Of course, the real winner is not Paco… but the patient.
Paco’s discoveries — and our affirmation of them — offered a monumental shift in our understanding of the heart. But how would the medical community react to this groundbreaking knowledge?
As we would find out, history tells a repetitive tale, one populated by the fierce stalwarts of tradition who are resistant to new thinking. They will hold onto old beliefs, despite a wealth of fresh data that confirms the helical ventricular myocardial band architecture can explain structural reasons for every cardiac motion.
Alternatively, a very different and pragmatic response is made by those who want to consider this new concept. They ask: “What does this discovery mean, and is it useful?”
That fundamental question addresses why the connection between structure and function is so powerfully important. Possessing this innovative knowledge yields a remarkable treasure, as it unearths a bevy of answers to problems that, until now, have frustrated the medical community. As we’ll see, an eruption of fresh insights will evolve into successful solutions for a wide range of common heart conditions, whose treatments so far have only addressed symptoms.
I will explore these uncharted waters in the upcoming chapters, using this new knowledge as a guide to understanding — and treating — these previously unsolvable cardiac issues:
heart failure in dilated hearts
heart failure in normal hearts that cannot relax
disorders in the ventricular septum and right ventricle
heart pacemaker shortcomings
Creativity — Important to All My Journeys
Beyond continuing to play a key role in my developing novel solutions to these and other heart problems, my creative energies have always fueled the artistic portions of my life. Creativity is adventure, and blends both art and science.
A glimpse into my artistic endeavors will be presented in a sequence of chapters (bracketed between each of the remaining scientific chapters) to reveal how my curiosity energizes a convergence of art and science in my life. They will disclose:
how the helix and heart interrelates with the human being
a video presentation of the helix and heart that won an international prize
heart function as reflected in a ballet called “The Cardiac Dance, Spirals of Life”
the heart and Stonehenge — surprisingly similar constructions
and finally, how my art and my science link with my lifestyle.
Paco’s work took us a giant step forward, because it raised the curtain on a deeper understanding of heart structure and its function. Our feet would have remained fixed without this insight, leading us to only stand on today. But with it, the beauty of tomorrow unfolds before us.
It is a future filled with unprecedented breakthroughs that come by having vision — not from simply looking.
CHAPTER 19
Art and Science: Nature’s Grand Design
One of the most wonderful things about a new scientific idea is its capacity to open a gateway to the next exploration.
Paco’s discovery of the helical heart’s architecture answered many unresolved questions, while simultaneously raising new ones. Each of these questions needed to be answered, for their solution will ensure the validity of his new helical heart model. The first query involved explaining the relationship between the helical heart’s structure and how its electrical connections can stimulate its rhythmical motions.
Little could I have predicted that this medical pursuit would reveal connections between the heart, nature, and the human being.
Starting Point
The heart’s electrical system was outside my area of expertise, so my initial step was to find a suitable scholar with an open mind who could listen, learn, and ask questions that might more fully uncover the helical heart’s structure / function relationships. I selected Jim Cox, a renowned cardiac surgeon and the master electro-physiologist who had designed a groundbreaking surgical procedure to treat atrial fibrillation.
Paco (Dr. Francisco Torrent-Guasp) had unmasked the heart’s hidden geometric form. For this reason, I asked him to fly in from Spain to join us at Georgetown University in Washington DC, where his revelations of cardiac anatomy could be shared with Jim Cox.
It was a momentous meeting. Jim was fascinated by how this concept simplified understanding the heart’s form while explaining its function. He was further impressed by the beauty of Paco’s silicon model. It allowed rapid unfolding of the heart into a rope-like configuration, and then refolded to reproduce normal structure. This phenomenal teaching tool allowed anyone to see the straightforward elegance of the heart’s construction.
The Lecture
Neither Jim nor I realized the full ramifications of this concept of ventricular architecture. Yet we both recognized the enormity of its potential. At the end of our discussion, Jim asked me to consider giving the Basic Science Lecture at the American Association of Thoracic and Cardiac Surgery (AATS) conference in 2001. He knew our colleagues would consider Paco’s work an exciting breakthrough.
The “Basic Science Lecture” is a high point of the association’s annual meeting — the world’s foremost gathering about heart surgery that is attended by 3,000 to 4,000 cardiac surgeons from all over the globe. As its president, Jim was free to select that year’s speaker. Having me present was a bold stroke, as the purpose of the lecture is to have a lasting impact that addresses subjects that go beyond surgery. It is not just about discussing new approaches to performing an operation. In fact, only one other surgeon had ever given this talk. Instead, Nobel Laureates, renowned physicists, genetic engineers, and other prominent individuals had been chosen. But Jim recognized that the implications of what I would present could be vast. It would lay out a novel approach that may finally link cardiac form and function. (Figure 1)
Jim saw this as a way to spring open the previously closed doors to new ways of thinking (an enticing goal, as it also lined up with my teaching mantra). I gladly accepted.
