Buckberg Gerald D
Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Box 951741, 62-258 CHS, Los Angeles, CA 90095-1741, USA.
Eur J Cardiothorac Surg. 2005 Feb;27(2):202-9. doi: 10.1016/j.ejcts.2004.10.052.
The central theme of surgical procedures is to interact structure and function. Two reviews of architecture by Torrent-Guasp and Lunkenheimer provide anatomic observations, and then only deduce, rather than test and verify functional relationships. Lunkenheimer previously showed the reciprocal helical configuration of the connective tissue scaffold, a weave-like network that may be the lattice for the descending and ascending segments of Torrent-Guasp's apical loop formed from the helical band. Lunkenheimer stresses cardiac development from a blood vessel, and exposes the need to disregard heart formation by a band that develops between the pulmonary artery and aorta. Torrent-Guasp's band-like concept is confirmed by MRI and sonomicrometer measurements, together with early systolic filling by ongoing, unopposed contraction of the ascending segment of the apical loop. This muscular component contradicts conventional concepts that elastic recoil causes rapid ventricular filling. However, direct physiologic measurements show that Torrrent-Guasp's physiologic timing sequence must be revised. While presumption is an important first step, proof of the marriage of structure and function happens only with measurement, a critical step before surgical action.
外科手术的核心主题是使结构与功能相互作用。托伦特 - 瓜斯普(Torrent - Guasp)和伦肯海默(Lunkenheimer)对心脏结构的两项综述提供了解剖学观察结果,但只是进行了推断,而非对功能关系进行测试和验证。伦肯海默此前展示了结缔组织支架的相互螺旋结构,这是一种类似编织的网络,可能是由螺旋带形成的托伦特 - 瓜斯普心尖环降段和升段的晶格。伦肯海默强调心脏由血管发育而来,并指出有必要摒弃认为心脏是由肺动脉和主动脉之间形成的一条带发育而成的观点。托伦特 - 瓜斯普的带状概念通过磁共振成像(MRI)和超声微测技术测量得到证实,同时心尖环升段持续、无对抗的收缩导致早期收缩期充盈。这种肌肉成分与弹性回缩导致心室快速充盈的传统概念相矛盾。然而,直接的生理测量表明,托伦特 - 瓜斯普提出的生理时间顺序必须修正。虽然推测是重要的第一步,但只有通过测量才能证明结构与功能的结合,这是手术操作前的关键一步。