Myocardial torsion and cardiac fulcrum

Abstract

Objective: The development of the myocardial band shows that it starts and ends at the origin of the great vessels and that the myocardium joins to these rings but does not inserted into them. We always considered that there should be a fixed end of the muscle band that would allow it a helical rotation to fulfill its fundamental movements of shortening-torsion (systole) and elongation-distortion (suction).

Material and methods: Seven young-bovine hearts (800-1000g) and seven human hearts (one embryo, 4g; one 10 years, 250g and five adult, 300g/average) were used for a detailed macrocoscopic and microscopic study.

Results: We have found in all the bovine and human hearts studied a nucleus underlying the right trigone, whose osseus, chondroid or tendinous histological structure depends on the specimen analyzed. The microscopic analysis revealed in the hearts a trabecular osteochondral matrix (fulcrum) with segmental lines in bovines and in the ten-year-old human. In the fetus, it was found pre-chondroid areas in a myxoid stroma. In the adult human hearts, the histological analysis revealed a matrix similar to that of a tendon. All the hearts studied presented myocardial attachment to the rigid structure of the fulcrum. Myocardiocytes were not found neither at the left or rigth trigonous nor at the base of the valves.

Conclusions: The finding of the fulcrum gives support to the spiral myocardial band being the point of fixation that allows the helicoidal torsion.

Keywords: Cardiac anatomy; Fulcrum; Heart; Myocardial torsion; Myocardium; Ventricular band.