Figure 1: Gerald Buckberg M.D. at Basic Science Lecture at AATS in 2001.
The Challenge Ahead
It was quite an honor to deliver this lecture, and much thought would go into creating it. This would be far different from all of my previous presentations, each of which had focused on specific scientific cardiac topics. While I knew my subject would center on Paco’s discovery, I also realized that if I was to introduce a new way of thinking, the talk needed to go beyond simply a discussion of the heart.
I needed to reveal that the structure of the heart is part of something much larger, a prelude to my exposing a concept that may give insight into the nature of life itself.
The lecture would blend art and science, and be entitled, “Basic Science Review: The Helix and the Heart.” Later, I will provide a link to a video of the lecture. This chapter will detail how the presentation evolved, and the incredible discoveries along the way.
Let me now describe the education of me, the educator.
Journey’s Beginning: The Student’s Mind
As I would be exploring new territory, I wanted to embrace a learning strategy similar to one that I often used with my two daughters when they were growing up.
My workweek was always very busy, so I treasured the special time I could be with my daughters during weekends. One of the things I did was to take them on a walk down a canyon near our house… where we played the game of “discovery.” Though we walked along corridors that we had traveled many times before, we’d look for different things each time. We talked about the concept of discovery, where you must be willing to see things freshly, and try to understand why they are there. It is the difference between “having vision,” rather than only “looking.”
I knew I wanted to touch on this process as I began my talk, as my lecture would be presented to a very accomplished and established collection of surgeons. Describing this discovery process would set the tone and hopefully help them open to a radically ne
w way of looking at the heart and more. I’d cite the academic adage that “Students are often wrong, but always in doubt… whereas professors are sometimes wrong, but never in doubt.”
I’d ask them to join me on this fresh “walk,” as together we maintain this student-like attitude, one that has energized my quest for new possibilities during my over 50 years of finding ways to create interaction between research and clinical practice.
Pilgrimage to Discovery Began Long Ago
While beginning my research into organizing this lecture, I quickly realized my presentation must cast a wide net, so that I needed to create new correlations between the heart, nature, and the human being.
Yet I was uncertain how to justify connecting these three subjects. But Albert Einstein, my hero, reassured me. “All our science, measured against reality, is primitive and childlike, and yet is the most precious thing we have,” he once said. His advice encouraged me to search for Nature’s yet-unrecognized grander picture.
The heart was a fine starting point, but I quickly realized that Paco and I were not the only ones to enter this educational trail involving the helical heart design. In fact, we were not at all the first.
I found that the English physician and physiologist, Richard Lower, had described helical fibers back in 1669, when looking at the vortex at the apex tip on the bottom of the heart. He noted that the helical arms were like a figure-eight, with reciprocal arms that cross each other in a clockwise and counterclockwise pattern. (Figure 2) Then later, in 1748, the French anatomist Senec inspected the inside of the heart and noted a similar reciprocal pattern of helical clockwise and counterclockwise formations of spiral muscle fibers (he also confirmed this inner helix was surrounded by a wrap of horizontal fibers that could compress or constrict the ventricle).
The prevalence of interest in this helical design surprised me. I found that in the 1400s, Leonardo da Vinci, another hero of mine, focused upon the heart’s apex, which he thought to be the motor of the ventricle. Leonardo was intrigued by the reciprocal spirals in the blood flow patterns that developed as blood was ejected into the aorta.
Figure 2: Lower’s illustration in the 1600s showing a helix with clockwise and counterclockwise spiral formations of ventricular muscle. The vortex at the apex, shows the outside spiral arm turns in and the inside spiral arm turns out.
Senec’s illustration in 1700s France showing the helical arrangement of ventricular muscle fibers create the cardiac architectural design.
I wondered what conclusions Leonardo might have drawn if he had been able to study (with the advanced imaging technology we possess today) the zebra fish, which developed 400 million years ago. I learned it also exhibits clockwise and counterclockwise spirals after heart blood is ejected into its aorta. This is especially thought-provoking as this fish’s anatomy is tiny — its aorta blood vessel microstructure being only one-third the size of a human hair! (Video 1) Yet the configuration of its aorta is the same as that of the human, as are the spiral whorls of blood flow observed after each heartbeat.
Would Leonardo have considered the same idea that I was considering? Namely, that we humans are not unique, but simply play a part, just like the zebra fish, in nature’s larger scheme?
Video 1: On left is elliptical working heart of zebra fish, whose aorta and heart shape mirror the human’s as commonality exists but the size differs: the five-cell thick zebra fish heart ejects blood into an aorta that is one-third the size of a single human hair (on right).
www.vimeo.com/buckberg/zebra-fish-heart
Figure 3: Reciprocal spirals in daisy, nature’s design.
World Beyond the Heart
An even more enthralling observation was still ahead of me, as I would find that the heart was not unique in its clockwise and counterclockwise architectural configuration. This natural pattern exists across a vast scope of life, and reveals magnificence and harmony throughout nature.
