But how to do that?
My curiosity toward developing inventive ways (ones I never used) to educate others, led me to consider making a video presentation. Its artistic medium, coupled with animation, seemed ideal to allow us to communicate these groundbreaking scientific discoveries. (There will be a link to view this Helix and Heart video at the end of this chapter.)
New Territory
The creative voyage of Paco Torrent-Guasp would be the focal point of this video production, as his unmasking of the previously hidden cardiac structure provided solid evidence of my belief that “elegance is simplicity” — instead of the “confusion is complexity” concept that had previously prevailed regarding the heart.
While being involved in such a production was a new experience to me, I had the good fortune to connect with a team called the Vesalius Group. They created medical videos and took their name from the Flemish anatomist considered to be “the father of anatomy.” How perfect. Their team included a director, medical artist, video specialist, narrator, and a producer who together could dramatize the story of Paco’s scientific milestone, while integrating current technologies like magnetic resonance imaging and radionuclide studies to furnish visual proof of his concepts.
Paco welcomed the prospect, as he could now provide commentary, along with observations from myself and other physicians, that would explain the new truths brought to light by his breakthrough.
Production Commences
We met in Jim Cox’s office at Georgetown University in Washington, DC to make the video.
A brilliant cardiologist named Cecil Coghlan introduced the video, by first confirming the phenomenal contributions of William Harvey’s theories about the circulatory system. Cecil then stated that Harvey’s understanding of anatomy was incomplete. He had incorrectly deduced that the heart constricted and dilated to circulate blood, a concept that prevails in medicine to this day. In this way, Cecil introduced Paco into the video, noting that 400 years after Harvey, Paco’s discovery of the architecture behind cardiac shape had initiated the revolutionary understanding of how cardiac structure can now explain all of the heart’s motions.
Paco Presents: Seeing is Believing
Early in the video, Paco traced his excitement back to when he was a medical student in Salamanca, Spain. His passion flowed from his words as he described the extraordinary simplicity of cardiac construction — one that resembles a helically-coiled rope. The concept of universality of form became evident as he disclosed this helical design was common to the hearts of many different species of animals that he studied in postmortem examinations.
Paco then visually demonstrated his concept as he used only his hands to dissect the heart (no instruments) and expose its rope-like configuration. The drama and grace of this presentation remains eternally etched in my mind. Yet this totally innovative look at the heart’s architectural configuration was accomplished during only three minutes of dissection.
He then crowned the demonstration by refolding it to rebuild the intact heart. We watched him unveil the utter simplicity and beauty of its mystery… an astonishing experience.
Making the Invisible Visible
Even before production began, I knew that we needed to bring the “dead model” to life, so we could dynamically display the helical heart’s sequential movements to all viewers. Toward that end, I was privileged that Lowell Offer, a dear friend and my swimming partner, who had just retired from Disney Studios, invited me to seek their counsel. We visited the Walt Disney Studios, and Paco (who was in town), Lowell, and I met with Andy Henry, who headed the audiovisual department. Andy joined us in being spellbound by the possibilities of Paco’s discovery, and found us an animator who could use Paco’s model as the guide to dramatically reconstruct the heart’s actions. The excitement of finding our next step seemed contagious, and I was thrilled with Andy’s team joining the project.
Paco’s concept showing cardiac motion would be demonstrated by photographing three-dimensional moving images of the heart from different perspectives: top, bottom, and side. A visually engaging animation would then be created to portray its rhythmic patterns of twisting and uncoiling — the drama of true cardiac motion.
First Contact with Paco
I was the next physician to appear on screen. Of course, I had to describe my colorful first meeting with Paco. After all, I was the professor, and he was someone few people took seriously. Yet after my explaining to him some thoughts about structure, his response made quite an impression. He boldly asserted that I had no understanding of cardiac anatomy, despite my 30 years as a heart surgeon! But I listened and learned, rather than being offended.
I was definitely curious about Paco’s novel information, particularly because I already knew the heart’s natural shape was conical, and also that when the helix’s normally slanted muscle fiber angles change to a more horizontal configuration… heart failure will follow.
So Paco’s perspective intrigued me as it suddenly made clear that these natural fiber angles became horizontal as the heart stretches to become spherical. This helped me understand how our rebuilding a normal shape would counter heart failure (as performed by our RESTORE team).
Stated simply, you cannot fix what is wrong until you know what is right, and Paco’s work provided that knowledge.
I additionally cited in the video that my search to learn about the heart revealed how its structure falls into the grand design of the helical spiral that exists throughout nature. As I had related in my AATS presentation, this is apparent in a series of natural spiral examples ranging from the tiny helical images of our microscopic DNA to a macroscopic spiral galaxy — riveting into place the breadth of commonality in nature’s universe.
“Evolving” Process
The video also illustrated how Paco’s striving to better comprehend how the heart developed compelled him to explore the human phylogenetic code (which describes the evolutionary development of a species).
