Stone Heart Research Articles

Development and prevention of ischemic contracture ("stone heart") in the pig heart.

Stone heart (ischemic contracture) is a rare and serious condition observed in the heart after periods of warm ischemia. The underlying mechanisms are largely unknown and treatment options are lacking. In view of the possibilities for cardiac donation after circulatory death (DCD), introducing risks for ischemic damage, we have investigated stone heart in pigs. Following cessation of ventilation, circulatory death (systolic pressure <8 mmHg) occurred within 13.1 ± 1.2 min; and a stone heart, manifested with asystole, increased left ventricular wall thickness and stiffness, established after a further 17 ± 6 min. Adenosine triphosphate and phosphocreatine levels decreased by about 50% in the stone heart. Electron microscopy showed deteriorated structure with contraction bands, Z-line streaming and swollen mitochondria. Synchrotron based small angle X-ray scattering of trabecular samples from stone hearts revealed attachment of myosin to actin, without volume changes in the sarcomeres. Ca2+ sensitivity, determined in permeabilized muscle, was increased in stone heart samples. An in vitro model for stone heart, using isolated trabecular muscle exposed to hypoxia/zero glucose, exhibited the main characteristics of stone heart in whole animals, with a fall in high-energy phosphates and development of muscle contracture. The stone heart condition in vitro was significantly attenuated by the myosin inhibitor MYK-461 (Mavacamten). In conclusion, the stone heart is a hypercontracted state associated with myosin binding to actin and increased Ca2+ sensitivity. The hypercontractile state, once developed, is poorly reversible. The myosin inhibitor MYK-461, which is clinically approved for other indications, could be a promising venue for prevention.

When Endoscopy Is Needed for a "Stone Heart".

Singh, Anupam Kumar MD, DM1; Neelam, Pardhu Bharath MD1; Abuji, Kishore MS2; Jena, Anuraag MD, DM1; Shah, Jimil MD, DM1; Sakaray, Yashwant Raj MS2; Dutta, Usha MD, DM1 Author Information

Stone heart: a case of endo-myocardial calcification with severely reduced left ventricular global strain in post-acute coronavirus syndrome in a quadragenarian.

Stone heart: a case of endo-myocardial calcification with severely reduced left ventricular global strain in post-acute coronavirus syndrome in a quadragenarian.

Stone heart syndrome after prolonged cardioplegia induced cardiac arrest in open-heart surgery – a pilot study on pigs

ObjectivesTo investigate Stone Heart Syndrome (SHS) as consequence of prolonged ischemic arrest in an experimental study on pigs in regards to onset of SHS and pathological changes. Outcomes defined as aortic cross clamp (ACC) time until onset of SHS and cellular changes characterized by SHS. MethodsEight pigs were included to undergo normothermic cardioplegia induced cardiac arrest ranging from 80 to 240 minutes of ACC. Duration of ACC was defined as time from initiation of aortic cross clamping until cessation. Normothermic, cardioplegic solution administered directly into the arterial system, though in a reduced dose compared to clinical practice. Myocardial contracture evaluated by palpation of the myocardium. Biopsies were collected from the left ventricle just after the induction of cardiac arrest and after reperfusion. Biopsies were evaluated for pathological changes indicative of SHS by electron microscopy. ResultsSix pigs completed the full trial, while two were lost to bleeding. Pigs undergoing 80 to 120 minutes of ACC regained heart rhythm either spontaneously or after defibrillation. Pigs undergoing more than 180 minutes of ACC had contracted hearts with no electrocardiographic response indicating the development of SHS. Electron microscopy findings after ACC of 80 to 120 minutes showed no or low degrees of cellular changes, whereas pig hearts with more than 180 minutes of ACC showed severe mitochondrial changes, endothelial damage, and shortening of sarcomeres consistent with SHS. ConclusionDevelopment of SHS in pigs was ACC time dependent and solely avoided when ACC was limited to a maximum of 120 minutes.

