Systolic ventricular filling

It is disappointing to see yet another review appearing in the surgical literature promoting a physiological concept on the anatomic basis of the ‘ventricular myocardial band’ [1]. It is well known that disputation is the lifeblood of science, but it is equally accepted that those promoting a new concept should first examine, and refute, any evidence that might invalidate it. As far as I am aware, neither Dr Torrent-Guasp, nor his co-workers, have offered any explanation as to why previous accounts of the architecture of the ventricular mass are deficient. In fact, there is a wealth of anatomic evidence [2–4] to show that, rather than being arranged in the form of a skeletal muscle, with an origin from one arterial root, and an insertion at the other, as claimed by Dr Torrent-Guasp and his supporters [1], the ventricular mass is arranged in the form of a modified blood vessel, with each myocyte anchored to its neighbour within a supporting fibro-collagenous matrix. If the ventricular mass were truly arranged in the form of the ‘ventricular myocardial band’, then the structure of the fibrous matrix determining this arrangement would be demonstrated by techniques such as serial histological sectioning or magnetic resonance imaging. In reality, these techniques show the ventricular myocardium to be arranged in a complex three-dimensional meshwork of tangential and intruding fibres [2,3]. Dissection techniques have been used to confirm this arrangement [4], but those using the destructive approach of dissection recognise that this methodology unequivocally produces artefacts, since the technique, of necessity, interrupts the integrity of the supporting fibro-collagenous matrix. For this reason, the investigation of Jouk and colleagues [5] is key in the ongoing debate, since these workers have confirmed the basic arrangement of intermingling tangential and intruding fibres, but without needing artefactually to take apart the musculature making up the ventricular mass. I recognise, of course, the prerogative of Torrent-Guasp to question the currently accepted arrangement of the ventricular mass, with its physiological and clinical correlates. When questioning this generally accepted hypothesis, nonetheless, I emphasise again that it is incumbent upon Torrent-Guasp, and those who now support him [1], to demonstrate its deficiencies. This they have singularly failed to do. Those who seek to interpret the known physiological facts in the fashion suggested by Torrent-Guasp and his colleagues, therefore, should be aware of the major shortcomings of their anatomical analysis.