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Ischemic myocardial contracture ("stone heart"). A complication of cardiac surgery
Insights
Stone heart, a rare but fatal complication of heart surgery, involves myocardial contracture. Prevention strategies like hypothermia and propranolol show promising results in high-risk patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiopulmonary Bypass
Background:
- Stone heart (ischemic myocardial contracture) is a severe complication during aortic valve replacement and coronary artery bypass grafting.
- It is characterized by myocardial contracture, rendering the heart unresponsive to manual massage, and often results in a fatal outcome.
- Predisposing factors include chronic heart failure and myocardial hypertrophy due to aortic valve or coronary artery disease.
Purpose of the Study:
- To identify and describe the stone heart syndrome.
- To discuss challenges in preventing this condition.
- To present effective preventive measures for high-risk patients.
Main Methods:
- Review of existing concepts and clinical observations regarding stone heart syndrome.
- Implementation of preventive strategies including topical and general hypothermia.
- Pretreatment with intravenous propranolol before aortic occlusion in high-risk individuals.
Main Results:
- Preventive measures, including hypothermia and propranolol pretreatment, have yielded satisfactory results in managing potentially high-risk patients.
- These interventions aim to protect the myocardium during anoxic cardiac arrest.
- The effectiveness of these measures suggests a viable approach to mitigating stone heart complications.
Conclusions:
- Stone heart syndrome is a critical entity that cardiac surgeons must recognize.
- Prophylactic measures, particularly hypothermia and propranolol, are crucial for preventing myocardial damage during cardiac arrest.
- Early recognition and implementation of preventive strategies can significantly improve outcomes for at-risk patients.
Abstract:
Stone heart or ischemic myocardial contracture is a complication of cardiopulmonary bypass characterized by contracture of the myocardium and inability to obtain cardiac output on manual massage. Stone heart has occurred only during aortic valve replacement and/or coronary artery bypass procedures. Predisposing factors are chronic congestive heart failure and myocardial hypertrophy with fibrosis secondary to longstanding aortic valve disease and/or coronary artery occlusive disease. Although the condition is rare, the outcome is usually fatal. Because of the biochemical and physiological implications of this syndrome, its prevention has been challenging. On the basis of our current concepts, prevention has been afforded by topical and general hypothermia and pretreatment with a small i.v. bolus of propranolol just prior to aortic occlusion. These measures have been utilized in potentially high-risk patients with the predisposition for stone heart and, thus far, the results have been satisfactory. The stone heart syndrome is an entity which should be recognized by all cardiac surgeons. Preventive measures must be aimed at protection of the myocardium during anoxic cardiac arrest.