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Doan TT, Bonilla-Ramirez C, Eilers L, Reaves-O'Neal D, Sachdeva S, Dolgner SJ, Masand PM, Gowda S, Qureshi AM, Binsalamah Z, Molossi S. Myocardial bridges in a pediatric population: Outcomes following a standardized approach. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00003-5. [PMID: 38199293 DOI: 10.1016/j.jtcvs.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/15/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To describe clinical, functional, surgical, and outcomes data in pediatric patients with a myocardial bridge (MB) evaluated and managed following a standardized approach. METHODS Prospective observational study included patients evaluated in the Coronary Artery Anomalies Program. Anatomy was determined by computed tomography angiography, myocardial perfusion by stress perfusion imaging, and coronary hemodynamic assessment by cardiac catheterization. RESULTS In total, 39 of 42 patients with a complete evaluation for MB were included (December 2012 to June 2022) at a median age of 14.1 years (interquartile range, 12.2-16.4). Sudden cardiac arrest occurred in 3 of 39 (8%), exertional symptoms in 14 (36%), and no/nonspecific symptoms in 7 (18%) patients. Exercise stress test was abnormal in 3 of 34 (9%), stress perfusion imaging in 8 of 34 (24%), and resting instantaneous wave-free ratio ≤0.89 or diastolic dobutamine fractional flow reserve ≤0.80 in 11 of 21 (52%) patients. As a result, 15 of 39 (38%) patients were determined to have hemodynamically significant MB, 1 of 15 patients started beta-blocker, and 14 of 15 were referred for surgery. Myotomy (n = 11) and coronary bypass (n = 1) were performed successfully, resulting in improved symptoms and stress testing results. One patient required pericardiocentesis postoperatively, and all were discharged without other complications. At median follow-up time of 2.9 (1.8-5.8) years, all (except 2 pending surgery) were doing well without exercise restriction. CONCLUSIONS Pediatric patients with MB can present with myocardial ischemia and sudden cardiac arrest. Provocative stress test and intracoronary hemodynamic tests helped risk-stratify symptomatic patients with MB and concern for ischemia. Surgical repair was safe and effective in mitigating exertional symptoms and stress test results, allowing patients to return to exercise without restriction.
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Affiliation(s)
- Tam T Doan
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
| | - Carlos Bonilla-Ramirez
- General Surgery Residency Program, Department of Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Lindsay Eilers
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Dana Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Stephen J Dolgner
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Prakash M Masand
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Pediatric Radiology, Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Srinath Gowda
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Athar M Qureshi
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Ziyad Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Heart Center, Houston, Tex; Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
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Sternheim D, Power DA, Samtani R, Kini A, Fuster V, Sharma S. Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2196-2212. [PMID: 34823663 DOI: 10.1016/j.jacc.2021.09.859] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of the epicardial coronary artery traverses through the myocardium for a portion of its length. The muscle overlying the artery is termed a myocardial bridge, and the intramyocardial segment is referred to as a tunneled artery. MB can occur in any coronary artery, although is most commonly seen in the left anterior descending artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB associated with ischemic symptomatology. The advent of contemporary functional and anatomic imaging modalities, both invasive and noninvasive, have dramatically improved our understanding of dynamic pathophysiology associated with MBs. This review provides a contemporary overview of epidemiology, pathobiology, diagnosis, functional assessment, and management of MBs.