The Threads of Magic by Alison Croggon

Reviewed by: The Threads of Magic by Alison Croggon Natalie Berglind Croggon, Alison The Threads of Magic. Candlewick, 2021 [384p] Trade ed. ISBN 9781536207194 $18.99 E-book ed. ISBN 9781536218268 $18.99 Reviewed from digital galleys R Gr. 5-8 When twelve-year-old street rat Pip steals a stone heart from a nobleman, it causes him and his sister a whole lot of trouble, as it belongs to a murdered seven-year-old prince and it’s charged with the power to eliminate the Specters, people who have gained near-immortality by transporting their souls to new bodies. This starts a series of events involving fifteen-year-old Princess Georgette, who is betrothed to a Specter from another country; Sibelius, who works for the anti-witchcraft Cardinal and who is the one who initially lost the heart; the witches, who need to figure out how to use the heart before the Specters retrieve it; and Pip himself, who has made a strange connection to the murdered boy and is losing track of which thoughts are his own. Croggon’s interesting world spans a variety of perspectives that add tension and insight at integral moments. The premise and the power-squabbling between the Specters, maneuvering with and against each other, are intriguing, but the distinct characters and a vein of humor that ensures the story never takes itself too seriously are really where this novel shines. Australian author Croggon, author of The Books of Pellinor series (The Naming, BCCB 9/05, etc.), delivers another great story targeted toward a younger audience in this new page turner. Copyright © 2021 The Board of Trustees of the University of Illinois

Prognostic implications of stone heart syndrome in cardiac arrest

Der Begriff Stone heart ist definiert als systolische Kontraktur des Herzens und wird auch als kontraktiler Herzstillstand bezeichnet. Er wurde erstmals 1972 durch den US-amerikanischen Herzchirurgen Denton Cooley bei Patienten mit Bypass-Operation beschrieben. Das Stone heart ist meist Folge eines prolongierten Herz-Kreislauf-Stillstands, welcher zu einer Anoxie bzw. Hypoxie des Myokards führt. Es wird über 3 Traumapatienten berichtet, welche nach kardiopulmonaler Reanimation in der postmortalen Computertomographie (CT) ein Stone-heart-Phänomen zeigten.

HeartMate 3 as Total Artificial Heart for the Treatment of Biventricular Heart Failure as Bridge to Transplantation

Despite maximal medican and surgical therapy, the outcomes of severe biventricular failure remain poor with mortality rates of up to 100%. The only definite therapy option for this disease is the total replacement of the heart - either by cardiac transplantation or by total artificial heart (TAH) implantation. Due to the lack of donor organs, mechanical assist devices are the most relevant option for these patients. The permanent availability of mechanical devices is especially attractive in emergency cases as well as in high-risk patients. The placement of two HeartMate 3 in the setting of a TAH is an alternative approach to pulsatile TAH implantation. We now present the worldwide first series of outcomes of this novel procedure. We performed a retrospective analysis of seven consecutive patients who underwent off-label HeartMate 3 TAH implantation after cardiectomy at two international medical institions. Data was acquired using the in-house clinical databases. Follow-up time was thirty days postoperatively. Among perioperative baseline characteristics, adverse events and survival data were collected and analyzed. The retrospective study was approved by the loca institutional ethics committee. Out of 7 patients 4 were male (57%). Primary diagnosis was dilated cardiomyopathy in four cases (4/7, 57%) Other diagnoses were stone heart syndrome, restrictive cardiomyopathy and post-partum cardiomyopathy. All patients were previously supported by ECMO. 3 patients suffered from severe ventricular thrombosis. Intraoperative mortality was 0%. One patient was successfully transplanted after 71 days on device. One patient is still on-going on the device, currently discharged and waiting for heart transplantation (POD 259). Full mobility was achieved in both patients. In all cases postoperative hemodynamic stability was successfully achieved. No device related technical complications occured. Four patients died within thirty days of support (51%; POD 10-21). Causes of death were sepsis and multi-organ failure (3/4) and stroke (1/4). It has been proven that the implantation of two HeartMate 3 VADs in the settings of a total artificial heart is a feasible concept with no technical adverse events in our patient population. In this high risk patient cohort, a reduction of 30-day-mortality from 100% to 57% was achieved.