He theorized that our evolution began as a worm one billion years ago, with a vascular tube (rather than a conventional heart) that looked much like a rope. The video used animation to illustrate that 400 million years ago, this evolved into a fish with gills — and a heart structure containing a helix and a single pumping chamber. This helical configuration continued when the amphibian / reptile developed 200,000 years ago with a heart where the two atriums and the ventricular septum each had a hole in their walls. But these internal cardiac holes closed as the ape/ human developed about 100,000 years ago — giving us the two separate atriums and two separate ventricles that form our four-chambered heart.
The video then highlighted the startling discovery I made while preparing my AATS lecture. This transition from worm to fish to amphibian / reptile to man took over a billion years. Yet a most remarkable similarity takes place when one looks at how the human develops during the first month and a half of embryonic gestation. The heart of the human fetus undergoes this same billion-year transition from worm-like heart, to fish-like heart, to amphibian / reptile-like heart… to finally the human heart. All within 50 days. Astounding!
Pictures Worth a Thousand Words
When Paco initially uncovered the anatomy of the heart, he had yet to determine how it functioned. One day he saw an MRI sequence that captured the dynamic motions of the functioning heart and it all came together for him. Our video replicated this stunning clarity of the heart’s sequential movements by including a multi-gated acquisition (MUGA) scan, which showed how components of the helical heart caused sequential cardiac motions — just as Paco had theorized.
This superb connection between structure and function was further dramatized in a video segment of a beating human heart during a surgical procedure… that demonstrated the harmonic rhythms that Paco fondly called the “cardiac dance.”
Stimulating the Helical Heart
The other physician to appear in our video was Jim Cox, the distinguished cardiac surgeon and electrophysiologist (a f
ield that focuses on the heart’s electrical system). Jim was fascinated by the straightforward solution to cardiac anatomy that became apparent as Paco literally uncoiled the Gordian knot of heart structure. Jim always believed there had to be a simple architectural answer (unlike many mystified others who concluded that heart design could never be fully understood). Jim delighted in learning that Paco Torrent-Guasp had untangled this “complex” mystery.
The validity of the helical heart was further reinforced when Jim described how the electrical, physiological, and functional data that he collected over many years — supported how impulses would be delivered throughout a ventricular band — the central component of Paco’s helical heart concept!
In fact, the video reported that credibility of this helical design continues to grow stronger, despite physicians having long been taught that the heart constricts and dilates (squeezing like a fist to eject blood and opening to fill). Instead, the spiral formation of the heart actually makes it twist and uncoil to eject and fill with blood — with these motions clearly confirmed by MRI studies demonstrating this movement during each heartbeat — caused by the heart’s helix and wrap configuration.
Importantly, this new knowledge of normality further sets the stage for understanding why deviation from the heart’s natural elliptical form into a spherical shape leads to the problem of congestive heart failure.
Heart Reflected in Architecture
This concept of healthy (and sick) hearts relating to structure — was expanded upon when Cecil Coghlan then related them to examples found in architecture, much like I had during my AATS lecture.
He highlighted that we can certainly marvel at Romanesque design, where circular structures offset stresses by using a centerpiece (or keystone) placed at a central focal point on the top of the arch. Forces that could cause disruption will be directed upward toward this centerpiece. Yet serious limitations exist in these Romanesque structures, whose circular form correlates with the spherical heart of congestive heart failure. They become unstable if their constructed arch is too high or wide, so that their strength is augmented by stacking individual arches in layers to gain the necessary height. This is evident when looking at Roman aqueducts in Segovia, Spain… or the Roman Coliseum (Figure 1).
Figure 1: Romanesque design contains many circular arches, with forces directed to the central point on top of each arch, called a keystone. This limitation means that many layers are needed to increase height.
Cecil elaborated that to achieve a greater height and width, architects subsequently used the gothic design, as exists in Notre Dame Cathedral (built in 1345) and others, whose external buttresses brace the arches whose structural forces would otherwise move downward. (Figure 2)
Figure 2: Gothic dome on left, whose great height is maintained by support from external (flying) buttresses on right.
Figure 3: The similarity of the cathedral on left, and the heart on right where the basal wrap is the buttress.
Cecil then presented an amazing juxtaposition, whereby he showed the parallels between gothic architecture and the healthy elliptical heart as he held Paco’s model upside down — its apex on top (like the gothic dome) and circumferential wrap (the heart’s buttress) below — precisely forming the cathedral design that we know so well. (Figure 3) They became one as both shared a powerful and stable form.
Ironically, gothic architects had copied the heart’s design many centuries ago, yet the heart’s own geometry was only “just discovered.”
Such types of comparisons help us to better understand the heart, including grasping the reasons for problems that develop during congestive heart failure. The sporting metaphor mentioned before was used again in the video to create a clear visual example, as we contrast the football (for normality) against the basketball (for heart failure). From Paco’s discovery, we now understood how ventricular stretching within this poorly functioning spherical form will distort the fiber structure within the helix. The resulting architectural change in these dilated hearts becomes the geometric cause of heart failure.
