Gerald Buckberg (September 29, 1935 - September 20, 2018) was a Distinguished Professor of Surgery, Division of Cardiothoracic Surgery, at the David Geffen School of Medicine at UCLA. His research interests initially centered in the area of myocardial protection and led to the introduction of blood cardioplegia, which is currently used by over 85% of surgeons in the United States and 75% of surgeons worldwide for adult and pediatric heart operations. He was a member of multiple surgical societies, including the American Association for Thoracic Surgery, American Surgical Association, and the Society of Thoracic Surgeons.
Basic science review: The helix and the heart (November 2002)
The Journal of Thoracic and Cardiovascular Surgery Vol. 124, No. 5. source
- We all have to be students, who are often wrong and always in doubt, while a professor is sometimes wrong and never in doubt. Please join me on my student pathway...
- [T]he heart... is, in reality, a helix that contains an apex. The cardiac helix form... was described in the 1660s by Lower as having an apical vortex, in which the muscle fibers go from outside in, in a clockwise way, and from inside out, in a counterclockwise direction.
- Note reference is to Lower's Tractatus de Corde.
- This combination of clockwise and counterclockwise vortexes is common in nature. For example, within the flower bud of a daisy...
- Nature contains many pathways of clockwise and counterclockwise spirals that are called reciprocal spirals. One example of natural reciprocal spirals is the sea shell. If one takes the tip of that shell and draws it outward, the formation becomes a helix... very similar to the shape of the heart.
- These helical patterns are common in many animals with horns, such as the ram or eland... [I]n combat... they do not break, because nature introduces... the formation of spirals within spirals... nature’s way of supporting one structure within itself. In a larger sense, nature introduces a harmony of structures from both outside and inside the visible shape.
- Pythagoras... described the golden section: the small is to the large as the large is to the whole... Throughout nature, there is a symphony of harmonies between... parts. ...Fibonacci ...defined this concept of harmony between parts as a logarithmic spiral... Throughout nature... logarithmic spirals are commonplace. ...[T]he logarithmic spiral of DNA, a double helix holding the sugar and phosphate ions... the recipe for the blueprint of... life. ...[W]e can proceed upward ...to observe the spiral galaxy ...in ...enormous macroscopic form.
- Counterclockwise and clockwise spirals exist within our fingertips. ...[T]his harmonic pattern within our fingertips also occurs in our heart, where clockwise and counterclockwise spirals are evident at the apex [lower tip]... shown in 1864 by Pettigrew... [W]e look at the heart anatomically and observe the internal and external spiral loops ...previously called the bulbospiral and sinospiral loops. Their infolding into the heart develops a pathway... similar to those that appear in the Handbook of Physiology and were made by Dr. Francisco Torrent-Guasp. Their format characterizes a structural problem... called the Gordian knot of anatomy.
- Reference is to Torrent-Guasp F., Buckberg G.D., Clemente C., Cox J.L., Coghlan H.C., Gharib M., The Structure and Function of the Helical Heart and its Buttress Wrapping. I. The Normal Macroscopic Structure of the Heart. Semin Thorac Cardiovasc Surg. 2001;13:301-19.
- Dr Torrent-Guasp... formalized this description by indicating that the heart looked like a "rope"... [in] three parts: a beginning and an end at the aorta and pulmonary artery; a wraparound loop called a basal loop; and... a helix that he called the apical loop. ...He described a [billion year old] worm... with a vascular tube... like a rope, with a venous and an arterial system. ...[F]ish evolved to show the first generation of a heart, containing a single pumping chamber, and included gills... [Next] the amphibian and the reptile appeared, in which we observe an atrium and a ventricle. Each chamber was separated by an atrial and ventricular septal defect. Human beings developed... [later] and both the atrial defect and the ventricular defect are closed.
- At 20 days of life, the heart of an evolving human being looks like a worm... At 25 days... a clear-cut... single pump... In a sense, we mirror... a fish... At 30 days, the embryologic heart contains a patent ventricular septal defect and an atrial septal defect... we resemble the amphibian and the reptile... Finally, at 50 days... an intact atrial and ventricular septum.... our cardiac evolution encompasses 1 billion years of the phylogenetic development.