Needle

Needle Eileen Chong (bio) But her end is bitter as wormwood, sharp as a two-edged sword. —Proverbs 5:4 She lifts amber to her lipsand speaks of roses and light.Eyes broken as k aleidoscopes,histor y spliced and repeating— a torrent: pain like a forestsprung from needles tossedfrom a basket. Tangled threadsglisten and vibrate, taut as webs. Listen: we can hear the fiddlers,urgent at their strings. The windwill carry music across the water.The river has worn a hole clean through the stone's heart. Everydrop relentless, hungr y for the sea. [End Page 115] Eileen Chong Eileen Chong has published eight collections of poems, including most recently A Thousand Crimson Blooms (UQP). Her work has been shortlisted for the Anne Elder Award, the Australian Arts in Asia Award, the NSW Premier's Literary Award, the Victorian Premier's Literary Award, and the Prime Minister's Literary Award (twice). She lives in Sydney. Copyright © 2021 Wayne State University Press

Deep Map Country: Literary Cartography of the Great Plains by Susan Naramore Maher

Reviewed by: Deep Map Country: Literary Cartography of the Great Plains by Susan Naramore Maher Matthew S. Luckett Susan Naramore Maher, Deep Map Country: Literary Cartography of the Great Plains. Lincoln: University of Nebraska Press, 2014. 256 pp. $45. American road trip passengers traversing the Great Plains have surely welcomed the invention of smart phones and seatback DVD players. Long derided as flat and boring, the Plains are too often seen as an unnecessary geographic obstacle to ostensibly more interesting geographic regions to the east and west. Similarly, certainly millions of airline passengers over the past several decades have opened up their airplane windows above Kansas or Nebraska, looked down upon the farms and villages peppering an end-less array of large green and brown squares, and quickly returned to their in-flight magazines. Those travelers are missing out. The region’s flat horizons belie its depths and hidden worlds, tricking visitors into not noticing the biome’s complex ecology, the landscape’s violent geological and historical past, and the land’s stubborn refusal to behave according to colonists’ expectations. Perhaps that is why, according to Susan Naramore Maher, Great Plains writers and scholars have pioneered “deep mapping,” or literary cartography, in their works. Literary cartography seeks to express, explore, accentuate, and add dimensionality to places that often seem blank or empty on maps, and featureless to newcomers. Maher’s study of this genre’s imprint on the region, [End Page 105] Deep Map Country: Literary Cartography on the Great Plains, is an essential synthesis to a body of work that transcends and frequently ignores disciplinary, cultural, and national boundaries. This study is organized thematically, beginning with first chapter introduction based on her 2001 article in Western American Literature that explains the concept of deep-mapping and its regional context. The four chapters that follow are each built around two or three works whose comparisons provide the substance of Maher’s discussion. Wallace Stegner’s Wolf Willow and William Least Heat-Moon’s PrairyErth exemplify efforts to recover deep map histories of the Plains from Saskatchewan to Kansas in Chapter Two. Maher then juxtaposes human settlement against Plains ecology in the third chapter, whose analysis of Don Gayton’s The Wheatgrass Mechanism, John Janovy Jr.’s Dunwoody Pond, and Wes Jackson’s Becoming Native to this Place illustrates their approach from “the edges [of the Plains], sharing the bounty of their research, yet understanding that science, by itself, is not enough to guide communities into settled futures” (28). Chapter Four discusses the work of deep time excavators John McPhee and Loren Eiseley, whose books Rising from the Plains and The Immense Journey, respectively, tell the grand story of the region’s geological past. Finally, Chapter Five investigates the experiential Plains through the works of Julene Bair’s One Degree West, Sharon Butala’s Wild Stone Heart, and Linda Hasselstrom’s Feels Like Far. Many readers may already be familiar with Stegner, McPhee, and other writers featured in Maher’s discussion. But for anyone unfamiliar with literary cartography as a transformative, cumulative literary genre, this book does a vital service. The discursive works surveyed here stand alone, and are in many ways idiosyncratic within their own literary and scientific niches. But as Maher demonstrates these works are in dialogue with one another, and their approaches emanate from a set of common concerns that the Plains are, popularly boring, endlessly fascinating, and existentially threatened by human overuse. These themes all figure prominently in the conclusion, which narrates both the recent resurgence of interest in the Plains among writers and their varied attempts to save Plains communities as they hemorrhage population. While Maher’s monograph is a welcome and necessary introduction to the rhizomatic world of deep mapping and its didactic application to the [End Page 106] Great Plains, maps and illustrations would help the reader better visualize this intricately layered world. This reviewer, a Great Plains scholar and longtime visitor, had no trouble imagining the historical, geological, and cultural layering of small towns and fissures in the earth, but what about the historian in Boston or the English professor in Berkeley? As important as this book is, it should be more accessible...