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Affiliation(s)
- David Sternheim
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David A Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/rowpower
| | - Rajeev Samtani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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3
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Hostiuc S, Negoi I, Rusu MC, Hostiuc M. Myocardial Bridging: A Meta-Analysis of Prevalence. J Forensic Sci 2017; 63:1176-1185. [PMID: 29044562 DOI: 10.1111/1556-4029.13665] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 01/27/2023]
Abstract
The main objective of this article was to analyze prevalence data about myocardial bridging (MB) in published studies. To this purpose, we performed a meta-analysis of studies published in English literature that contained data about the prevalence of MB and its anatomical characteristics. The overall prevalence was 19% (CI: 17-21%); autopsy studies revealed an overall prevalence of 42% (CI: 30-55%), CT studies 22% (CI: 18-25%), and coronary angiography 6% (CI: 5-8%). Most bridges were located on the left anterior descending artery (82% overall, 63% on autopsy studies), had a mean thickness of 2.47 mm and a mean length of 19.3 mm. In conclusion, autopsy studies should be the gold standard in evaluating the actual prevalence of myocardial bridges, while in vivo high-resolution CT scanning should be preferred to coronary angiography studies.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ionuț Negoi
- Department of Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 042122
| | - Mugurel C Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 020021.,MEDCENTER, Centre of Excellence in Laboratory Medicine and Pathology, Bucharest, Romania, 021021
| | - Mihaela Hostiuc
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, 020021
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4
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Teofilovski-Parapid G, Jankovic R, Kanjuh V, Virmani R, Danchin N, Prates N, Simic D, Parapid B. Myocardial bridges, neither rare nor isolated—Autopsy study. Ann Anat 2017; 210:25-31. [DOI: 10.1016/j.aanat.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/25/2016] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
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5
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Histologic and immunohistochemical analysis of the antiatherogenic effects of myocardial bridging in the adult human heart. Cardiovasc Pathol 2014; 23:198-203. [DOI: 10.1016/j.carpath.2014.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 12/30/2022] Open
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Loukas M, Von Kriegenbergh K, Gilkes M, Tubbs RS, Walker C, Malaiyandi D, Anderson RH. Myocardial bridges: A review. Clin Anat 2011; 24:675-83. [PMID: 21751254 DOI: 10.1002/ca.21150] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 01/16/2011] [Accepted: 01/23/2011] [Indexed: 11/06/2022]
Abstract
Much has been written regarding the potential clinical significance of myocardial bridges. As such bridging is often seen in normal individuals, it is clear that not all arteries bridged by myocardial segments produce clinical symptoms thereby suggesting that this feature may simply be an anatomical variant. However, some authors who have considered these bridges as the cause of cardiac ischemia have suggested two potential mechanisms for their pathophysiology. The first is a phasic systolic compression of the bridged segment with persistent mid-to-late diastolic reduction in arterial diameter and the second proposes a reduction in arterial flow. Both mechanisms may contribute to a reduced reserve in coronary blood flow. In this review, we discuss the evidence that exists regarding myocardial bridging and the potential for bridging to cause myocardial ischemia.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies.
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7
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Ishikawa Y, Kawawa Y, Kohda E, Shimada K, Ishii T. Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease. Circ J 2011; 75:1559-66. [DOI: 10.1253/circj.cj-10-1278] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukio Ishikawa
- Department of Pathology, Toho University School of Medicine
| | - Yoko Kawawa
- Division of Diagnostic Radiology, National Cancer Center Hospital
| | - Eiichi Kohda
- Department of Radiology, Toho University Medical Center, Ohashi Hospital
| | - Kazuyuki Shimada
- Department of Neurology, Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences
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8
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Abstract
Congenital coronary arterial abnormalities as isolated lesions are exceedingly rare. The electrocardiogram, while a reasonable adjunct in the diagnosis of coronary arterial abnormalities, should not supplant a good history and physical examination. Careful attention must be devoted to any signs or symptoms of ischaemic pain in the chest or syncope, which must not be overlooked. Exertional pain in the chest and exertional syncope should prompt an extensive evaluation by both the echocardiographer and the electrophysiologist. Clearance for participation in sports should be curtailed until a complete evaluation has ruled out the presence of any of the following disorders: a channelopathic mutation, a cardiomyopathy, or a congenital coronary arterial anomaly. Major abnormalities in the coronary arteries may present in the first few months of life or remain dormant until the exertional demands of adolescence unmask symptoms of myocardial ischaemia. Congenital coronary arterial anomalies may be analysed in the following major diagnostic groups: anomalous origin of the left coronary artery from the pulmonary artery, anomalous aortic origin of a coronary artery from the wrong aortic sinus of Valsalva, atresia of the left main coronary artery, myocardial bridges, and coronary arterial fistulas. The advent of state-of-the-art modalities of imaging seems, at times, to have supplanted the electrocardiogram in making the diagnosis of potentially serious coronary artery abnormalities, especially in asymptomatic patients. However, as is also the case for a detailed history and physical examination, the electrocardiogram provides a potentially insightful look at the coronary arteries. Furthermore, the past decade has witnessed an increase in the use of the electrocardiogram as a screening tool in the assessment of the risk of sudden cardiac death in athletes in high school.