- To unfold the heart, we must separate the aorta from the pulmonary artery... to expose the free wall of the right ventricle. ...[W]e must unfold the helix of the heart ...unroofing ...the aorta from its ventricular attachment to separate the ascending and descending [helix] limbs... by unwrapping the coil. ...[A] longitudinal myocardial band is demonstrated that corresponds directly to an open stretched rope. ...Dr Torrent-Guasp has performed this unfolding or unscrolling while dissecting an intact heart... to define the intact myocardium as a single muscle band that extends between the aorta at its termination to the pulmonary artery at its beginning. ...A fascinating study was done by Dr P. P. Lunkenheimer... which can counteract concerns that this... may not be repro-ducible...
- The classic view of cardiac anatomy relates to contracting and relaxing, or more specifically, constricting to narrow and eject, and dilating to widen and fill. This sequence was defined by William Harvey. However, the predominant motion of the heart is... rather shortening and narrowing. There are four fundamental motions... narrowing, shortening, lengthening, and widening... a downward twisting of the muscle fibers... shorten and thicken and thereby make the heart eject. This twisting or torsion was described by Borelli, in the 1600s, to simulate the wringing of a rag. ...[P]rogression of contraction into the ascending segment ...results in twisting and thickening in an opposite direction. This sequence is followed by relaxation to allow the ventricle to fill during the remainder of the diastolic phase. ...[T]he heart twists to eject and reciprocally twists to fill in a clockwise and counterclockwise manner... twisting and untwisting of the conical heart muscle in reciprocal directions. ...[T]he predominant action is shortening and lengthening, rather than narrowing and widening... ejection during shortening and suction to fill during lengthening...
- The spiral formation within the helical heart conforms nicely to the mathematical description of spiral described by Fibonacci... [A]fter manual dissection of the ascending segment from the descending segment... [t]hese lengths have a harmonic proportion, and... conform... to the ratio Pythagoras described within the golden section: the small is to the large as the large is to the whole. ...[A] hidden harmony of spirals... [that] starts with the master plan of DNA, a double helix...
2015 Lecture: The Helix and the Heart given by Dr. Gerald Buckberg
- source. See also "Helix and the Heart Lecture: Presented by Gerald Buckberg at the 81st AATS Annual Meeting" May 8, 2001.
- [Y]ou think about knowledge and university. The student is often wrong, and always in doubt. The Professor is sometimes wrong and never in doubt.
- If you pick the heart up and look at the bottom... there are spirals... a spiral going inside-out, and outside-in. The same reciprocal spirals happen in flowers. ...[T]he circles get bigger as they get further outward. ...[T]hat increase in size is the secret of growth. ...[T]hese beautiful reciprocal spirals... are not just in daisies, but you see this in seashells... you pick the tip of the spiral... or the shell up... it becomes a helix, just like the heart... or the horns of an eland. ...Inside the horns ...are spirals within spirals. ...[T]he spirals... go into the... blueprint of life...in DNA between the sugar and the phosphates. The use of the same reciprocal spirals exist in the microscopic way, just as they exist macroscopically in the galaxy. ...We all have spirals in our fingertips... But your finger is different than somebody else's finger, and that's because there is harmony in variance.
- [N]ot only does the fingertip have a spiral, but [there is] the spiral at the tip of your heart. Perhaps the tip of your heart is your apical fingertip. ...The ventricle, which is the beating part of the heart, has a spiral... it goes from inside-out, and outside-in. That spiral is very typical. It goes down to the apex of the heart, the tip of the heart, which is a vortex. The thing that really makes the heart a part of an active way of living.
- [I]t was thought many years ago that no one could understand the heart. The heart was called the Gordian Knot.
- [I]f you look at the helical heart, you see a hidden harmony of spirals. You see the DNA... the blueprint... You see the ventricle... You see that you have ejection and suction with the spirals going in different directions, with the spirals within spirals. You see it in the microscopic structure of the heart, the different forms of the heart called the myosin, actin, calcium, [tropomyosin]... It's all the same. It's a reproduction of what is normal and very efficient.
- [I]t's really amazing... you look at a calcium coil that is the calcium ions... It spirals... and you look at the single calcium ion and see a spiral. So it's everywhere. So what we really have, in a sense, are gargantuan relatives. They're ionic and they're cosmic.
