An analysis of the spatial arrangement of the myocardial aggregates making up the wall of the left ventricle

Objective: We used the technique of peeling of myocardial aggregates, usually described as ‘fibres', to determine the spatial arrangement of the myocytes in the left ventricular wall of a healthy autopsied human heart. Methods: We digitised the left ventricular outer and inner boundaries, as well as the pathways in space, of almost 3000 aggregates harvested from the left ventricular myocardium. During the process of gradual peeling, we sought to identify the myocardial aggregates as uniformly as possible. Despite this, interpolation was necessary to complete the pattern so as to construct a unit vector field that represented the preferred direction of the myocardial aggregates throughout the entirety of the walls of the left ventricle of this individual human heart. Results: Apart from the overall systematic arrangement of the aggregates necessary to achieve physiologic ventricular contraction, we documented substantial local heterogeneities in the orientation of the myocardial aggregates. In particular, a significant proportion of aggregates was found to intrude obliquely with respect to the ventricular boundaries, with markedly heterogeneous distribution. Moreover, the distribution of the helical angle of the aggregates relative to the ventricular base varied notably throughout the left ventricular free walls and the septum. Within the generally quite uniform and continuous structure of the ventricular mass, we were, however, unable to identify any organised tracts or functional subunits such as a ‘helical ventricular band', nor did we find radial fibrous lamellas coursing across the ventricular wall. Conclusion: We suggest that the impact of local anatomical inhomogeneities, associated with gradients in regional contractile function on global ventricular dynamics, has been systematically underestimated in the past. Our analysis confirms furthermore the continuous nature of the myocardium associated with an overall gross organisation of the fibre direction field; however, there is no evidence of substructures compartmentalising the ventricle

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

With the increasing interest now paid to volume reduction surgery, in which the cardiac surgeon is required to resect the ventricular myocardium to an extent unenvisaged in the previous century, it is imperative that we develop as precise knowledge as is possible of the basic structure of the ventricular myocardial mass and its functional correlates. This is the most important in the light of the adoption by some cardiac surgeons of an unvalidated model which hypothesises that the entire myocardial mass can be unravelled to produce one continuous band. It is our opinion that this model, and the phylogenetic and functional correlates derived from it, is incompatible with current concepts of cardiac structure and cardiodynamics. Furthermore, the proponents of the continuous myocardial band have made no effort to demonstrate perceived deficiencies with current concepts, nor have they performed any histological studies to validate their model. Clinical results using modifications of radius reduction surgery based on the concept of the continuous myocardial band show that the procedure essentially becomes ineffective. As we show in this review, if we understand the situation correctly, it was the erstwhile intention of the promoters of the continuous band to elucidate the basic mechanism of diastolic ventricular dilation. Their attempts, however, are doomed to failure, as is any attempt to conceptualise the myocardial mass on the basis of a tertiary structure, because of the underlying three-dimensional netting of the myocardial aggregates and the supporting fibrous tissue to form the myocardial syncytium. Thus, the ventricular myocardium is arranged in the form of a modified blood vessel rather than a skeletal muscle. If an analogy is required with skeletal muscle, then the ventricular myocardium possesses the freedom of motion, and the ability for shaping and conformational self-controlling that is better seen in the tongue. It is part of this ability that contributes to the rapid end-systolic ventricular dilation. Histologic investigations reveal that the fibrous content of the three-dimensional mesh is relatively inhomogeneous through the ventricular walls, particularly when the myocardium is diseased. The regional capacity to control systolic mural thickening, therefore, varies throughout the walls of the ventricular components. The existence of the spatially netted structure of the ventricular mass, therefore, must invalidate any attempt to conceptualise the ventricular myocardium as a tertiary arrangement of individual myocardial bands or tract

Beta-blockade at low doses restoring the physiological balance in myocytic antagonism

