“Follow the argument, wherever it leads.”

The Apology of Socrates.

Plato (427 BC – 327 BC).

“It is the customary fate of new truths to begin as heresies.”
Thomas Henry Huxley (1825-1895)
 

When the established knowledge is challenged by new discoveries, a lot of time, discussions and efforts, are needed to accept new concepts, particularly when they are so revolutionary towards what has been taught over centuries.

Because of this reason many scientists world-wide are now studying the Torrent-Guasp's HVMB with different perspectives, in order to learn more about the cardiac anatomy and physiology. The scientific community has to be involved in the evaluation of the new concepts of cardiac anatomy and physiology and their potential impact on the understanding of the heart functioning and on the management of heart diseases.

The Perils of Pioneering

CTSNet's "In My Opinion" article series

by Ralph J. Lewis, MD

"... An idea is like a shooting star bursting forth with brilliant illumination but dimming and disappearing ever so quickly. At one time or another almost everyone gets a good idea, and some even get several good ideas. Either from a lack of motivation, or from a mysterious inability to proceed, or for various unknown reasons, few people make a serious attempt to develop an idea. Unfortunately, only a fraction of even this small enthusiastic group will ever bring their original idea to some kind of fruition. These few are characterized as innovators who persevere despite almost impossible obstacles confronting them.

At inception, any idea will have many rough edges, yet, these early, crude versions will gradually become refined, and improved with time, experience and, most importantly, from the invaluable suggestions and numerous contributions of others.

Poor ideas do not survive no matter how much support they receive, whereas, good ideas cannot be suppressed no matter how much opposition they encounter..."

Scientific priorities:

Buckberg GD, Weisfeldt ML, Ballester M, Beyar R, Burkhoff D, Coghlan HC, Doyle M, Epstein ND, Gharib M, Ideker RE, Ingels NB, LeWinter MM, McCulloch AD, Pohost GM, Reinlib LJ, Sahn DJ, Sopko G, Spinale FG, Spotnitz HM, Torrent-Guasp F, Shapiro EP.
Left ventricular form and function: scientific priorities and strategic planning for development of new views of disease.
Circulation. 2004 Oct 5;110(14):e333-6.

State of the art:

Anatomy and MRI:

Ventricular myocardium has proven remarkably resistant to macroscopic analyses of functional anatomy. Pronounced and practically indefinite global and local structural anisotropy of its fibers and other ventricular wall constituents, produces electrical and mechanical properties that are nonlinear, anisotropic, time varying, and spatially inhomogeneous.

Anatomical dissections of the HVMB are often criticized to be "destructive, subjective, non-reproducible, artificial, etc".

Since the earliest times of anatomy, to dissect, inevitably means to destruct and decompose the integrity of an object. But, the principal feature of anatomical dissection is best described by Glisson's words:

"Anatome and Anatomia: the words signify as much as a dissection. But being taken for an art and applied to a certain object, they signify an artificial dissection of that object in such manner as may most conduce to the perfect knowledge of the same and all its parts... Now this artificial dissection implies not the manual dissection only, but in especial manner the mental. For though the manual dissection be first in regard it leads us to the mental, yet the mental is that which mainly denominates the artist an Anatomist, and hath use in living as well as dead bodies; and nobody desires the manual dissection of dead bodies but in order to the living, that so by mental assignation of the parts he may give an account of them in the living as well as the dead... The end of artificial dissection is not to mangle and cut the object it takes in hand rudely into shreds, but to gain the perfect knowledge of the same and all its parts thereby."

Francis Glisson - English physician and anatomist.
(Glisson drew up this definition to introduce a series of public anatomies he gave in 1641 at the College of Physicians of London.)

Modern imaging technology (DT-MRI) with powerful computer support allow us to examine the structure of intact heart, overcoming mayor disadvantages of classical anatomical dissections.

Recent studies with myocardial fiber tracking in 3D have shown, at least, basic concordance with some principle observations by Torrent-Guasp. Below, you may see a few of them:
 

Torrent-Guasp's anatomical specimens of the HVMB (1-4)

CalTech: Leonid Zhukov, Alan H. Barr (1-4)

Berkeley: Damien Rohmer, Arkadiusz Sitek, Grant T. Gullberg (1-4)

Leonid Zhukov, Alan H. Barr (1-3); TUM: Polina Kondratieva, Jens Krüger, Rüdiger Westermann (4)

Stanford: Daniel Ennis (1,2); Leeds: Arun Holden (3,4)

“The logic of life will neither be recognized without precise understanding of the manifold of components that give rise to biological function, nor without a clear conception of the dynamic interactions between individual components on every level of functional integration. Likewise, the logic of life lies exclusively neither in the most incredible detail, nor in the most sweeping synopsis. Neither integrationism, nor reductionism, is self-sufficient. Both are obligatory to our quest for knowledge.”

 

Kohl P, Noble D, Winslow R, Hunter PJ.

Computational modelling of biological systems: tools and visions.

Phil Trans R Soc Lond A 2000;358(1776):579-610.

(pdf 972 KB)

Education:

This HVMB appeared in the latest editions of the leading texts of anatomy in books written by Keith L. Moore, Artthur F. Dalley, Ann M.R. Agur and  by Carmine D. Clemente.

When this concept was introduced at a recent Anatomy meeting Dalley said:

“Modern technology changes many things, but not anatomy. Now the myocardial band has changed anatomy”.

The novel insight brought by unraveling the helical heart structure, and uncovering the resultant function may allow the myocardial band to create a revolution in thinking about cardiovascular dynamics that could rival the work of William Harvey in 1638.

Controversies:

Although the basic anatomical investigations were completed by 1972, the first integral anatomical description of HVMB was published in 1980 (Torrent-Guasp F. La estructuración macroscópica del miocardio ventricular. Rev Esp Cardiol 1980;33(3):265-87).

The background of this concept was more than 1000 meticulously prepared general or special (finite segments) dissections of the hearts of different species.

Since then, some basic principles and advances in understanding of HVMB form and function, derived from Torrent-Guasp’s continuous efforts to refine this concept, as well as from different studies done by others, were published in numerous papers.

Up to date, this concept has been supported and denied. This fact is easily understandable, because it reflects both enthusiasm and resistance, coming along with every "out of the box" thinking.

Here you may gain insight in the arguments of mayor HVMB opponents:

• Dorri F, Niederer PF, Redmann K, Lunkenheimer PP, Cryer CW, Anderson RH.

  An analysis of the spatial arrangement of the myocardial aggregates making up the wall of the left ventricle.
  Eur J Cardio-Thorac Surg 2007;31(3):430-437.

   

• Lunkenheimer PP, Redmann K, Westermann P, Rothaus K, Cryer CW, Niederer P, Anderson RH.

  The myocardium and its fibrous matrix working in concert as a spatially netted mesh: a critical review of the purported tertiary structure of the ventricular mass.

  Eur J Cardio-Thorac Surg 2006;29(Suppl 1):S41-S49.
   

• Criscione JC, Rodriguez F, Miller DC.

  The myocardial band: simplicity can be a weakness.
  Eur J Cardio-Thorac Surg 2005;28(2):363-364.

A lot of time and work, providing new evidences, either pro or contra, will bring the answer to commonly asked question:

• von Segesser LK.

  The myocardial band: fiction or fact?

  Eur J Cardiothorac Surg 2005; Surgery 27:181-182

One way or another, the truth will win. All we have to do is: "to follow the argument, wherever it leads".