O34-1 - A Case Suspected of Stone Heart

Stone heart is ischemic myocardial contracture, known as a rare but devastating complication of cardiopulmonary bypass. We report a case suspected stone heart requiring biventricular assist device (BiVAD). A 54-year old man with mitral valve regurgitation received mitral valve plasty. At the termination of cardio-pulmonary bypass, myocardium became contracted and unable to wean from cardio-pulmonary bypass. Cardioplegia was re-infused antegradely and retrogradely, and intra aortic balloon pumping (IABP) and peripheral extracorporeal membrane oxygenation (pECMO) were immediately installed. He was transferred to our institution for further treatment. Echocardiography showed no systolic contraction with marked thickening of myocardium and substantial decreases in left ventricular cavity. Coronary angiography showed no significant stenosis. Based on these findings, he was diagnosed with stone heart and pECMO was converted to central ECMO. However, no contractility resumed in both ventricle, and a biventricular assist device (BiVAD) was implanted on the 15th day. Histologic examination from right ventricle revealed interstitial and replacement fibrosis associated with mild lymphocyte infiltration. Tl-201 scintigraphy showed perfusion defect at anterior and posterior wall. After tracheotomy, he received systemic care and comprehensive rehabilitation program to become a candidate for heart transplantation. Despite all these maximal efforts, he died of repeated hemorrhagic strokes on the 59th day. Macroscopic findings at autopsy showed extensive necrosis around the heart.

In the News

AbstractIn the Editors' opinion, the information summarized for this section can help with the development of health policies, standards, daily care practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet‐based medical news websites, some free of charge, such as PLoS Medicine, MedScape, Stone Heart, Cochrane Collaboration, American College of Physicians, and the World Medical Association.

Stone heart or apical retraction and calcification in Chagas' cardiomyopathy

A 42-year old Caucasian male was found with first-degree atrioventricular block, right bundle branch block, and left anterior hemiblock on electrocardiogram ( Panel A ) and cardiomegaly on chest X-ray ( Panel B ). The left ventricle (LV) was severely dilated by echocardiography with a spherical shape (diastolic dimension 75 mm), reduced systolic function (EF 45%), and an akinetic, retracted LV apex with prominent endomyocardial calcification ( Panels C and D ). Coronary angiography revealed normal coronary arteries (see Supplementary data online, Video S1 ), and LV angiography confirmed calcification ( Panel E ), retraction, as well as akinesia and fixation of the apex ( Panel F ) (see Supplementary data online, Video S2 ). Cardiac …

In the News

AbstractIn the Editors' opinion, the materials summarized in this section have the potential for the development of health policies, standards, or for use in the daily practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet‐based medical news websites, some free of charge, such as PLoS Medicine, MedScape, Stone Heart, American College of Physicians, and the World Medical Association.

In the News

AbstractIn the Editors' opinion, the materials summarized in this section have the potential for the development of health policies and standards, or for use in the daily practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet‐based medical news websites, some free of charge, such as PLoS Medicine, MedScape, Stone Heart, American College of Physicians, and the World Medical Association.

Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve: From Concept to Clinical Application and Evaluation (Part 2)

This study sought to review the acute procedural outcomes of patients who underwent transcatheter aortic valve (TAV)-in-surgical aortic valve (SAV) implantation at the German Heart Center, Munich, and to summarize the existing literature on TAV-in-SAV implantation (n = 47). There are several case reports and small case series describing transcatheter aortic valve implantation for a failing surgical aortic valve bioprosthesis (TAV-in-SAV implantation). From January 2007 to March 2011, 20 out of 556 patients underwent a TAV-in-SAV implantation at the German Heart Center Munich. Baseline characteristics and clinical outcome data were prospectively entered into a dedicated database. The mean patient age was 75 ± 13 years, and the mean logistic European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons' Risk Model scores were 27 ± 13% and 7 ± 4%, respectively. Of the 20 patients, 14 had stented and 6 had stentless surgical bioprostheses. Most cases (12 of 20) were performed via the transapical route using a 23-mm Edwards Sapien prosthesis (Edwards Lifesciences, Irvine, California). Successful implantation of a TAV in a SAV with the patient leaving the catheterization laboratory alive was achieved in 18 of 20 patients. The mean transaortic valve gradient was 20.0 ± 7.5 mm Hg. None-to-trivial, mild, and mild-to-moderate paravalvular aortic regurgitation was observed in 10, 6, and 2 patients, respectively. We experienced 1 intraprocedural death following pre-implant balloon aortic valvuloplasty ("stone heart") and 2 further in-hospital deaths due to myocardial infarction. TAV-in-SAV implantation is a safe and feasible treatment for high-risk patients with failing aortic bioprosthetic valves and should be considered as part of the armamentarium in the treatment of aortic bioprosthetic valve failure.

Calcium controls cardiac function – by all means!

Calcium controls cardiac function – by all means!

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AbstractIn the Editors' opinion, the materials summarized in this section have the potential for the development of health policies and standards, or for use in the daily practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet‐based medical news websites, some free of charge, such as MedScape, Stone Heart, American College of Physicians, and the World Medical Association.

Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation--a cardiovascular magnetic resonance study.

Background'Stone heart' resulting from ischemic contracture of the myocardium, precludes successful resuscitation from ventricular fibrillation (VF). We hypothesized that mild hypothermia might slow the progression to stone heart.MethodsFourteen swine (27 ± 1 kg) were randomized to normothermia (group I; n = 6) or hypothermia groups (group II; n = 8). Mild hypothermia (34 ± 2°C) was induced with ice packs prior to VF induction. The LV and right ventricular (RV) cross-sectional areas were followed by cardiovascular magnetic resonance until the development of stone heart. A commercial 1.5T GE Signa NV-CV/i scanner was used. Complete anatomic coverage of the heart was acquired using a steady-state free precession (SSFP) pulse sequence gated at baseline prior to VF onset. Un-gated SSFP images were obtained serially after VF induction. The ventricular endocardium was manually traced and LV and RV volumes were calculated at each time point.ResultsIn group I, the LV was dilated compared to baseline at 5 minutes after VF and this remained for 20 minutes. Stone heart, arbitrarily defined as LV volume <1/3 of baseline at the onset of VF, occurred at 29 ± 3 minutes. In group II, there was less early dilation of the LV (p < 0.05) and the development of stone heart was delayed to 52 ± 4 minutes after onset of VF (P < 0.001).ConclusionsIn this closed-chest swine model of prolonged untreated VF, hypothermia reduced the early LV dilatation and importantly, delayed the onset of stone heart thereby extending a known, morphologic limit of resuscitability.

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AbstractThe Editors strive to select worthy medical news and materials of interest for the international readers of the Journal. These materials can help with development of medical and public health policies and standards. For in‐depth information, readers should visit the links cited at the end of each news item. Additional medical news can be found on the Internet‐based websites, some free of charge, such as MedScape, Stone Heart, American College of Physicians, and the World Medical Association.

In the News

AbstractIn the Editors' opinion, the materials summarized in this section have the potential for the development of health policies and standards; or for use in the daily practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet‐based medical news websites, some free of charge, such as MedScape, Stone Heart, American College of Physicians, and the World Medical Association.