- Our job is to restore the helix... because congestive heart failure is the major killer in the world today. ...[T]he thing that makes the heart very effective is the way the spiral of the ventricle is formed. ...The minute you ...stretch the ventricle... the tranverse part... in the basal loop, it doesn't contract as effectively.
- [I]f you look at the diseases we see... a narrowing in the coronary artery... a valve becomes leaky, either the aortic valve or the mitral valve, or people who have muscular disease. The heart changes from an ellipse to a sphere. In a sense... from a football to a basketball. ...[T]here's alteration in the fiber direction of the ventricle.
- [A] normal heart... is twisting and it's very happy. But... a sick heart... it's dilated and not very efficient. ...What you have to make, is a basketball into a football. ...[A]s you do this operation, it's... not very complicated. Here's the dilated ventricle with the scar in it. We basically open the scar, put a little stitch in there, bring the edges together, throw a patch in there and fix the ventricle. ...The job is to make abnormality normality... restore nature, restore the natural form.
- [A] cathedral... has the principle of a dome and a buttress. ...There's the heart. It's exactly the same thing. ...There's ...an iceberg. The iceberg and the heart are the same [form]. Imagination is that you have to see what is, not what you want to see. ...[T]he hurricane and a heart have exactly the same direction. They whirl in the same way. [T]he galaxy... it's exactly the same concept.
- Creation... is filling an empty room with new ideas. Testing them with ongoing change as you learn. It's a process. It's never an event. It's a process... ask questions and you begin to answer them.
- Torrent-Guasp was a Spanish cardiologist and artist who wrote a book [Anatomia Funcional del Corazon] about how the heart was formed, and nobody listened... because he deviated from society. ...He showed the ventricle had reciprocal spirals. ...[H]e looked at a pine cone because a pine cone has the same reciprocal spirals that the heart does. It's part of nature. A heart is just a part of a grand design and the design shares things everywhere. ...He says "Nature is simple, but scientists are complicated."
- [T]he simplicity of nature is, you find it if you look for it, and you find a commonality, and there's something that goes from one thing to another.
- There was a famous cardiologist named Erasistratus... and he talked about the heart twisting...
- William Harvey... who in England discovered the circulation... wrote this wonderful book called Anatomical Exercises... [S]uddenly he is here with the new idea of the circulation and some other ideas... He contradicted Vesalius who fitted to the Galenic system of ebb and flow concept. That's the twist and suction that the heart always has. Harvey says it didn't happen that way. It didn't dilate and take the shape of cupping glass and suck blood into it. Well, Harvey was a brilliant and wonderful person, but he wasn't perfect, and he was wrong. Because the heart does exactly what he said it didn't do.
- I picked up a book [The Illustrations from the Works of Andreas Vesalius of Brussels ed., Saunders & O'Malley] on Vesalius... [H]e cut the heart... to see the different cavities... in the 1500s. ...[T]he cardiac structure is the first example since Leonardo da Vinci showing the thickness of the walls and the shape of the cavities.
- I looked up Leonardo [Leonardo Da Vinci The Anatomy of Man: Drawings from the Collection of Her Majesty Queen Elizabeth II] to see what Leonardo found. Leonardo... showed also that the heart had these different cavities with different sizes. ...[H]e said "The apex, or tip of the heart comprises the left ventricle." ...[T]hat ...is the vortex. And then Leonardo made these fabulous drawings ...and he looked at the aorta, and he found as the blood came out it goes in reciprocal spirals going in different directions. ...[H]e said that's how the blood flows.
- The zebrafish is... interesting... It's aorta is 1/3 the size of a human hair. But yet.. it works exactly like yours and mine do. ...So we're not unique. We're just a part of a wonderful scheme of nature. ...[W]e're such a part of a scheme that we look at reciprocal spirals in heaven...
- [W]e... talk about gravity as being pulled down, but Einstein said no, it's a warping of space and time. It's pulling you down into an ellipse. ...[T]he moving down-up of time may be no different than moving up and down of your heart, with ejection and suction.
- No matter how much we dislike something, we always have to listen, and find if some nugget of truth, some change is available to us. We can't just dislike someone. We have to realize there are many parts to them.
