How are the cardiomyocytes aggregated together within the walls of the left ventricular cone?

Abstract

The manner of packing together of the cardiomyocytes within the walls of the cardiac ventricles has now been investigated for over half a millennium. In 1669, Lower dissected the ventricular mass, likening the arrangement to skeletal musculature, in the form of a myocardial band extending between the right and left atrioventricular junctions. Pettigrew subsequently showed obvious helical arrangements to be evident within the ventricular walls, but emphasised that the cardiomyocytes were attached to each other, and could not justifiably be compared with skeletal cardiomyocytes. Torrent-Guasp then reactivated the notion that the ventricular mass was formed of a solitary band. Unlike Lower, he dissected the band as extending between the pulmonary to the aortic roots. Multiple investigations conducted using gross dissection and histology, and more recently diffusion tensor magnetic resonance imaging and computed tomographic analysis, have shown an absence of any anatomical boundaries within the walls that might permit the mass uniformly to be dissected so as to reveal the band. A response to a recent letter to the Journal, nonetheless, claimed that the dissections had been validated by clinicians interpreting the findings so as to provide an explanation for ventricular cardiodynamics, arguing that the findings provided a suitable anatomical model for this purpose. Anatomical models, however, are of no value unless they are anatomically correct. In this review, therefore, we summarise the evidence showing that the cardiomyocytes making up the ventricular walls, rather than forming a ventricular myocardial band, are instead aggregated together to form a three-dimensional myocardial mesh.

Polarized Light Imaging of the Myoarchitecture in Tetralogy of Fallot in the Perinatal Period

“…This absence of visible boundaries within the heart implies the incompatibility of our data with Torrent-Guasp's Model (34)(35)(36)(37)(38)(39)(40)(41)(42).…”

Journal of Anatomy January 2020

“…‘How are the cardiomyocytes aggregated together within the walls of the left ventricular cone?’ by Anderson et al ()…”

“…Most of our papers report original research, but we have also published several insightful and useful review articles including the following -'The moment arms of the muscles spanning the glenohumeral joint: a systematic review' by Hik and Ackland (2019) 'Challenges in creating dissectible anatomical 3D prints for surgical teaching' by Ratinam et al (2019) 'Anatomy transformed' by Lee et al (2019) 'How are the cardiomyocytes aggregated together within the walls of the left ventricular cone?' by Anderson et al (2019) 'Toward safer thanatopraxy cares: formaldehyde-releasers use' by Varlet et al (2019) 'A reappraisal and revision of the numbering of the pharyngeal arches' by Graham et al (2019) We are always keen to publish more high-quality Reviews and if you have a suggestion for a topic do submit that to the Editors in Chief who will give it consideration.…”

Assessing Myocardial Architecture: The Challenges and Controversies

“…Myocardial architecture and cardiac function are closely linked [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Hence, the anatomy of the heart and the cellular construction of the myocardium has been the focus of research for centuries [ 8 ]. Traditionally, histology has been the method of choice [ 9 , 10 , 11 ], but owing to its two-dimensional nature, this technique fails to visualise the myocardial mass in its entirety.…”

“…It was LeGrice and co-workers [ 39 ] who originally posited the existence of myocardial aggregates using electron microscopy. Computed tomography [ 8 ], confocal microscopy [ 19 ], ultrasound [ 40 ], and even photographically based methods [ 41 ], have also been used to evaluate the micro-anatomical features of the myocardial aggregates. None of these methods, however, can assess the aggregate normal vector, which we believe is key to calculating the precise orientation of the myocardial aggregates.…”