Keen observation uncovers new understanding. For example, in botany, flower buds display this same reciprocal spiral arrangement. (Figure 3) Moreover, the tiny circles in the center “floral disc” expand as you go from center toward its outer rim. This marvelous growth design is called the “botanical logarithmic spiral theory of phyllotaxis.” The magical joining of science, mathematics, and life.
I quickly realized that spirals were not limited to the heart or a flower’s bud. You can see the same pattern in the growth of a pinecone. Even the nautilus shell contains a spiral. Moreover, I was astounded that a helix shape — similar to that of the heart, (Figure 4) becomes apparent if you view the narrowed (vortex) end of seashell when it is upright.
Figure 4: Demonstration of how the conical helix is formed from the flat spiral.
Ecstatic, I began looking further, and found helical patterns common to many animals with horns, such as the ram or eland. But again, this isn’t a matter of visual aesthetics. It’s a matter of function. These horns do not break during combat. Why? Because nature has provided a very sturdy structure by creating additional spirals inside the horns — again, the interweaving of spirals within spirals is exposed as one of nature’s tricks.
My pursuit widened as I wondered: how prevalent might the spiral be in nature?
I found more and more examples. Looking to better understand this fundamental harmony drew me back even further in history to 600 BC, when the Greek mathematician Pythagoras defined the concept of the golden section. This relationship emerges from a simple rectangular figure. A line placed within it will create two proportional dimensions, as the ratio of the smaller component to the larger component… mirrors how the larger component compares to the whole. (Figure 5)
The numerical characteristics of this interaction were later discovered in AD 1250 by Fibonacci, who mathematically described a logarithmic spiral that identified a harmony between parts. He defined these proportions as 0.618…. (a number without end, infinite like that of π or pi). Placing these rectangular parts together (as in the diagram) creates a spiral. (Figure 5, bottom) It again shows the beauty of harmony and variance — yet another instance of spirals that maintain core similarities even while appearing in different forms.
Figure 5: The golden proportion of Pythagoras (above) in 600 BC where the small is to the large, as the large is to the whole. Bottom is how interweaving the golden proportions will form a spiral, as described by Fibonacci in AD 1250.
Gargantuan Relatives
Enchanted by my findings, I again turned my attention to nature’s smallest components. Leaping forward in time to 1953 and more contemporary revelations made through microscopic surveys, scientists were finally able to unveil the structure of DNA, the recipe for the master plan of life. And what did they find?
That DNA has a double helix (spiral) structure.
The scope of correlations seemed infinite, for I found other examples in microbiology as well as in the heart. Substances that ignite the proteins that cause the heart’s muscle contractions (such as myosin, actin, and tropomyosin)108 all display the double helix structure. The same spiral arrangement within calcium ions can be observed by using scanning electron microscopy to look deeply into a cell.
I was uncovering an entire symphony of interrelated double helix forms — each reflecting spiral configurations that are the “keys to the natural kingdom.” This unity stretches across a spectrum from microscopic ionic images to the macrostructure of the galaxy of spiral whorls in the heavens above us! (Figure 6)
Figure 6: Gargantuan relatives, as the spiral exists in an ion of calcium, in the same way it appears in the cosmos.
We see many of the same patterns wherever we look, confirming an inevitable conclusion: the heart is part of a greater design that exists within nature.
Einstein believed in such possibilities, and, in fact, resisted the assumption of the innate randomness in the universe that was proposed by quantum mechanics. He famously said, “God does not play dice with the universe.” In other words, God is not arbitrary in deciding how
things will be. There is a grand plan, and I had found that the spiral and helix are fundamental to it.
As Close as Your Fingertips
Bringing it back to Earth and toward something relatable to us as humans, we can witness nature’s spirals by looking at our own hands — our fingerprints. While all of us possess relatively similar-looking fingerprints, there are slight variations such that no two are alike. Amazingly, these overlapping clockwise and counterclockwise fingerprint spirals — resemble those at the vortex of our heart’s apex! Could our “heart fingerprints” be another unique human signature and means of identification?
Even more stunning, while all fingerprint spirals are not the same, they all conform to the Fibonacci number, adhering to same 0.618…. ratio. Again, this elegance of agreement (innate similarity) and variance (with differences) prevails.
Impressionist Makes Lasting Impression
It was only after creating my lecture that I would realize my pathway into the “world of spirals” and similarities with differences probably began much earlier — starting with my fascination for a series of paintings by one of my favorite artists, Claude Monet, a French Impressionist. Long before meeting Paco, I was drawn to Monet’s series of paintings from the late 1800s of haystacks near his home and of the cathedral in Rouen. In both cases, he painted the same objects numerous times under varying light conditions. I was captivated by how within each set of the haystacks and of the churches, he had identified commonality… while at the same time revealing variations. Each fresh vista differed due to the changing natural light. (Figure 7)
Solving the Mysteries of Heart Disease Page 34