- A dilemma that I see is that ignorant people are unknowledgable, but can learn. Arrogant people are knowledgeable but unable to be taught.
- [A]s you look at this scheme of how we learn and grow... we go up and down this pipe. ...[G]rowth is knowledge to analyze, to differentiate, to take things apart. Wisdom is to synthesize, integrate, to bring them together. Wholeness means you have complimentary activity to use them both. You have to do something. Something has to happen, and as a surgeon we are lucky. We have the ability to combine wisdom and knowledge into action.
Solving the Mysteries of Heart Disease (2018)
- : Life-Saving Answers Ignored by the Medical Establishment (A Summary)
- Stopping the heart is accomplished by shutting off its blood supply (a process called ischemia). I discovered blood cardioplegia... We initally realized the return of regular blood to a heart that has been without blood supply, will create severe damage. We then discovered how to prevent this injury by using a blood cardioplegic solution that contains selected chemical ingredients (including key amino acids...)that safely protects the heart... [E]ffectiveness... depended upon their arriving at specific locations... But many of our patients had narrowed arteries... This barrier was overcome by delivering it in a "backward direction" via the heart’s main vein... further enhanced by administering it at different temperatures during the beginning and end of the operation.
- Heart attacks occur because a part of the heart stops squeezing after there is sudden loss of blood supply to that area. ...the damaged portion of the heart does not regain its ability to contract. The long-term aftermath is that 30% of surviving patients will develop heart failure within five years, despite having the artery successfully reopened. ...However, if instead of initially returning normal blood to the damaged region... we add specific ingredients to this nourishing blood and... control how it is delivered... contraction returns immediately. ...[T]he required equipment already exists in the cath lab, and needs only minor modifications. Yet this is not done, due to a lack of willingness to learn...
- Today, wonderful operations can be performed on babies to repair heart defects. This includes "blue babies." During the corrective procedure, high levels of oxygen are typically administered by a heart-lung machine... But... lung and heart damage may worsen. ...[O]ne cause of the problem were the high levels of oxygen administered ...as toxic substances are produced when such oxygen concentrations are metabolized. Babies are particularly vulnerable... Yet we found this "re-oxygenation injury" could be avoided by lowering oxygen levels delivered... There was excellent recovery of heart function without lung or body swelling. ...A 2012 overview on reoxygenation injury was published in the World Journal for Pediatric and Congenital Heart Surgery that summarized international papers from others... [R]aising such questions to traditionalists garners vehement rejection, along with counterarguments that keeping oxygen levels high is a strategy ..."proven..." over many decades (since not all blue babies suffer damage...) They perceive the greater risk is losing the baby because of "insufficient... oxygen"... and... blame... unforeseen complications on other factors.
- Conclusive answers are not gained by adhering to past beliefs or by assuming that what seems logical is valid. The answer is only revealed through investigation.
- Sudden death... cardiac arrest... occurs because the heart suddenly stops (having either no beat, or develops a totally ineffective beat such as ventricular fibrillation). CPR is typically performed... and if one is available, a defibrillator... restoring the heartbeat. Yet... the harsh reality is that 85 to 90% of these patients die, and severe brain damage develops in half of those who do survive. ...CPR, defibrillation ...does not address the heart defect ...[W]hy stay so stubbornly attached to a method in which 85 to 90% of patients perish?
- An alternate and effective three-step approach has been used experimentally... First, CPR specifically designed to provide sufficient blood pressure is employed to ensure blood nourishment to the brain. Second, body circulation is supported using a small portable heart-lung machine whose catheters easily access the groin arteries. ...Third, the dead heart is then brought back to life by the delivery of blood containing ...added ingredients ...[T]his new method was applied internationally to 34 sudden death patients. ...80% ...survived ...only one patient sustained brain injury. ...[W]ith present methods... 100% will die if CPR/defibrillation does not return an efficient heartbeat within 15 minutes. Yet these 34 patients underwent CPR for an average of 72 minutes... Because it also treated the cause behind the sudden death and not just the symptom (the heart stopping).