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9
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Myocardial bridges of the coronary arteries in the human fetal heart. Anat Sci Int 2009; 85:140-4. [DOI: 10.1007/s12565-009-0069-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022]
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10
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Investigation and review of myocardial bridges in adult cadaver hearts and angiographs. Surg Radiol Anat 2009; 32:437-45. [DOI: 10.1007/s00276-009-0590-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
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Lazoura O, Kanavou T, Vassiou K, Gkiokas S, Fezoulidis IV. Myocardial bridging evaluated with 128-multi detector computed tomography coronary angiography. Surg Radiol Anat 2009; 32:45-50. [DOI: 10.1007/s00276-009-0542-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
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12
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Ding H, Chen Z, Shen L, Xu M, Zhou Y, Xu S, Zeng Y. Heart pump system in "heart-mural coronary artery-myocardial bridge" simulative device. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2009; 32:105-11. [PMID: 19623862 DOI: 10.1007/bf03178636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The myocardial tissue covering the artery is termed a myocardial bridge. But so far many researches on the myocardial bridge have been involved with clinical patients or animals, which have some limitations (e.g. lack of systematicness, difficulties in measuring the flow in the mural coronary artery and so on). Designing a "Heart-Mural coronary artery-Myocardial Bridge" Simulative Device provides a good approach to solve above problems; however, documents on this subject have seldom been reported until now. The heart pump as the key part of the whole simulative device should be able to simulate the waveform of blood pressure, adjust blood flow and regulate heart rate. Our experimental results basically met above requirements. The heart pump proposed in the paper presented an alternative experimental method to go further into other issues about the cardiovascular circulation system.
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Affiliation(s)
- H Ding
- Department of Mechanics and Engineering Science, Fudan University, Shanghai, China
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13
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Atar E, Kornowski R, Fuchs S, Naftali N, Belenky A, Bachar GN. Prevalence of myocardial bridging detected with 64-slice multidetector coronary computed tomography angiography in asymptomatic adults. J Cardiovasc Comput Tomogr 2007; 1:78-83. [PMID: 19083883 DOI: 10.1016/j.jcct.2007.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 07/31/2007] [Accepted: 08/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Myocardial bridging is a congenital condition in which a segment of an epicardial artery has an intramural course within the myocardium. The aim of the present study was to evaluate the prevalence of myocardial bridging and the ability of 64-slice coronary computed tomography angiography to identify myocardial bridging in asymptomatic adults. METHODS One hundred sixty-nine consecutive asymptomatic subjects underwent 64-row multidetector computed tomography (MDCT) of the coronary arteries. Two experienced CT radiologists identified myocardial bridging >1 mm in thickness, by consensus. We examined the frequency of myocardial bridging and evaluated the length, thickness, and coronary wall lesions. RESULTS Myocardial bridges were found in 28 (17%) of 165 subjects. Twenty-one subjects (75%) had 1 bridge and 7 subjects (25%) had 2, for a total of 35 myocardial bridges. Twenty-one bridges (60%) were located in the left anterior descending, 8.5% in the diagonal branch, and 2.8% in the circumflex arteries. The segment beneath the myocardial bridge was always free of coronary wall plaques, but the arterial segment proximal to it had significant coronary wall plaques in 24 cases (68.6%). CONCLUSION We found that the incidence of myocardial bridging in asymptomatic adults is 7%, which is in agreement with some pathologic studies in the literature. Our study shows that MDCT of the coronary arteries is a reliable and noninvasive technique, which can accurately locate the site of myocardial bridging, and measure its thickness, course, and length.
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Affiliation(s)
- Eli Atar
- Department of Radiology, Rabin Medical Center, Petah Tiqwa 49100, Israel
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14
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Loukas M, Curry B, Bowers M, Louis RG, Bartczak A, Kiedrowski M, Kamionek M, Fudalej M, Wagner T. The relationship of myocardial bridges to coronary artery dominance in the adult human heart. J Anat 2007; 209:43-50. [PMID: 16822268 PMCID: PMC2100301 DOI: 10.1111/j.1469-7580.2006.00590.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Myocardial bridging is recognized as an anatomical variation of the human coronary circulation in which an epicardial artery lies in the myocardium for part of its course. Thus, the vessel is 'bridged' by myocardium. The anterior interventricular branch of the left coronary artery has been reported as the most common site of myocardial bridges but other locations have been reported. The purpose of this study was to provide more definitive information on the vessels with myocardial bridges, the length and depth of the bridged segment, and the relationship between the presence of bridges and coronary dominance. Two hundred formalin-fixed human hearts were examined. Myocardial bridges were found in 69 (34.5%) of the hearts with a total of 81 bridges. One bridge was found in 59 of these hearts and multiple bridges were observed in ten (eight with double bridges and two with triple bridges). Bridges were most often found over the anterior interventricular artery (35 hearts). Bridges were also found over the diagonal branch of the left coronary artery (14), over the left marginal branch (five) and over the inferior interventricular branch of the left coronary artery (six). Bridges were also found over the right coronary artery (15 hearts), over the right marginal branch (four) and over the inferior interventricular branch of the right coronary artery (two). The presence of bridges appeared to be related to coronary dominance, especially in the left coronary circulation. Forty-six (66.6%) of the hearts with bridges were left dominant. Forty-two of these had bridges over the left coronary circulation and four over the right coronary circulation. Seventeen hearts (24.6%) were right dominant. Eleven of these had bridges over the right coronary circulation and six over the left coronary circulation. The remaining six hearts were co-dominant with four having bridges over the left coronary circulation and two over the right coronary circulation. The mean length of the bridges was 31 mm and the mean depth was 12 mm. The possible clinical implications of myocardial bridging may vary from protection against atherosclerosis to systolic vessel compression and resultant myocardial ischaemia.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies.
