Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.
Medical Education, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):112-119. doi: 10.1093/ejcts/ezx290.
The concept of the 'unique myocardial band', which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there.
“独特心肌带”的概念，即提出心室心肌圆锥排列类似于骨骼肌，为理解血液动力学提供了一个有吸引力的框架。这个最初的想法是由 Francisco Torrent-Guasp 提出的。Torrent-Guasp 使用煮沸的心脏和钝性解剖，创建了一个从肺动脉干延伸到主动脉根部的心室心肌单一带，由此构建的带环绕两个心室腔。然而，煮熟的心脏可以用许多方式进行解剖。在这篇综述中，我们表明该带不存在具有明确边界的解剖实体。相反，心室心肌细胞首尾相连，通过分支形成错综复杂的网状结构。在左心室壁的厚度上，心肌细胞链呈现出逐渐变化的螺旋角，中间形成一个周向区域。如果壁是由单个包裹带的相对肢体构成的，那么不会出现螺旋角的突然变化，心肌细胞的长轴也不会始终与独特心肌带的长轴一致。此外，没有结缔组织结构可以被认为是其所谓边界的标志。独特心肌带应该与进化相一致，尽管鱼类和爬行动物的心室壁有一层或多层，但没有发现单一的带。1965 年，Lev 和 Simpkins 警告说，煮熟的心脏的心室肌肉质量几乎可以根据解剖学家的突发奇想进行解剖。我们认为独特心肌带应该到此为止。
