title: The difficult access to morphology of the heart: clinical implications.
abstract: The literature on the morphology of the heart is reviewed within the context of recent histological findings. There is strong evidence for a dualistic myocardial function, whereby both ventricular constricting and expanding forces are supposed to act synchronously although with variable effect over the heart cycle.The morphological basis of this dualistic myocardial function is the contorted rope-like structure worn into the bulk of the heart muscle. Opinions are divided about the invasiveness of blunt preparation on the heat denatured heart by which the fascicular architecture is carved out of the muscle. Histology confirms the existence of a fascicular substructure. It results from an inhomogeneous repartition of myocardial fibre branchings and the arrangement of the delicate connective tissue netting by which myocardial strands are bundled and wrapped. One important feature of the fascicular structure of the heart muscle is an oblique transmurally arranged element which yields a force vector opposing systolic wall thickening. This structural element which acts in the direction of ventricular dilation probably gains pathological import in some cases of architectural remodelling, namely in myocardial fibrosis and hypertrophy.
authors.affiliation: Experimentelle Thorax-, Herz- und Gefässchirurgie, Westfälische Wilhelms-Universität Münster, Deutschland.
authors.forename: P P
authors.initials: PP
authors.lastname: Lunkenheimer
authors.affiliation: Experimentelle Thorax-, Herz- und Gefässchirurgie, Westfälische Wilhelms-Universität Münster, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Redmann
authors.affiliation: Institut für Numerische und instrimentelle Mathematik, Westfälische Wilhelms-Universität Münster, Deutschland.
authors.forename: C W
authors.initials: CW
authors.lastname: Cryer
authors.affiliation: Zentrale Tierexperimentelle Abteilung, Westfälische Wilhelms-Universität Münster, Deutschland.
authors.forename: K D
authors.initials: KD
authors.lastname: Richter
authors.affiliation: Institut für Biomedizinische Technik und Medizinische Informatik, der Uniuersität und ETH, Zürich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Niederer
authors.affiliation: Department of Histopathology, King's College School of Medicine and Dentistry, London, UK.
authors.forename: W F
authors.initials: WF
authors.lastname: Whimster
authors.affiliation: Department of Exploración Cardiopulmonar, Hopital Universitario San Carlos, Universidad, Complutense, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Torrent-Guasp
keywords: Blunt preparation; Cleavage plane; Compartmentation; Fascicular structure of myocardium; Fibre alignment; Freedom of motion; Rope structure; Wall stress; heart; heat deanatured