ULTRASTRUCTURAL ANALYSES OF STONE HEART SYNDROME AT ONSET AND SIX DAYS LATER FOLLOWING TOTAL SUPPORT OF THE CIRCULATION WITH A PARTIAL ARTIFICIAL HEART OR LEFT VENTRICULAR ASSIST DEVICE (ALVAD)

Ischemic myocardial contracture developed in a 21-year-old man following aortic and mitral valve replacement. The patient's circulation was supported totally for 6 days with an abdominal left ventricular assist device (ALVAD). Cardiac allografting was then undertaken. Samples of myocardium taken at the original operation and 6 days later at transplantation were analyzed ultrastructurally. At the onset of ischemic cortracture, left ventricular abnormalities included hypercontraction of myofibrils, loss of normal A-band and Z-band patterns, mitochondrial swelling with fusion of cristae, interfibrillar edema and glycogen depletion. Capillaries demonstrated swelling of endothelial cells and basement membrane disruption. Six days later, ultrastructural morphology showed further degeneration. The myofibrils remained hypercontracted, but were more fragmented. Degenerative changes in mitochondria were more advanced and calcium deposition in cristae was present. No glycogen was seen. The right ventricular myocardium exhibited significantly fewer ultrastructural abnormalities. The principal right ventricular changes were endothelial swelling and basement membrane disruption. Glycogen granules were present. Ischemic contracture affects the left ventricle more than the right, and the morphology becomes more abnormal with time. To our knowledge, this is the first instance wherein morphologic progressions of the ultrastructural alterations of ischemic contracture have been documented.