Architecture must document functional evidence to explain the living rhythm

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 fitting 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. White presumption is an important first step, proof of the marriage of structure and function happens only with measurement, a critical step before surgical action. (C) 2005 Elsevier B.V. All rights reserved.