Myocardial cell damage in “stone hearts”

The “stone heart” syndrome is a rare pattern of irreversible cardiac arrest in systole during or immediately after total cardiopulmonary bypass. In 13 cases reported a marked left ventricular hypertrophy with conduction disturbances was present in all, and generally a high pressure gradient across a stenotic aortic valve was present. The main histologic finding was a widespread degenerative process of the myofibrils in hyper-contracted cardiac muscle fibers, with anomalous acidophilic, transverse band formations and subsequent loss of the alloplasmic material. The result is a myocytolytic myocardial necrosis which is seen in a variety of both human and experimental conditions, especially in catecholamine-induced necrosis. Hypothermia has been successfully used to reduce the incidence of “stone heart” and more recently a beta-adrenergic receptor blocking agent has been effectively used.