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The aphorism from Mencken, which we have chosen as the header for our review, is particularly pertinent to the ongoing controversies regarding the anatomic arrangements of the myocytes that make up the ventricular mass. The 3-dimensional architecture of these cells has fascinated anatomists for centuries. Despite multiple investigations, it has proved difficult to relate the presumed anatomic arrangements to function so as to adequately explain the contractions that produce the forces driving the systemic and pulmonary circulations. In particular, it has been difficult to explain why, although the individual myocytes thicken by only one sixth as they shorten, the ventricular walls made up of the aggregated myocytes thicken by an appreciably greater proportion during systole. Most anatomic investigations, exemplified perhaps by the detailed study of Pettigrew, have shown that the long axis of the aggregated myocytes changes in angulation relative to the ventricular equator at different depths within the ventricular walls. In recent years, at least 2 alternative concepts of myocytic aggregation have come to the fore, although neither has been substantiated by independent anatomic investigation. One of these concepts is based on the premise that radial fibrous lamellas interpose between ordered layers of myocytes, permitting them to slide between each other during the process of systolic thickening of the ventricular walls. A cartoon used to illustrate this concept, however, shows the lamellas extending uniformly from the epicardium to the endocardium. Any examination of a histologic section across the thickness of the ventricular wall is sufficient to show that there is no support for this particular notion. Such examination also shows that there is no order in the arrangement of the supporting fibrous matrix sufficiently regular to segregate the walls into uniform myocardial sheets. It is the other concept, equally spurious in our opinion, that has received greater attention in the surgical literature. Thus over the past few years, multiple articles have been published to support the notion that the ventricular myocardium is arranged in the form of a ‘‘unique myocardial band.’’ The concept itself stems from the work of Torrent–Guasp, who initially published his ideas in a book written in Spanish. To the best of our knowledge, the evidence supporting the notion has never subsequently been submitted to peer review, nor has the concept received support from any independent investigator. On the other hand, numerous groups, including ourselves,

Structural–functional correlates of the 3-dimensional arrangement of the myocytes making up the ventricular walls