“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
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
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..."
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,
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
specimens of the HVMB (1-4)
Zhukov, Alan H. Barr (1-4)
Rohmer, Arkadiusz Sitek, Grant T. Gullberg (1-4)
Leonid Zhukov, Alan H. Barr
Kondratieva, Jens Krüger, Rüdiger Westermann (4)
Leeds: Arun Holden
“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)
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.
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.
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
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
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
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
One way or another, the truth will win. All we have to
do is: "to follow the argument, wherever it leads".