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.