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From Vision to Mission in Myocardial Restoration

Singapore

The first 20% of the full text of this article appears below.

What do myocardial restoration and hyperspace theory have in common? The usual perception of tissue engineering, the fledgling new science, is of an art in 3 dimensions aimed at the reproduction of natural tissue in terms of structure and function. However, in the case of the heart, more than 3 dimensions need to be realized: the 4^th is the heart rhythm, and the 5^th is the contractile action and mechanics. Any ambitious attempt to manufacture cardiac muscle will have to address some unique issues if the product is to be one of high fidelity to nature. In the following, some important aspects of myocardial restoration will be discussed.

Some 10 years ago, aspiring tissue engineers and heart surgeons such as us, stood up and stated that Homo sapiens would be producing the first bioartificial left heart chamber within the decade. Unfortunately this prediction has proven premature, if not naïve. This is for obvious reasons. First, the heart is a highly asymmetric organ. The architecture of the diverse portions of the heart differs from site to site. The left ventricle is built differently from the right, and fulfills its function on a different scale. Furthermore, the form of the heart is not that of a simple sphere. Would it be so, then the maximal possible ejection fraction would not exceed 15%. The heart comprises a helix of uniquely arranged muscular bands (Torrent-Guasp bands), overlaying each other at an angle of approximately 60°.¹ . . . [Full Text of this Article]