Pathology of the stone heart syndrome. Massive myocardial contraction band necrosis and widely patent coronary arteries.

Among 201 patients dying at some time after cardiac surgery employing cardiopulmonary bypass and studied at autopsy following postmortem coronary arteriography and fixation of the heart in a distended state there were 4 (2%) with the stone heart syndrome. All 4 fo these patients had undergone aortic valve surgery for aortic stenosis employing hypothermic anoxic arrest. At the conclusion of an uncomplicated operation the heart was firm, contracted, prone to fibrillate, and could not sustain the circulation. Pathological study showed widely patent coronary arteries and severe contraction band necrosis of the inner portions of both ventricular walls. The observations here, as in previous studies, suggest that contraction band necrosis may be elicited by a brisk reflow phase following a potentiating phase of anoxic arrest of the myocardium. The stone heart syndrome appears to be simply the manifestations produced by massive contraction band necrosis in a severely hypertrophied heart.