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15
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Kawawa Y, Ishikawa Y, Gomi T, Nagamoto M, Terada H, Ishii T, Kohda E. Detection of myocardial bridge and evaluation of its anatomical properties by coronary multislice spiral computed tomography. Eur J Radiol 2006; 61:130-8. [PMID: 17045767 DOI: 10.1016/j.ejrad.2006.08.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 08/26/2006] [Accepted: 08/29/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial bridge (MB) is a common anatomical condition, under which a part of the coronary artery running in the epicardial adipose tissue, is covered with myocardial tissue. It regulates atherosclerosis development and sometimes evokes coronary heart disease through haemodynamic alterations. We attempted to efficiently detect MB and evaluate the anatomical properties of MB by coronary multislice spiral computed tomography (MSCT). METHODS Sixteen-row MSCT was conducted on 148 patients with coronary heart disease. MSCT images were reconstructed and reformed with transverse scans, curved planar reformat and three-dimensional volume-rendered images. The MB, over 1.0 mm in thickness, was identified by the presence of the "step-down and step-up" appearance. After "trial and error" essays, we could consistently examine the frequency of MB and evaluate the anatomical properties of MB, especially its thickness, together with coronary wall lesions. RESULTS Twenty-three patients (15.8%) had MB over 1.0 mm in thickness: 21 MBs (87.5%) were located in the left anterior descending artery with a mean thickness and length of 1.8+/-0.7 and 20.0+/-8.6 mm. Moreover, although the tunneled segment beneath MB was always free of coronary wall lesions, 79.2% (19/24) of the segments proximal to MB demonstrated coronary wall lesions. Of special significance were three symptomatic MB patients without any atherosclerotic lesion throughout all the coronary arteries. CONCLUSION Coronary MSCT is a new imaging technique that provides a non-invasive diagnostic tool for MB and yields much better results of MB detection than previous imaging methods.
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Affiliation(s)
- Yoko Kawawa
- Department of Radiology, Toho University Medical Center Ohashi Hospital, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
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Ozbag D, Kervancioglu P. The investigation of perivasculary space under the myocardial bridge in different species. Int J Clin Pract 2004; 58:1008-13. [PMID: 15605662 DOI: 10.1111/j.1742-1241.2004.00168.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Our purpose in this study was to investigate the perivasculary space under the myocardial bridges (MB) in dog, sheep, goat and human hearts. A total of 160 hearts were studied, and perivasculary space under the myocardial bridges was examined under microscope. The specimens belonged to 25 dogs, 100 sheep, 25 goats and 10 humans. Special attention was paid to evaluate the distance between the MB and coronary arteries (CA), CA and underlying myocardium (UM) and to find the relation of concomitant vein number accompanying the CA and MB. 219 myocardial bridges were found in total of hearts, and specimens from these bridges were examined under microscope. There were large variations in distance between the MB and CA (0-714 microm) and distance between CA and UM (0-309 microm). The myocardial bridges were classified into three groups in terms of the number of veins accompanying CA, the bridges with no concomitant veins with one concomitant vein and with two concomitant veins. This suggests that the distance between the MB and CA is crucial to determine how much force is on the CA. The environment surrounding the CA may be a crucial factor in determining whether the MB influences the induction of heart disorders or not.
