1. Editorial Heart Failure Clinics
Ragavendra R. Baliga, MD, MBA 
Heart Failure Clinics 
Volume 4, Issue 3, Pages xiii-xix (July 2008)
DOI: /j.hfc
Copyright © 2008 Elsevier Inc. Terms and Conditions

2. Fig. 1
(A, B) Muscular architecture demonstrating the feasibility of the concertina or bellows mechanism The upper panels are sequential dissections by Professor Damian Sanchez-Quintana, University of Extremadura, Spain. (A) A normal heart viewed from the front shows the circumferential to oblique arrangement of the myofibers in the subepicardium. (B) Myofibers lying deeper than the subepicardium retain the circumferential arrangement in the right ventricle but change from oblique to circumferential in the left ventricle. The lower panels depict, in simplistic fashion, the subepicardial myofibers (left panel) and the deeper myofibers (right panel) in the ventricles of the normal heart. (C, D) Artist's rendition of the concertina pump. Ao, aorta; CS, coronary sinus; ICV, inferior caval vein; LA, left atrium; LV, left ventricle; PT, pulmonary trunk; RA, right atrium; RV, right ventricle. (Parts A and B from Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart 2006;92(Suppl 1):i2–13; with permission; and Parts C and D courtesy of Dennis Mathias, Ohio State University Cardiovascular Division, Columbus, OH.)
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
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3. Fig. 2
(A) Myocardial fiber and sheet orientation within a block of muscle excised from the anterior wall of the left ventricle. Myocytes lie in planes parallel to the long axis of the heart. Within these planes, myocyte orientation is circumferential at the mid-wall, but rotates clockwise (when viewed from the outside) to form a 60 degree left-handed helix in the epicardium (Epi) and counterclockwise to a +60 degree right-handed helix in the endocardium (Endo). Myocytes are organized into sheets 4 cells thick that are stacked like shingles. (B) Myocardial sheet movement during cardiac cycle. During systole, due to rearrangement of myocytes, sheets are becoming more perpendicular toward the endocardium, thus helping to transform a 14 percent decrease in myocyte length to 40 percent thickening of the left ventricular wall. (From Thomas JD, Popovic ZB. Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol 2006;48(10):2012–25; with permission.)
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
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4. Fig. 3
Two-dimensional representation of the plane, which, in reality, twists through the wall, as the sheets are perpendicular to the helically progressing fibers across the wall. (Solid and dashed lines) Lateral myolaminar sheets in systole and diastole, respectively. With alternating sheet families through the wall, wall thickening (D) may be due to laminar transverse shear (A), laminar extension (B), and laminar thinning (C) of each population. (From Harrington KB, Rodriguez F, Cheng A, et al. Direct measurement of transmural laminar architecture in the anterolateral wall of the ovine left ventricle: new implications for wall thickening mechanics. Am J Physiol Heart Circ Physiol 2005;288(3):H1324–30; with permission.)
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
Copyright © 2008 Elsevier Inc. Terms and Conditions

5. Fig. 4
(A) Clefts seen in 7 volunteers and 5 patients. (A to G) Vertical long-axis cine images in all 7 of the 120 healthy volunteers studied who had clefts (arrowheads) visible in diastole in the basal inferior wall. (H to K) Comparable appearances in patients who had (H) hypertrophic cardiomyopathy, (I) systemic hypertension, (J) repaired tetralogy of Fallot, and (K) relieved pulmonary stenosis. (L) Arrowhead pointing to a cleft from the right ventricular side in the interventricular septum of a patient who had repaired tetralogy of Fallot, located adjacent to the insertions of right ventricular trabecular bands. (B) Clefts viewed in specifically aligned orthogonal planes short-axis (A, B), oblique long-axis (C, D), and tangential (E, F) diastolic images of a male patient with suspected hypertrophic cardiomyopathy. The left ventricular mass index of 93 g/m2 was just within normal limits. In A, C, and E, the arrowheads point to an anteroseptal cleft, which was shown in other views to penetrate to a very small muscular ventricular septal defect in early systole, occluding later in systole. In B, D, and F, the arrowheads point to an inferoseptal cleft. Dotted lines and arrows indicate the relative orientations of slices. Note that both clefts were located adjacent to the insertion of the right ventricle into the left ventricle (A, B). (From Johansson B, Maceira AM, Babu-Narayan S, et al. Clefts can be seen in the basal inferior wall of the left ventricle and the interventricular septum in healthy volunteers as well as patients by cardiovascular magnetic resonance. J Am Coll Cardiol 2007;50(13):1294–5; with permission.)
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
Copyright © 2008 Elsevier Inc. Terms and Conditions

6. Fig. 4
(A) Clefts seen in 7 volunteers and 5 patients. (A to G) Vertical long-axis cine images in all 7 of the 120 healthy volunteers studied who had clefts (arrowheads) visible in diastole in the basal inferior wall. (H to K) Comparable appearances in patients who had (H) hypertrophic cardiomyopathy, (I) systemic hypertension, (J) repaired tetralogy of Fallot, and (K) relieved pulmonary stenosis. (L) Arrowhead pointing to a cleft from the right ventricular side in the interventricular septum of a patient who had repaired tetralogy of Fallot, located adjacent to the insertions of right ventricular trabecular bands. (B) Clefts viewed in specifically aligned orthogonal planes short-axis (A, B), oblique long-axis (C, D), and tangential (E, F) diastolic images of a male patient with suspected hypertrophic cardiomyopathy. The left ventricular mass index of 93 g/m2 was just within normal limits. In A, C, and E, the arrowheads point to an anteroseptal cleft, which was shown in other views to penetrate to a very small muscular ventricular septal defect in early systole, occluding later in systole. In B, D, and F, the arrowheads point to an inferoseptal cleft. Dotted lines and arrows indicate the relative orientations of slices. Note that both clefts were located adjacent to the insertion of the right ventricle into the left ventricle (A, B). (From Johansson B, Maceira AM, Babu-Narayan S, et al. Clefts can be seen in the basal inferior wall of the left ventricle and the interventricular septum in healthy volunteers as well as patients by cardiovascular magnetic resonance. J Am Coll Cardiol 2007;50(13):1294–5; with permission.)
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
Copyright © 2008 Elsevier Inc. Terms and Conditions

7. Ragavendra R. Baliga, MD, MBA
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
Copyright © 2008 Elsevier Inc. Terms and Conditions

8. James B. Young, MD Consulting Editors
Heart Failure Clinics 2008 4, xiii-xixDOI: ( /j.hfc )
Copyright © 2008 Elsevier Inc. Terms and Conditions