The video includes an operation done by the RESTORE team that shows them reconstructing a normal ventricular shape in a patient with heart failure — improving heart performance as this changes the basketball shape back into a football form.
Acknowledgment of a Major Contribution
Paco’s revelations of heart structure are so far reaching, that Cecil Coghlan compared their impact to William Harvey’s groundbreaking discovery of the body’s circulatory system in 1628. Cecil felt (and Jim Cox and I concurred) that Paco’s novel understanding of cardiac structure may exceed the contributions of William Harvey.
Appropriately, the video’s final scene involved only Paco, who reappeared with the helically looped rope to emphasize the straightforwardness of his spectacular findings. He concluded by declaring his contribution was “simple, not complicated.”
Of course, that is its beauty and power. Paco’s discovery reaffirms the elegance of nature.
The Freddie Award
Copies of the video were sent to anatomists worldwide and to directors of every cardiac surgery residency program.
I was subsequently invited to visit Lake Louise in Canada to present this video at their Canadian cardiology meeting. A highly enthusiastic response followed the video presentation, and one of the staff came up to ask if I was interested in submitting the work for the “Freddie Awards.” Apparently, this was the competition of the International Health and Medical Media Awards for health and medical videos. The biomedical equivalent to the Oscars and the Emmys, it was to be held in New York City as a black-tie event.
We submitted our video and won the Clinical Science Award. I could not attend the prize ceremony in New York because I was in Argentina. Richard Craig, the writer and producer from Vesalius, attended in my place. In addition to the awards for individual categories, a final Surgeons General Award was to be given to the best submission within the entire competition.
Soon after the conference, Richard phoned me. “Gerry, are you sitting down? You’re not going to believe this. We not only got the Clinical Science Award… but our Helix and Heart video received the Surgeons General Award as well!”
I was deeply gratified by this, not because we had “won,” but because to me it meant that the video had meaning.
The Legacy
How our video, and the information it presents, impacts the medical field in a profound and lasting way is still to be seen.
I am reminded of a commonality between Harvey and Paco, both legendary masters of the cardiovascular system. Harvey had brilliantly described the systemic circulatory system, overturning 1,800 years of how medicine looked at the heart / body connection. Interestingly, Harvey could only postulate the existence and role of the body’s capillary network, due to scarcity of measuring instruments. It wasn’t until three years after Harvey’s death that Italian anatomist Marcello Malpighi actually detected capillaries using a microscope.
In a similar way, Paco’s helical ventricular myocardial band has provided the mechanical functional basis to accurately explain cardiac actions, resolving 400 years of limitations due to anatomic misconceptions. Yet the importance of his discovery only started to become clear eight years following his death (2005), after others were able to fully correlate his architectural discoveries with the movements that exist in the functioning heart. I wrote papers and delivered lectures on it while new imaging tools (including advanced velocity vector imaging, MRIs, and 3D echocardiograms) unequivocally confirmed how heart motion precisely matches what Paco proposed.
I had a remarkable experience in Birmingham, Alabama, where I traveled to meet with Navin Nanda, the editor of the Journal of the American Society of Echocardiography. When I told him what Paco had uncovered, Navin said, “Gerry, with velocity vector imaging, we should be able to see what you just described.” This was my first exposure to VVI, which takes rapid pictures of the heart lasting just microseconds, and each image deta
ils every directional movement. Navin could break down one heartbeat into perhaps 150 photographs or “slices.” I was amazed. Why? It was not because the technology was impressive (it was). But rather, because I was able to look at those slices — and tell Navin exactly what was causing every single muscle movement at every moment.
Navin was astonished, and frankly, so was I! With Paco’s work, I had finally found the “secret formula,” and suddenly could explain everything occurring during each heartbeat!
Changes Ahead
Indeed, the enormous contributions of William Harvey and Paco Torrent-Guasp do parallel each other, as Harvey discovered the circulation… while Paco illuminated the functional heart anatomy that occurs during both health and disease.
People are finally getting interested in learning about Paco’s findings. Yet there can be great distance between what is known and what is accepted. New ideas make you think differently, and as has been the case in the world of art, there will almost always be initial opposition. These hurdles cause scientific acceptance to be a far-off goal. Yet the truth will win.
The world resisted the early French impressionists, but now long after they have passed on, the world looks at art in a different and grander way because of their efforts. So it will be for Paco and the grand contributions he made to understanding our hearts. He allowed the medical field to look at the heart differently, and use this knowledge to uncover new solutions to illnesses.
Svetlana Alexievich, winner of the 2015 Nobel Prize in Literature, captures this potential. She writes, “History records the lives of ideas. People don’t write it, time does.”
Solving the Mysteries of Heart Disease Page 39