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Affiliation(s)
- D Ozbag
- Veterinary Faculty, Department of Anatomy, Dicle University, Diyarbakir, Turkey
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18
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Roul G, Sens P, Germain P, Bareiss P. Myocardial bridging as a cause of acute transient left heart dysfunction. Chest 1999; 116:574-80. [PMID: 10453894 DOI: 10.1378/chest.116.2.574] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The significance of myocardial bridging is still a matter of debate, and although several reports have underlined its pathologic potential, myocardial bridging is often considered to be a benign phenomenon. We present here the case of a 63-year-old woman with a history of acute left heart failure and ECG evidence of ischemia, and whose primary abnormality on extensive workup was myocardial bridging. This case further underlines that myocardial bridging can lead to significant cardiac events.
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Affiliation(s)
- G Roul
- Cardiology Department, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, France.
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19
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Karahan ST, Sürücü HS, Karaöz E. Chronic degenerative changes in the myocardium supplied by bridged coronary arteries in eight postmortem samples. JAPANESE CIRCULATION JOURNAL 1998; 62:691-4. [PMID: 9766709 DOI: 10.1253/jcj.62.691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In humans, the coronary arteries course not only subepicardially but also intramyocardially. The intramyocardial course of the coronary artery is reported to lead to acute ischemic heart disease and, as well, it may be symptomless. The aim of this study was to investigate the long-term ischemic effects of bridged arteries on the myocardium, and was carried out on 8 autopsy hearts with myocardial bridges and 2 hearts without myocardial bridges. The samples from the myocardium were examined with light microscopy. In the myocardium supplied by the bridged arteries, it was observed that there was an increase in the intercellular connective tissue, which was rich in collagen bundles, lymphocytes, fibroblasts and macrophages. Compression of the coronary artery by myocardial bridges may cause chronic degenerative changes, which may remain silent for a long time.
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Affiliation(s)
- S T Karahan
- Department of Anatomy, Faculty of Medicine, Ankara University, Turkey.
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20
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Abstract
The term myocardial bridge (MB) describes the surprisingly common situation in which part of the left anterior descending coronary artery (LAD), running in epicardial adipose tissue, is covered by a bridge of myocardial tissue. The presence of an MB may influence arterial tissue through the alteration of haemodynamic forces by the myocardial contraction of the bridge itself. Histopathologically and ultrastructurally, any manifestations of atherosclerosis elsewhere in the LAD are suppressed in the intima beneath the MB. By scanning electron microscopy, abrupt changes in endothelial cell morphology indicate that the intima beneath the bridge is protected by haemodynamic factors. Furthermore, the closer the bridge to the left coronary ostium, the greater the extent of proximal intimal thickening. In parallel with this, considering the occurrence of myocardial infarction in cases of proximal MB together with previous reports on relationships between MB and coronary ischaemia, it appears that anatomical characteristics such as the location, length, and thickness of the MB have a bearing on the effects of this abnormality. When the pathologist examines the heart at autopsy, this quite common condition should be borne in mind, in view of its potential but complex relationship to atherosclerosis and ischaemic heart disease.
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Affiliation(s)
- T Ishii
- Department of Pathology, Toho University, School of Medicine, Tokyo, Japan.
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Morales AR, Romanelli R, Tate LG, Boucek RJ, de Marchena E. Intramural left anterior descending coronary artery: significance of the depth of the muscular tunnel. Hum Pathol 1993; 24:693-701. [PMID: 8319950 DOI: 10.1016/0046-8177(93)90004-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To establish whether an intramural left anterior descending coronary artery (LADA) is a simple anatomic or a singularly pathologic variant we studied 39 hearts, each with an intramural course of the LADA and no coronary artery disease, valvular derangement, cardiomyopathy, or congenital anomaly. Seventeen of the 39 hearts had no myocardial lesions, while 22 had gross and/or microscopic alterations in the myocardial territory supplied by the intramural LADA. The myocardial lesions consisted of one or more of the following: interstitial fibrosis, replacement fibrosis, contraction band necrosis, and/or increased vascular density in areas of focal fibrosis. The coronary anatomy of the 22 hearts with myocardial lesions (group 1) was compared with that of the 17 hearts without myocardial changes (group 2). Each of the group 1 hearts had an intramural LADA deeply placed within the ventricular wall and attenuation of potential collateral blood flow because of a co-existing intramural course of the posterior descending artery, other epicardial coronary arteries, and/or a diminutive right coronary artery. The myocardial changes in group 1 hearts and their absence in group 2 hearts suggest that the deep, intramural LADA of the group 1 hearts is abnormal rather than a simple anatomic variant of normal. Furthermore, the deep intramural LADA may be associated with sudden death since 13 of the 22 group 1 hearts were from sudden death victims. Six of these 13 persons died suddenly during vigorous exercise.
