It was one of two songs on In Utero remixed by Scott Litt prior to the album's release, due to the band's dissatisfaction with the original mixing by producer Steve Albini.

The Litt remix also featured additional vocal harmonies and guitar by Cobain, which were the only elements on the album's 12 main tracks not recorded during the original sessions with Albini in February 1993.

Although the single was not released in the United States, to avoid competing with album sales, the song generated considerable American radio airplay, reaching number one on the Billboard Modern Rock Tracks chart.

"Heart-Shaped Box" was written by Cobain in early 1992 at the apartment in the Fairfax district of Los Angeles, California he shared with his wife, the American musician Courtney Love.

[4] Nirvana's first attempts to work on it were unsuccessful; Cobain said he waited for bassist Krist Novoselic and drummer Dave Grohl "to come up with something but it just turned into noise all the time".

[6] Producer Craig Montgomery recalled hearing the song during the band's soundcheck in São Paulo, saying that "even then Kurt knew this was the single ... All the other [new] stuff they had was way more noisy and abrasive than this.

These early versions of the song featured unfinished lyrics and what music journalist Gillian G. Gaar called "a far more experimental solo, more akin to the group's improvs".

According to Albini in a 2013 interview for the audio series Spotify Landmark, "Heart-Shaped Box" was the only song recorded during the sessions that required "more than a couple of takes", along with eventual fourth single, "Pennyroyal Tea".

[9]The guitar effect was eventually removed when the song was remixed, along with second single "All Apologies", by Scott Litt at Bad Animal Studios in Seattle in May 1993, several months before the album's release.

Cobain and Novoselic had agreed that the vocals and bass were too quiet in Albini's original mix of the album, and elected to have the two future singles remixed.

"Heart-Shaped Box" was the final song played at Nirvana's last show, on March 1, 1994, at Terminal 1 of Munich-Riem Airport in Munich, Germany.

[12] Journalist Gillian Gaar described "Heart-Shaped Box" as "the Nirvana formula personified, with a restrained, descending riff played through the verse, building in intensity to the cascading passion of the chorus".

Charles R. Cross, author of the 2001 Cobain biography Heavier Than Heaven, described the lyric, "I wish I could eat your cancer when you turn black" as "what has to be the most convoluted route any songwriter undertook in pop history to say 'I love you'".

"[13] Cobain's unused liner notes for In Utero, first described in Heavier Than Heaven and published in Journals the following year, featured an explanation for "Heart-Shaped Box" that "fell completely apart", according to Cross, "but touched on The Wizard of Oz, 'I Claudius', Leonardo da Vinci, male seahorses (who carry their young), racism in the Old West, and Camille Paglia".

[14] The song's title was inspired by the collection of heart-shaped candy boxes Love kept in the front room of the Fairfax apartment she and Cobain lived in.

[28] Reviewing In Utero for Rolling Stone, Fricke called "Heart-Shaped Box" "the kind of song Stone Temple Pilots couldn't write even with detailed instructions", and cited it as evidence, along with "Dumb", that if Generation X "is ever going to have its own Lennon — someone who genuinely believes in rock & roll salvation but doesn't confuse mere catharsis with true deliverance — Cobain is damn near it".

wrote that "on the current single Heart-Shaped Box, the sublime All Apologies ... and the convalescent croon of Penny Royal Tea, [Cobain] re-stakes his claim as one of his generation's most absorbing songsmiths.

"[30] John Mulvey of the NME called the song "a strangulated, semi-f-ed-up anthem of sorts for a generation who fell in love to 'Teen Spirit' and are now as disturbed as Kurt by a growing sense of maturity".

[31] In his review of Nirvana's eponymous greatest hits album in 2002, Will Bryant of Pitchfork wrote, "I've always considered 'Heart-Shaped Box', with its elliptical guitar figure and explosive choruses, to be one of Cobain's most accomplished compositions.

For all its heavy-handed symbolism, the song strikes deepest to Cobain's preoccupation with birth, the menstrual cycle, and female anatomy, wound tightly with primal tension in the verses and released with sublime catharsis in the choruses."

[40] In a 2013 interview with Andrew Romano of Daily Beast, Corbijn recalled "a really eerie moment" where the actor playing the video's elderly man, "fell down while walking, on the set.

According to Corbijn, the two other characters in the video, the overweight woman and the young girl, were easier to cast, "although it was difficult sometimes I think for the child to act because there was blood coming out of her blouse at some point.

"[41] The "Heart-Shaped Box" video begins and ends with the band watching the elderly man on a hospital bed being administered medication through an IV drip.

Most of the video takes place in what Garr called "a surreal 'outdoor' setting; a field of bright red poppies with a large cross standing in the middle, adjacent to a wood of creepy old trees (both elements in key scenes in The Wizard of Oz).

The room is actually a box designed by Corbjin with a large heart on top, but the band initially disapproved of the way it looked, and Novoselic asked that it not be filmed from a distance.

[42] As Garr pointed out, the Ku Klux Klan imagery recalled Cobain's original idea for the "In Bloom" video,[42] which was to feature a young girl born into the KKK who eventually rejects her parents as "evil".

"[43] However, Corbjin then edited a different version which replaced this shot with additional footage of the young girl and woman, as well as scenes of Cobain lying in the poppy field, covered in mist.

[46][47] Both the "Original" and "Director's Cut" versions of the video appeared as bonus footage in 2013 on the Live and Loud DVD, which was issued as a standalone release as well as part of the 20th anniversary In Utero "Super Deluxe" package.

Soon after Kerslake wrote Cobain a letter, addressed to "kurdt", thanking him for the invitation but expressing his unhappiness over reports that his alleged ideas had been used in Corbijn's shoot.

[61] In February 2016, Grohl reunited with actress Kelsey Rohr, who played the girl in the "Heart-Shaped Box" music video 23 years earlier, at the age of six.