Cardiac Fiber Orientation and the Left‐Right Asymmetry Determining Mechanism

Delhaas, Tammo; Decaluwe, Wim; Rubbens, M.P.; Kerckhoffs, Roy; Arts, Theo

doi:10.1196/annals.1302.016

Cited by 20 publications

(14 citation statements)

References 25 publications

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“…In the present contribution, it is shown that the helical arrangement of Torrent-Guasp's ventricular myocardial band model does not reflect the changes in configuration of the embryonic heart loop. This fact seems to be in accord with data from a recent study on situs inversus hearts suggesting that the definitive sense of twist of the helically arranged ventricular muscle fibres does not depend on the chirality (left-or right-handed) of the embryonic heart loop [31]. The ontogenetic evolution of the definitive structural and functional organization of the ventricular myocardial mass, therefore, most likely starts in the post-looping embryonic heart.…”

Section: Discussionsupporting

confidence: 88%

Ontogenetic development of the helical heart: concepts and facts

Männer

2006

European Journal of Cardio-Thoracic Surgery

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The structural and functional organization of the ventricular myocardial mass is a controversial matter that cannot be resolved by anatomical studies alone. Therefore, other approaches such as investigations of the ontogenetic development of the ventricular myocardium might help to resolve controversies about its structural and functional organization. It has recently been proposed that the spatial orientation of Torrent-Guasp's ventricular myocardial band model (basal and apical loops) might be the mature morphological correlate of twists and torsions of the embryonic heart loop. In the present contribution, the suggestions made in this concept were analyzed in the light of currently known facts about the development of the embryonic heart. It was found that some of the suggestions made in this concept do not correspond to embryological facts, whereas other suggestions could neither be disproved nor confirmed on the basis of our current knowledge on heart development. The answer to the question as to which of the various models of myocardial fibre organization fits best with the ontogenesis of the myocardial mass awaits future studies. The myocardial units of Torrent-Guasp's myocardial band model are said to have a functional rather than a morphological personality. Future studies on the ontogenetic development of the myocardium, therefore, should comprise not only anatomical analyses of dead specimens but should additionally comprise high resolution in vivo analyses of the development of the spatio-temporal contraction patterns of embryonic and fetal hearts.

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Section: Discussionsupporting

confidence: 88%

Ontogenetic development of the helical heart: concepts and facts

Männer

2006

European Journal of Cardio-Thoracic Surgery

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“…For example, in congenital anomalies, such as situs inversus totalis, the orientation of the apical and epicardial basal fibers is normal, but the orientation of the deeper endocardial basal fibers is inverted. 24 Twist is, thus, normal at the apex, but changes direction at the base, 25,26 causing absence of relative apex to base rotation. 26 Similarly, in patients with LV noncompaction and hypoplastic hearts, the absence of normal fiber architecture causes both the LV base and apex to rotate in the same direction, exhibiting none or minimal twist, a physical type of rotation that is called rigid body rotation.…”

Section: Impact Of Myocardial Structuralmentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

101

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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“…Interestingly, individuals who have all organs arranged in a mirror-image pattern (situs inversus) generally face no adverse physiological consequences. However, cardiac muscle fiber architecture in these people is reversed only in the basal region of the left ventricle, leading to abnormal (not just reversed) torsion during the cardiac cycle (Delhaas et al, 2004). In contrast, serious malformations may result if the heart is the only organ that is reversed (dextrocardia).…”

Section: Studies Of Looping Directionalitymentioning

confidence: 99%

Biophysical mechanisms of cardiac looping

2006

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During early embryogenesis, the heart is a single, relatively straight tube which bends and twists (loops) rightward to create the basic plan of the mature heart. Despite intensive study for many decades, the biophysical mechanisms which drive and regulate cardiac looping have remained poorly understood. This review discusses, from a historical perspective, studies of looping mechanics and various theories which have been proposed for this complex process. Then, based on recently acquired data, a new biomechanical hypothesis is proposed for the first phase of looping (c-looping). Understanding morphogenetic mechanisms would facilitate research devoted to preventing and treating congenital heart malformations caused by looping abnormalities.

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Cardiac Fiber Orientation and the Left‐Right Asymmetry Determining Mechanism

Cited by 20 publications

References 25 publications

Ontogenetic development of the helical heart: concepts and facts

Ontogenetic development of the helical heart: concepts and facts

Left Ventricular Twist and Torsion

Biophysical mechanisms of cardiac looping

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