- It is universally believed that just five minutes or more of no blood flow to the brain is always lethal. We had already verified that controlled reflow of blood after a heart attack (adding specific chemical ingredients...) returns healthy cardiac function. We tested if a similar recovery could occur in the brain... and showed an astounding return of complete brain function after 30 minutes of no brain blood flow! ...Yet ...the NIH rejected our request for funding to study this further. They... deemed this... as "not interesting."
- [O]ur lab studies on test subjects... implied that while CPR plays a positive role in treating witnessed arrest (when applied quickly once the heart stops beating)... application of CPR in unwitnessed arrest (when there is a delay before its use) is... wrong... because after the brain has been ischemic... CPR will return normal blood to the brain. ...Yet medicine continues endorsing this approach—despite the 99% mortality.
- Our findings could lead to radical changes in protocol, in which CPR is not immediately applied in unwitnessed arrest, and other techniques are used instead... [to] include using controlled reflow (adding specific chemical ingredients...) ...additional lab studies suggest this new... approach could possibly lead to treatments for stroke victims that avoid brain injury, since the same extended period of insufficient blood flow to the brain occurs... [T]here are 700,000 stroke victims annually in the United States alone. Further funding and research... are vitally needed.
- Surgical Ventricular Restoration was successfully tested internationally in 1200 patients. Instead of the [typical] 50-to-75% two-year death rate... this surgical treatment showed a 70% five-year survival, with a return to near normal heart function and only very rare occurrences of dangerous ventricular rhythms.
Sadly, a faulty NIH-funded study of this groundbreaking treatment utilized physicians who were not qualified... disregarded proper selection of patients, and incorrectly performed procedures. Its erroneous findings led to... abandonment... despite a European Society of Cardiology report that supports this treatment... Its dismissal... is tragic, and leads to enormous and unnecessary suffering upon... millions
- In managing heart failure in dilated hearts, we must recognize its cause is flawed heart anatomy... normality is restored after rebuilding the natural cardiac form.
- Paco Torrent-Guasp’s revelation of the heart’s authentic structure finally explains... stretching (dilation) during heart failure causes the heart’s normal elliptical shape (like a football) to become spherical (like a basketball). This geometric alteration rearranges the heart muscle pathways so the natural helix figure-eight pattern now becomes horizontal. ...[T]he spherical heart loses its normal ability to twist, which markedly reduces its contraction power, causing fatigue and breathlessness. ...Conventional treatments that only remedy diseased narrowed arteries or leaky valves do not restore... function correctly. ...Normality can only be returned by restoring the... shape... Paco’s helical heart... became my guide, leading to a new procedure called "Pacopexy"... [achieving] functional improvement... not... possible without... ventricular restoration to rebuild normality.
- Fifty percent of [heart] failures are caused by poor contraction of the ventricle (systolic dysfunction) that pumps blood... But the other half have poor filling (diastolic dysfunction) of blood into the ventricle... despite... normal heart contraction. ...[T]here has been uncertainty in how to treat diastolic dysfunction because its mechanical causes have been unknown.
- Understanding Paco’s "helix and wrap" structure solves this problem. ...[W]e found that suction accounts for most of filling (70%)... during the first 1/3 of the period when the heart relaxes... caused by how the figure-eight helix arms and its surrounding wrap interact. ...[W]hen the ventricle’s pumping ...during a heartbeat lasts longer than it is supposed to... [t]his shortens the available time for suction to fill... diastolic dysfunction develops. ...[W]e found ...calcium influences contraction and relaxation ...Cariporide ...uniquely prevented calcium buildup. ...[T]he ...pharmacological trial ...failed after the manufacturer disregarded advice from the study’s steering committee. ...Diastolic dysfunction’s cause (helix and wrap dynamics) and curative drug (Cariporide) are neither taught in medical school, nor... known by... cardiologists...
- A recent survey of 3,292 post-operative patients showed approximately 40% had septums that were bulging or showing "paradoxical motion." ....[A]fter valve surgery [it was] 60%. ...[T]he entire cardiovascular community (cardiologists and surgeons) has a lack in awareness of the critical importance of the septum.