Objective: The ventricular mass is organized in the form of meshwork, with populations of myocytes aggregated in a supporting matrix of fibrous tissue, with some myocytes aligned obliquely across the wall so as to work in an antagonistic fashion compared to the majority of myocytes, which are aggregated together in tangential alignment. Prompted by results from animal experiments, which showed a disparate response of the two populations of aggregated myocytes to negative inotropic medication, we sought to establish whether those myocytes that aggregated so as to extend obliquely across the thickness of the ventricular walls are more sensitive to beta-blockade than the prevailing population in which the myocytes are aggregated together with tangential alignment. If the two populations respond in similar differing fashion in the clinical situation, we hypothesize that this might help to explain why drugs blocking the beta-receptors improve function of the ventricular pump in the setting of congestive cardiac failure. Methods: We implanted needle probes in 13 patients studied during open heart surgery, measuring the forces generated in the ventricular wall and seeking to couple the probes either to myocytes aggregated together with tangential alignment or to those aggregated in oblique fashion across the ventricular walls. In a first series of patients, we injected probatory doses intravenously, amounting to a total bolus of 40-100mg Esmolol, while in a second series, we gave fixed yet rising doses of 5, 10, and 20mg Esmolol in three separate boluses. Results: Forces recorded in the aggregated myocytes with tangential alignment decreased insignificantly upon administration of low doses (57.1±12.4mN→56.6±7.6mN), while forces recorded in the myocytes aggregated obliquely across the ventricular wall showed a significant decrease in the mean (59.3±11.6mN→47.4±6.4mN). Conclusions: The markedly disparate action of drugs blocking beta-receptors at low dosage seems to be related to the heterogeneous extent, and time course, of systolic loading of the myocytes. This, in turn, depends on whether the myocytes themselves are aggregated together with tangential or oblique alignments relative to the thickness of the ventricular wall

Adsorption Properties of Surface Chemically Pure Sodium Perfluoro‑<i>n</i>‑alkanoates at the Air/Water Interface: Counterion Effects within Homologous Series of 1:1 Ionic Surfactants

The unusual behavior of saturation adsorption calculated from experimental equilibrium surface tension (σ_e) versus logarithm of concentration (<i>c</i>) isotherms within the homologous series of aqueous sodium perfluoro-<i>n</i>-alkanoate solutions represents a particular problem in the adsorption of homologous ionic 1:1 amphiphiles at fluid interfaces. Special precautions were taken to guarantee surface-chemical purity for all solutions, avoiding falsifying effects by surface-active trace impurities. Surprisingly, all homologues’ adsorption isotherms reveal ideal surface behavior. The minimal surface area demand per molecule adsorbed for shorter-chain homologues slightly decreases with increasing chain lengths but then goes up steeply after having passed a minimum. A similar feature has been observed with the chemically quite different homologous series of the hydrocarbon surfactants of sodium-<i>n</i>-alkylsulfates. Comparing the corresponding 3D saturation concentrations in the boundary layer and in the bulk, it becomes evident that at high bulk concentrations when boundary layer and bulk concentrations are of the same order of magnitude the adsorption behavior may be treated as that of a pseudononionic surfactant. However, under conditions of the homologues’ strongest surface activity, adsorption seems to become increasingly governed by electrostatic repulsion, resulting in increasingly greater cross-sectional areas. Deviation from pseudononionic behavior sets in when the Debye length becomes distinctly greater than the adsorbent’s diameter at saturation. Formerly available theories on ionic amphiphiles’ adsorption deal either with electrical conditions of surfactant ions and counterions in the adsorption boundary layer or alternatively with pseudononionic behavior neglecting the former theories completely. Warszynski et al.’s novel theoretical model of the “surface quasi-two-dimensional electrolyte” seems to be capable of describing the adsorption of ionic amphiphiles at fluid interfaces in general. We conclude that the conditions of the two alternative approaches may be met within homologous series of ionic amphiphiles as limiting cases only