The end of the unique myocardial band: Part I. Anatomical considerations. (24th August 2017)

• Record Type: Journal Article
• Authors: MacIver, David H; Stephenson, Robert S; Jensen, Bjarke; Agger, Peter; Sánchez-Quintana, Damián; Jarvis, Jonathan C; Partridge, John B; Anderson, Robert H
• Is Part Of: European journal of cardio-thoracic surgery. Volume 53:Number 1(2018)
• Page Start: 112
• Page End: 119
• Publication Date: 2017-08-24
• Subjects: Helical ventricular myocardial band -- Helical heart -- Ventricular anatomy -- Cardiac computed tomography -- Histology -- Echocardiography -- Embryology -- Comparative anatomy; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezx290
• Languages: English
• ISSNs: 1010-7940

Abstract

Summary: The concept of the 'unique myocardial band', which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there.