La bomba de succión cardíaca. Aplicación de la banda miocárdica de Torrent Guasp al tratamiento quirúrgico de la insuficiencia cardíaca

Trainini, Jorge C.; Herreros, Jesús; Cabo, J.; Coto, Eduardo Otero; Cosín-Aguilar, Juan

doi:10.1016/s1134-0096(11)70064-x

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…(12) El fondo de saco del ápex ha sido utilizado en la técnica de reconstrucción elipsoidal del ventrículo izquierdo. (13,14) La incisión, con ingreso por el vértice y de orientación paralela a la arteria descendente anterior, actúa sobre el área limitada por los segmentos descendente y ascendente de la banda miocárdica, corrige la distorsión del septum, y permite que se realice la cirugía ingresando en la pared avascular del ventrículo izquierdo, lo que impide arrastrar durante la resección el sistema arterial. La técnica de suturar los extremos superponiéndolos genera un efecto geométrico de solapa y refuerza el ápex, lugar especialmente vulnerable en la dilatación cardíaca.…”

Section: Segmento Ascendenteunclassified

Investigación anatómica del ápex cardíaco

Trainini¹,

Beraudo²,

Wernicke³

et al. 2022

Rev Argent Cardiol

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Objective: Understanding cardiac anatomy is the key to solve unknown issues about its function. The continuous and helical myocardial structure plays a fundamental role in its torsion-detorsion motions. Does the apex, a constitutive part of the ventricle, have relevance in cardiac dynamics or is it simply a cul-de-sac? The aim of this study was to answer this question. Methods: Four young bovine and four human hearts (two embryos and two adults) were used for the anatomo-histological studies. Two procedures were carried out for this investigation: a) the continuous myocardium unfolding to observe the fiber arrangement at the tip of the left ventricle, called the apical zone; and b) horizontal and longitudinal sections to study the structure of the apex. The horizontal sections were performed between the middle 2/3 and the apex, and the longitudinal ones, sectioning left ventricular apex, with an apex-base orientation. Results: In all the human and bovine hearts studied we found that the apex corresponds only to the left ventricle, where the twist of the descending segment is located, in the ascending continuity of the myocardium. The apical cul-de-sac has practically no muscular plane at its end. It is internally lined by the endocardium and externally by the epicardium. The muscular plane has only 10% thickness of the adjacent myocardium, a structural concept confirmed by transillumination. Conclusions: The apex is a cul-de-sac practically devoid of muscle, in which the endocardium and epicardium are attached, but which performs the functions of supporting intraventricular pressures and being a constitutive part of the torsion and de torsion motions

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Section: Segmento Ascendenteunclassified

Investigación anatómica del ápex cardíaco

Trainini¹,

Beraudo²,

Wernicke³

et al. 2022

Rev Argent Cardiol

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“…As a result of this anatomo-functional process, the apex (space between the two bands) has in normal conditions the power of annular narrowing (sphincter-like mechanism) to bear the retrograde intraventricular pressure produced by blood ejection. At the beginning of the isovolumic (active) phase, erroneously considered as belonging to diastole, which instead should be named suction phase, the persistent contraction of the ascending band with left ventricular lengthening generates the fall of intraventricular pressure, sufficient to achieve ventricular suction [17][18][19]. This pressure fall produced by the persistent contraction of the ascending band during the isovolumic phase with every left ventricular orifice closed, works as a "plunger" mechanism (suction phase) at the moment it starts lengthening.…”

Section: Functional Aspects Of the Ventricular Myocardial Bandmentioning

confidence: 99%

Untitled

2019

TAP

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“…Some authors question that these mechanisms were sufficient to explain rapid left ventricular filling [1][2][3]. A mechanism was postulated by which at the onset of diastole (isovolumic diastolic phase) the ventricle aspirates blood actively [2][3][4][5]. The active mechanism has been expl ained by the spatial arrangement of the muscle band [1].…”

Section: Introductionmentioning

confidence: 99%

Ventricular torsion and cardiac suction effect: The electrophysiological analysis of the cardiac band muscle

Jorge¹,

Benjamen²,

López-Cabanillas³

et al. 2017

Interventional-Cardiology

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Ventricular torsion and cardiac suction effect:The electrophysiological analysis of the cardiac band muscle Introduction and objectives: The Torrent Guasp concept postulates that the ventricles are formed by a continuous muscle band that begins at the level of the pulmonary valve and extends to the aortic root, limiting in this way the two ventricular chambers. This specific anatomical arrangement would support the interpretation of two fundamental aspects of left ventricular dynamics: 1) the torsion mechanism and 2) the physiology of rapid diastolic filling by the suction effect. Methods: Five patients with no structural cardiac abnormalities and normal QRS complexes underwent three-dimensional endoepicardial electroanatomic mapping during ablation of lone atrial fibrillation or concealed epicardial accessory pathways. The propagation times of the electrical activation by the muscular band was measured in milliseconds (ms). Results: 1) The apical loop is activated by a simultaneous depolarization of the distal descending and proximal ascending band segments. 2) At the point of crossing of both bands a radial activation spreads from the descending to the ascending band. From this point, begins a simultaneous and opposing activation of the proximal and distal ascending band.3) The activation of the distal ascending band segment is the latest. Conclusions: The novel activation sequence of the Torrent Guasp band found in this study would explain the previous process triggering the ventricular torsion and suction mechanism. Moreover, this work demonstrates that activation of the ascending band segment completes the QRS. This finding explains the persistent contraction of this muscle segment during early diastole, rejecting the traditional concept of passive relaxation.

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La bomba de succión cardíaca. Aplicación de la banda miocárdica de Torrent Guasp al tratamiento quirúrgico de la insuficiencia cardíaca

Cited by 5 publications

References 24 publications

Investigación anatómica del ápex cardíaco

Investigación anatómica del ápex cardíaco

Untitled

Ventricular torsion and cardiac suction effect: The electrophysiological analysis of the cardiac band muscle

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