The three‐dimensional arrangement of the myocytes in the ventricular walls

The arrangement of the myocytes aggregated together within the ventricular walls has been the subject of anatomic investigation for more than four centuries. The dangers of analyzing the myocardium on the basis of arrangement of the skeletal myocytes have long been appreciated, yet some still described the ventricular myocardium in terms of a unique band extending from the pulmonary trunk to the aorta. Another current interpretation, with much support, is that the ventricular myocytes are compartmentalized in the form of sheets, albeit that the extent of division, and interrelations, of the sheets is less well explained. Histological examination, however, shows that the only muscular unit to be found within the myocardial walls is the cardiac myocyte itself. Our own investigations show that, rather than forming a continuous band, or being arranged as sheets, the myocytes are aggregated together as a three-dimensional mesh within a supporting matrix of fibrous tissue. Within the mesh of aggregated myocytes, it is then possible to recognize two populations, depending on the orientations of their long axes. The first population is aligned with the long axis of the aggregated myocytes tangential to the epicardial and endocardial borders, albeit with marked variation in the angulation relative to the ventricular equator. Correlation with measurements taken using force probes shows that these myocytes produce the major unloading of the blood during ventricular systole. The second population is aligned at angles of up to 40 degrees from the epicardium toward the endocardium. The correlation with measurements from force probes reveals that these intruding myocytes produce auxotonic forces during the cardiac cycle. The three-dimensional arrangement of the mesh also serves to account for the realignment of the myocytes that must take place during ventricular contraction so as to account for the extent of systolic mural thickening.