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Debating the Role of the Heart
To the Editor:
In your January issue, an article by Walter Alexander (“Branko Furst’s Radical Alternative. Is the Heart Moved by the Blood, Rather Than Vice Versa?”) argues against the conventional idea that the heart is the energy source for driving blood through the peripheral and pulmonary vasculatures.1 It would have us believe that the important function of the heart is its valving, enabling it to function like a water ram pump (never mind the fact that a water ram pump depends upon an inexhaustible energy source—gravity—that’s not part of the author’s scheme for moving blood).
I wonder if the implication has been taken that, if true, this notion suggests a radical new treatment for heart failure: remove the heart and make a low-resistance, valved connection between the connected outflow of the inferior and superior vena cavae and the pulmonary artery, and another between the pulmonary veins and the aorta. This would eliminate that troublesome impedance offered by the heart and allow the purported energy sources within the pulmonary and peripheral microvasculatures shown in Figure 5 to do their job of driving blood flow.
As an alternative, perhaps consider the points raised in my letter to the editor of the American Journal of Physiology, Heart and Circulation2 and by others cited in that letter that support the alternative view that the left ventricle supplies the energy that drives blood through the peripheral vasculature and that a residual portion of this energy is what supplies the work done in expansion of the right ventricle during diastole?
Thanks to Rafael Dalmau, MD, for bringing this article to my attention.
- Alexander W. Branko Furst’s radical alternative. Is the heart moved by the blood, rather than vice versa?. P T 2017;42;(1):33–39.
- Brengelmann GL. Letter to the editor: why persist in the fallacy that mean systemic pressure drives venous return?. Am J Physiol Heart Circ Physiol 2016;311;(5):H1333–H1335.