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How much of the right heart belongs to the left?

Cook, AC; Anderson, RH; (2009) How much of the right heart belongs to the left? In: Congenital Diseases in the Right Heart. (pp. 9-20).

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Abstract

In the preceding chapter, we have seen how from the outset of development the right heart has very separate origins from the left. We have learned how the cells from the secondary heart field are responsible for the formation of the right ventricle and outflow tract, and how they are added to the initial linear heart tube slightly later in development compared to the part that gives rise to the left ventricle [1-5]. We now know that the apical components of the ventricles balloon from the linear heart tube, which is made up of primary myocardium, and that the molecular characteristics of the working myocardium of the right and left ventricles thus formed differ markedly from the primary variant [6]. In this chapter, we explore how these embryonic features are carried over into the structure of the heart subsequent to the completion of septation. In an effort to describe just how much, in morphological terms, of the right heart belongs to the left, we begin by emphasizing the current gaps in our understanding of the mechanics of early myocardial organization. We then define our approach to analysis of the ventricular component of the heart. We put this into the historical perspective of myocardial structure and contrast this traditional approach, based on centuries of investigation, and which is in keeping with our own observations, with recent spurious suggestions that the myocardium making up the ventricular mass can be unwrapped in the form of a unique band, which takes its origin in the fashion of skeletal muscle from the pulmonary trunk, and inserts at the aorta [7] . In terms of this latter concept, we show that, despite its apparent attraction to those seeking to explain the helical movements of the ventricular mass during contraction and relaxation, it is fatally flawed due to the total lack of supporting scientific evidence. © Springer-Verlag London Limited 2009.

Type: Book chapter
Title: How much of the right heart belongs to the left?
ISBN-13: 9781848003774
DOI: 10.1007/978-1-84800-378-1_2
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health
URI: http://discovery.ucl.ac.uk/id/eprint/1339907
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