European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR RESPONSE Anderson’s profound misunderstanding of structure/function evolves from the MacIver’s 2018 ‘The end of the myocardial band’ paper . Thinking that twisting is a relatively minor motion versus longitudinal shortening and cir- Gerald D. Buckberg* cumferential strain promotes a position that clashes against its causing 80% of Department of Cardiothoracic Surgery, David Geffen School of Medicine at the RV function, tricuspid annular plane systolic excursion (TAPSE)  and the UCLA, Los Angeles, CA, USA left ventricular failure development after its loss. They fail to understand that the right sided helix’s inner spiral arm contraction causes longitudinal shorten- Received 23 February 2018; accepted 26 February 2018 ing... and diastolic dysfunction; the wrap compresses. In response to their question about RV anatomy, no helix exists in its free wall, but it contains left Keywords: Helical ventricular myocardial band � Structure/function � helical arm ﬁbres: Can Anderson’s team’s proposed anatomy have merit, if its function relationships are impossible?  Misconceptions � Cardiac mechanics � Determinism (cause and effect) Anderson and MacIver’s ‘end of the myocardial band’ edict cannot be achieved. As Svetlana Alexievich, the 2015 Nobel Laureate in Literature said, ‘History records Robert Anderson consistently tries to cast away the helical ventricular myocar- the lives of ideas. People don’t write it, time does’. They should listen. dial band, using terms such as ‘skeletal muscle, inaccurate notion, unique, and oversimpliﬁed’ towards this end [1, 2]. My motto is ‘Elegance is Simplicity and Confusion is Complexity’ with 3 monumental truths: E = mc (Einstein), M = fa REFERENCES (Newton) and how the ‘helix and wrap’ (Torrent Guasp) concept solved the age-old dilemma of the cardiac form/function relationship. Masters are identiﬁed. Anderson selected Pettigrew, a heralded anatomist.  Anderson RH, Agger P, Stephenson RS. The incorrect notion of the Mine was Claude Bernard, a physiologist using vivisection. He believed ‘life is ‘unique myocardial band’. Eur J Cardiothorac Surg 2018. motion’, stating that ‘only groping and empiricism’ would exist without a cause  Buckberg GD. Right ventricular failure after surgical ventricular restor- and effect approach. To him, biology meant ‘anatomists deduce to explain ation: operation or myocardial protection problem? Eur J Cardiothorac physiology’, whereas ‘physiologists explain it by anatomy’. Surg 2017;52:1018–21. The landmark question, ‘the heart moves, but why?’ must be solved. Torrent  Buckberg GD, Hoffman JI, Coghlan HC, Nanda NC. Ventricular Guasp’s anatomy showed that its 6 movements of narrowing, shortening, structure-function relations in health and disease: part I. The normal lengthening, widening, twisting and uncoiling are caused by just 3 muscles—‘2 heart. Eur J Cardiothorac Surg 2015;47:587–601. helical arms and the surrounding wrap’ . Their interaction is documented  Sjostrand F, Allen BS, Buckberg GD, Okamato F, Young H, Bugyi HI et al. by sono-micrometer crystals, 2-dimensional and 3-dimensional (3D) echo, Studies of controlled reperfusion after ischemia: IV. Electron microscopic ventriculogram, magnetic resonance imaging, velocity vector imaging and studies: importance of embedding techniques in quantitative evaluation electrocardiographic recordings-is that an inaccurate notion? of cardiac mitochondrial structure during regional ischemia and reperfu- This in-depth architectural understanding unhinges several current misconcep- sion. J Thorac Cardiovasc Surg 1986;92:512–24. tions in cardiovascular dynamics, including cardiac topography limitations [the  MacIver DH, Partridge JB, Agger P, Stephenson RS, Boukens BJD, Omann left ventricle and the right ventricle (RV) and septum], isovolumetric relaxation C et al. The end of the unique myocardial band: part II. Clinical and time, when the mitral valve opens, muscular reasons for torsion (twisting), the functional considerations. Eur J Cardiothorac Surg 2018;53:120–8. term untwisting, why longitudinal and circumferential strain happen, resynchroni-  Buckberg G. Echogenic zone in mid-septum: its structure/function rela- zation, the RV function and diastolic dysfunction cause and treatment. tionship. Echocardiography 2016;33:1450–6. Histological anatomy and autopsy analysis may be deceiving since (i) ‘dead hearts don’t beat’ and (ii) preservation errors occur. Hearts previously thought dead after 6 h of coronary artery occlusion were alive and functioning because *Corresponding author. Department of Cardiothoracic Surgery, David Geffen histology—not the heart—was wrong . William Harvey thought boiled hearts School of Medicine at UCLA, 10833 Le Conte Avenue, 62-258 CHS, Los looked circular, mirroring those in Anderson’s report. Harvey’s circulation discovery Angeles, CA 90095, USA. Tel: +1-310-2061027; e-mail: gbuckberg@mednet. changed Galen’s (180 AD) observation of twisting (ebb and ﬂow) to the traditional ucla.edu (G.D. Buckberg). ‘all at once’ or clenched and open ﬁst concept of compression and dilation. This misconception lasted 400 years, until 3D imaging reconﬁrmed twisting. doi:10.1093/ejcts/ezy119 The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Downloaded from https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy119/4937878 by Ed 'DeepDyve' Gillespie user on 07 June 2018 LETTER TO THE EDITOR
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Mar 14, 2018
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