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Affiliation(s)
- A R Morales
- Department of Pathology, University of Miami School of Medicine, FL
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Teofilovski G, Filipovic B, Bogdanovic D, Trpinac D, Rankovic A, Stankovic G, DiDio LJ. Myocardial bridges over coronary arteries in Cercopithecus. Ann Anat 1992; 174:435-9. [PMID: 1449220 DOI: 10.1016/s0940-9602(11)80268-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The presence of myocardial bridges over the coronary arteries has been studied in 29 monkey (Cercopithecus aethiops) hearts. The great resemblance between the Cercopithecus subepicardial arterial net with the corresponding one in humans has been revealed. There is a high incidence (83%) of myocardial bridges only over the ventricular branches of both coronary arteries. Myocardial bridges are usually (90%) located over the left coronary artery branches, and the left anterior interventricular branch is the most frequently (69%) overbridged vessel. The bridges are always single over the vessel examined and their length varies from 0.5 mm to 31.6 mm. No statistically significant sexual difference in myocardial bridges distribution is reported.
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Affiliation(s)
- G Teofilovski
- Institute of Anatomy, School of Medicine, University of Belgrade, Yugoslavia
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23
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Baptista CA, DiDio LJ. The relationship between the directions of myocardial bridges and of the branches of the coronary arteries in the human heart. Surg Radiol Anat 1992; 14:137-40. [PMID: 1641738 DOI: 10.1007/bf01794890] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The variations of the direction of the myocardial bundles of the bridges over coronary arteries and branches were studied in relation to the direction of the vessels over which they are found. The investigation was performed on 82 hearts of individuals whose death was accidental and unrelated to cardiac disease. The hearts were obtained from cadavers of individuals of either sex and different racial groups, whose age ranged from 7 to 68 years. The angle between the direction of the musculature and of the vessels may explain why in some cases there is no change in the structure of the "pontine portion" of the wall.
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Affiliation(s)
- C A Baptista
- Department of Medicine, Medical College of Ohio, Toledo 43699-0008
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24
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Ferreira AG, Trotter SE, König B, Décourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. BRITISH HEART JOURNAL 1991; 66:364-7. [PMID: 1747296 PMCID: PMC1024775 DOI: 10.1136/hrt.66.5.364] [Citation(s) in RCA: 168] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the arrangement of myocardial bridges. DESIGN A necropsy study of 90 consecutive hearts (56 male, 34 female). RESULTS Myocardial bridges, either single or multiple, were seen in 50 (55.6%) of the 90 hearts. The left anterior descending artery was the most commonly affected artery. Thirty five of the 50 hearts which contained in total 41 muscle bridges were dissected further with a magnifying glass. Two different types of muscle bridges could be identified. Thirty one of these 41 myocardial bridges were superficial, crossing the artery transversely towards the apex of the heart at an acute angle or perpendicularly. The remaining 10 myocardial bridges crossed the left anterior descending coronary artery and surrounded it by a muscle bundle that arose from the right ventricular apical trabeculae and crossed the artery transversely, obliquely, or helically before terminating in the interventricular septum. CONCLUSIONS The superficial type of myocardial bridge does not seem to constrict the artery during systole but the deep muscle bridges, by virtue of their relation with the left anterior descending coronary artery, could twist the vessel and thus compromise its diastolic flow. This may result in ischaemia.
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Affiliation(s)
- A G Ferreira
- Department of Internal Medicine, Faculty of Medicine, University of State of Pará, Belém, Brazil
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25
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Bezerra AJ, DiDio LJ, Piva L. Myocardial bridge over the right coronary artery in man. Surg Radiol Anat 1989; 11:271-3. [PMID: 2617409 DOI: 10.1007/bf02098694] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A rare case of myocardial bridge over the trunk of the right coronary a. is described in the heart of a male, adult, Caucasian, Brazilian, whose death occurred after an automobile accident. After a review of the literature, the unusual finding is described and illustrated. Other bridges on the beginning of the right marginal a.; the right anterior ventricular a.; and on the anterior interventricular a. (left anterior descending) a. were observed. The location and significance of myocardial bridges over coronary a. are discussed.
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Affiliation(s)
- A J Bezerra
- Department of Anatomy, Medical College of Ohio, Toledo 43699
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