- [O]ne of the great anguishes in medicine is its inability to treat right (ventricle) heart failure... [due to] an absence of understanding how the normal right ventricle... functions. Conventional views hold... a 400-year-old belief that the right ventricle compresses like "a bellows"... But... that... only accounts for 20% of the... pumping... The shortening of the septum... produces 80% of its function. ...Torrent-Guasp’s "helix and wrap"... model clarifies why... [m]odern 3-D imaging confirms that the septum portion of the helix... twists to pump... from the right ventricle to the lungs... In animal testing, we further verified [this].
- Clearly it’s important not to injure the septum during operations. So why is it happening repeatedly? ...[L]ikely ...improper myocardial protection (the technique used to protect the heart... that was my initial major medical discovery and quickly adopted worldwide). We... tested 119 consecutive patients and found no septum damage when protection was done correctly. ...Successful protection involves ...the cardioplegic solution and adopting a correct delivery strategy. ...[I]f surgeons are to prevent the all-too-frequent injury to the heart’s vital septum, they must avoid taking shortcuts that compromise this essential combination.
- [P]acemakers elevate the heart rate... but they don’t always reproduce a normal heartbeat. ...[I]f the pacemaker leads are placed directly in ventricular muscle... the natural electrical system is not utilized. ...[T]here is loss of the natural twisting motion needed for efficient contraction.
It may even cause heart function to worsen and produce heart failure in patients with dilated hearts. In other patients, fatigue will not improve, and shortness of breath will not get better.
- I used [Paco's] heart model... as my guide, to place pacemaker electrodes through a location on top of the septum... to reach the natural conducting system. The twisting motion was immediately reproduced to create normal heart performance!
This approach was applied to over 700 patients around the world... and yielded similarly positive outcomes. Yet conventional cardiac approaches have not changed. Why..? Manufacturers would need to produce new types of pacemakers... Cardiologists would need to learn new techniques... Acquiring proficiency... is a little harder at first, but once learned, requires only 20... minutes of added [surgery] time.
Solving the Mysteries of Heart Disease | Gerald Buckberg with Barry Kibrick (Sep 6, 2018)
- Between the Lines With Barry Kibrick, source
- I have a way of looking at things, because I discover failure and find solutions. ...I'm grateful that I've been able to implement medical care that's given, but realize there are major limitations, major failures... I have spent... fifty years finding solutions to many of those different problems.
- [T]he age-old obstacle to growth, it's called rigidity. ...When you talk about... finding an answer, proving it, and nobody uses it. A book called The Cry and the Covenant by Morton Thompson... it was about... Ignaz Philipp Semmelweis who worked in a maternity ward and found that many women after they gave birth... would die. ...He found the women that lived were delivered by the wet nurses and the women that died were delivered by the doctors... He realized that the doctors that would deliver the babies, go across the street [and] do an autopsy, but there's no germ theory. The doctors would wipe off their hands, and go back and infect the women. ...[H]e said, what you have to do is to wash your hands. He told the Titans of medicine. They still exist today. All these Titans of medicine that know everything, that you're doing it wrong. ...[T]hey didn't listen to him but eventually... it did win, it was right, because truth always wins.
Quotes about Buckberg
- What Dr. Buckberg and I did for 35 years is, we looked at... ischemia reperfusion... What Gerry and I did for all of that time was to look at how can we avoid that injury. How can we let those cells repair themselves rather than being damaged with reperfusion? ...How do we protect the heart? Because every heart surgery, or the majority of them, you have to stop the heart so we can operate... while it's not having blood supply and while it's not beating. That means... you may have a reperfusion injury... [S]olutions that Dr. Buckberg pioneered probably helped save more people that any surgeon alive, because those solutions protect the heart. But we took it to the next levels because there are a lot of diseases like heart attacks... nothing more than a part of the heart gets no blood supply, and that part eventually dies. A stroke... transplants where we take organs out and they're ischemic. ...[W]e apply that concept to these other things. ...If we have a patient that has a heart attack... the cardiologist... will open up the artery, and suddenly the blood goes in there and the patient's pain goes away... but they've still killed that area of the heart. ...What we would recommend is... avoiding that reperfusion injury. ...[T]hose patients with some of this dead muscle, 1/3 - 40% of them will go into heart failure... 4 to 5 years later... which is a huge cost to society.
- Dr. Bradley Allen, "Fixing Hearts and Healthcare" (June 15, 2019) Between the Lines with Barry Kibrick