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Myocardial Bridging: Diagnosis, Functional Assessment, and Management: JACC State-of-the-Art Review.Journal of the American College of... Nov 2021Myocardial 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... (Review)
Review
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.
Topics: Computed Tomography Angiography; Coronary Angiography; Coronary Circulation; Coronary Vessels; Disease Management; Humans; Myocardial Bridging; Ultrasonography, Interventional
PubMed: 34823663
DOI: 10.1016/j.jacc.2021.09.859 -
Brazilian Journal of Cardiovascular... Feb 2016Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features... (Review)
Review
Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.
Topics: Coronary Artery Disease; Humans; Myocardial Bridging; Percutaneous Coronary Intervention; Stents
PubMed: 27074276
DOI: 10.5935/1678-9741.20150082 -
Heart (British Cardiac Society) Dec 2023Myocardial bridging is a common anatomical variant in which a major epicardial coronary artery takes an intramyocardial course, leading to dynamic systolic compression.... (Review)
Review
Myocardial bridging is a common anatomical variant in which a major epicardial coronary artery takes an intramyocardial course, leading to dynamic systolic compression. Because coronary perfusion occurs primarily during diastole, most patients with this anatomical variant have no associated perfusion abnormalities or symptoms. Despite this, there is a subset of patients with myocardial bridging who experience ischaemic symptoms. Determining which anatomical variants are benign and which are clinically relevant remains a challenge. Further complicating the picture, functional factors such as diastolic dysfunction and coronary vasospasm may exacerbate myocardial bridging-related ischaemia. In patients with ischaemic symptoms in the absence of alternative explanations, a detailed assessment of myocardial bridging with invasive physiology should be performed to define the significance of the lesion and guide tailored medical therapy. Patients with refractory symptoms despite maximally tolerated medical therapy should be considered for surgical coronary unroofing.
Topics: Humans; Myocardial Bridging; Heart; Coronary Angiography
PubMed: 37344169
DOI: 10.1136/heartjnl-2022-321586 -
Journal of Forensic Sciences Jul 2018The 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... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Autopsy; Coronary Angiography; Forensic Pathology; Humans; Myocardial Bridging; Prevalence; Tomography, X-Ray
PubMed: 29044562
DOI: 10.1111/1556-4029.13665 -
The New England Journal of Medicine Feb 2024
Topics: Humans; Coronary Angiography; Myocardial Bridging; Risk Factors
PubMed: 38294977
DOI: 10.1056/NEJMicm2307383 -
Cardiovascular Revascularization... Sep 2020Myocardial bridging is a congenital coronary anomaly with normal epicardial coronary artery taking an intra-myocardial course also described as tunneled artery. The... (Review)
Review
Myocardial bridging is a congenital coronary anomaly with normal epicardial coronary artery taking an intra-myocardial course also described as tunneled artery. The majority of patients with this coronary anomaly are asymptomatic and generally it is a benign condition. However, it is an important cause of myocardial ischemia, which may lead to anginal symptoms, acute coronary syndrome, cardiac arrhythmias and rarely sudden cardiac death. There are numerous studies published in the recent past on understanding the pathophysiology, diagnostic and management strategies of myocardial bridging. This review highlights some of the recent updates in the diagnosis and management of patients with myocardial bridging. We discuss the role of various non-invasive and invasive diagnostic methods to evaluate functional significance of bridging. In addition, role of medical therapy such as beta-blockers, percutaneous coronary intervention with stents/bioresorbable scaffolds and surgical unroofing in patients unresponsive to medical therapy is highlighted as well.
Topics: Coronary Angiography; Death, Sudden, Cardiac; Humans; Myocardial Bridging; Myocardial Ischemia
PubMed: 32173330
DOI: 10.1016/j.carrev.2020.02.014 -
Revue Medicale Suisse Jun 2019Myocardial bridging, corresponds to an abnormal, usually congenital, anatomical relationship between the myocardium and a coronary vessel. It most commonly affects the... (Review)
Review
Myocardial bridging, corresponds to an abnormal, usually congenital, anatomical relationship between the myocardium and a coronary vessel. It most commonly affects the left anterior descending coronary artery. Despite technological advances, angiography remains the gold standard diagnostic method with a typical image of systolic compression (milking). Typically benign and asymptomatic, myocardial bridging can exceptionally be responsible for serious life threatening complications. Different therapeutic options may be considered, including pharmacological or interventional treatments. We present a clinical case and a review of the respective literature.
Topics: Coronary Angiography; Humans; Myocardial Bridging; Myocardium
PubMed: 31194299
DOI: No ID Found -
Trends in Cardiovascular Medicine Jan 2024Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during... (Review)
Review
Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during the third and fourth decades of life. MB provokes myocardial ischemia through different mechanisms including supply-demand mismatch, endothelial dysfunction, coronary microvascular dysfunction and external mechanical compression. The association between MB and atherosclerotic disease is controversial. Recent studies established a significant association of MB with myocardial infarction and non-obstructive coronary artery disease. The first line medical treatment is based on beta-blockers and calcium channel blockers. Ivabradine is used in second line therapy. Invasive approaches involving percutaneous coronary intervention, coronary artery bypass graft and myotomy are performed in patients with symptoms refractory to maximally tolerated medical treatment. The choice of revascularization technique depends on anatomical characteristics, clinical condition and physician experience. Available data derived from anecdotal evidence view the lack of randomized clinical trials.
Topics: Humans; Myocardial Bridging; Coronary Artery Disease; Myocardial Ischemia; Coronary Artery Bypass; Myocardial Infarction; Coronary Angiography
PubMed: 35697237
DOI: 10.1016/j.tcm.2022.06.002 -
Journal of the American College of...
Topics: Humans; Myocardial Bridging
PubMed: 25457408
DOI: 10.1016/j.jacc.2014.07.993 -
Acta Cardiologica Feb 2022
Topics: Cardiomyopathy, Hypertrophic; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Humans; Myocardial Bridging
PubMed: 33432884
DOI: 10.1080/00015385.2020.1867779