to grow from his achievements. His unscrolling of the transverse basal loop and oblique apical loop to create a cardiac helix surrounded by an outer buttress has profound implications for understanding normality and disease. Mathematical engineering is genomic and nature is poetic, and their marriage will define the variability of life. This relationship is summarized by my expression ‘Nature makes why, Humans find how, If how does not explain why, find another how’.
The authors search for continuity and discontinuity follows goals set out by Einstein [7] in the recent book ‘Einstein, 1905: The Standard of Greatness‘ where his four papers changed the world of science. He sought simplicity, and stated ‘make it simple, but not too simple’. Einstein used the term E=mc 2, and the authors use the expression F=ma, a formula also quoted in this book as a fundamental theory. The myocardial fold, separating the heart into the basal and apical loops shall fall into this category of simple, but universal truths.
Torrent-Guasp's dissections unraveled the simple structure of the Nature's model, thereby permitting bioengineers to investigate what nature has created. It seems the bioengineering challenge is to study real models that simulate nature, rather than those postulated for intact hearts by using computers to penetrate an unknown target. Elegance is simplicity, confusion is complexity.
The editorial conveys a cavalier disenchantment with the myocardial band, and its implications for understanding heart failure. A surprising stance, since the first two authors' work stems from a senior author who focuses upon secondary mitral valve complications of heart failure, rather than its ventricular cause. Their investigation of differences between hubris and humility is suggested.
As Jean-Jacques Rousseau said, ‘Nature never deceives us; it is we who deceive ourselves’.
In 2005, we commemorate 100 years of Einstein's contributions to changing science. Perhaps, 2005 will initiate recognition of Torrent-Guasp's gargantuan contribution to understanding heart structure. Claude Bernard [8] stated that ‘great men are like torches that light the way’. Torrent-Guasp's flame will not be extinguished by complicated scientists.
References
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