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Folia Morphologica 2020Myocardial bridging (MB) is an anatomical variant in which an epicardial coronary artery passes under a bridge of myocardium. The most commonly affected vessel is the...
Myocardial bridging (MB) is an anatomical variant in which an epicardial coronary artery passes under a bridge of myocardium. The most commonly affected vessel is the left anterior descending coronary artery, although other branches such as the marginal branches, diagonal branches and posterior descending right coronary artery may be occasionally involved. Technological advances in radiological techniques have enabled better diagnosis of myocardial bridges especially coronary angiography and coronary computed tomographic angiography (CCTA). During a routine angiography by means of CCTA in a 60-year-old male patient with arrhythmia, a case of MB was found in two segments of the posterior interventricular artery and a small segment of the right coronary artery. Although most cases of myocardial bridges are asymptomatic, knowledge of its pathophysiology is of great clinical importance as some cases of MBs have been associated with acute coronary syndromes, ischaemia, arrhythmias and even sudden death.
Topics: Computed Tomography Angiography; Coronary Angiography; Humans; Male; Middle Aged; Myocardial Bridging
PubMed: 31448810
DOI: 10.5603/FM.a2019.0080 -
Radiology Case Reports Jul 2022Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending....
Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending. However, myocardial bridging involving coronary arteries other than left anterior descending is less-common and rarely reported, especially in the elderly population. We report a rare case of multiple myocardial bridging involving the left anterior descending, first obtuse marginal, and ramus intermedius in a 68-year-old Asian female. We also briefly discuss the imaging evaluation and pathophysiology of myocardial ischemia in myocardial bridging. This is the second reported case of myocardial bridging involving such combination, and to our knowledge, the first for elderly patient.
PubMed: 35601387
DOI: 10.1016/j.radcr.2022.04.018 -
Interventional Cardiology Clinics Apr 2023Myocardial bridging (MB) was historically considered a benign structure as most people with MB are clinically asymptomatic. Recently, however, mounting evidence... (Review)
Review
Myocardial bridging (MB) was historically considered a benign structure as most people with MB are clinically asymptomatic. Recently, however, mounting evidence indicates that MB can cause adverse cardiac events owing to arterial systolic compression/diastolic restriction, atherosclerotic plaque progression upstream from MB, and/or vasospastic angina. In MB patients with refractory angina, the optimal treatment strategy should be determined individually based on versatile anatomic and hemodynamical assessments that often require multidisciplinary diagnostic approaches. The present review summarizes the clinical implication and management of MB, highlighting the role of imaging modalities currently available in this arena.
Topics: Humans; Myocardial Bridging; Coronary Angiography; Plaque, Atherosclerotic; Diastole; Systole
PubMed: 36922068
DOI: 10.1016/j.iccl.2022.12.007 -
BMC Cardiovascular Disorders Apr 2021Myocardial bridging is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to...
BACKGROUND
Myocardial bridging is a congenital anomaly defined as a segment of epicardial coronary arteries running through the myocardium. Various complications related to myocardial bridging have been reported, but at present, cardiac arrest has rarely been reported.
CASE PRESENTATION
We report one case of a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest and was diagnosed with myocardial bridging accompanied by myocardial ischaemia. A 50-year-old woman who had been resuscitated from cardiac arrest transferred to our institution for evaluation and management of out-of-hospital cardiac arrest. We confirmed the diagnosis of significant myocardial bridging with evident myocardial ischaemia by coronary angiography, resting echocardiography and heart MRI. Vasospasm was thought to be a trigger factor judging from the transient ST elevation on electrocardiography. In addition, the finding of septal buckling was detected for the first time throughout the whole cardiac cycle by resting echocardiography in MB.
CONCLUSION
We report a rare case of survival after out-of-hospital cardiac arrest that might be caused by significant myocardial bridging-induced myocardial ischaemia, which was objectively confirmed by echocardiography and heart MRI. Although myocardial bridging is often overlooked as an aetiology for sudden cardiac death, this case highlights the importance of expanding the differential diagnosis to myocardial bridging in the work-up for the cause of sudden cardiac death.
Topics: Coronary Angiography; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Myocardial Bridging; Myocardial Ischemia; Out-of-Hospital Cardiac Arrest; Predictive Value of Tests; Resuscitation; Treatment Outcome; Ventricular Fibrillation
PubMed: 33853525
DOI: 10.1186/s12872-021-01975-x -
Journal of the American College of... Sep 2023Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for... (Review)
Review
Angina with nonobstructive coronary arteries (ANOCA) is increasingly recognized and may affect nearly one-half of patients undergoing invasive coronary angiography for suspected ischemic heart disease. This working diagnosis encompasses coronary microvascular dysfunction, microvascular and epicardial spasm, myocardial bridging, and other occult coronary abnormalities. Patients with ANOCA often face a high burden of symptoms and may experience repeated presentations to multiple medical providers before receiving a diagnosis. Given the challenges of establishing a diagnosis, patients with ANOCA frequently experience invalidation and recidivism, possibly leading to anxiety and depression. Advances in scientific knowledge and diagnostic testing now allow for routine evaluation of ANOCA noninvasively and in the cardiac catheterization laboratory with coronary function testing (CFT). CFT includes diagnostic coronary angiography, assessment of coronary flow reserve and microcirculatory resistance, provocative testing for endothelial dysfunction and coronary vasospasm, and intravascular imaging for identification of myocardial bridging, with hemodynamic assessment as needed.
Topics: Humans; Microcirculation; Myocardial Bridging; Myocardial Ischemia; Angina Pectoris; Coronary Angiography
PubMed: 37704315
DOI: 10.1016/j.jacc.2023.06.043 -
Hellenic Journal of Cardiology : HJC =... 2023
Topics: Humans; Myocardial Bridging; Endocardium; Myocardial Infarction; Anterior Wall Myocardial Infarction
PubMed: 36184035
DOI: 10.1016/j.hjc.2022.09.010 -
Military Medicine Aug 2022Myocardial bridging is an uncommon cause of a quite common emergency department complaint for chest pain and is often associated with left ventricular hypertrophy. We...
Myocardial bridging is an uncommon cause of a quite common emergency department complaint for chest pain and is often associated with left ventricular hypertrophy. We present a case of an otherwise healthy middle-aged U.S. military service member who presented with acute coronary syndrome which was ultimately determined to be the result of myocardial bridging.
Topics: Chest Pain; Electrocardiography; Emergency Service, Hospital; Humans; Ischemia; Middle Aged; Myocardial Bridging; Risk Factors
PubMed: 33686440
DOI: 10.1093/milmed/usab042 -
Journal of Cardiovascular Computed... 2012Myocardial bridging describes the clinical entity whereby a segment of coronary artery is either partially or completely covered by surrounding myocardium. It represents... (Meta-Analysis)
Meta-Analysis Review
Myocardial bridging describes the clinical entity whereby a segment of coronary artery is either partially or completely covered by surrounding myocardium. It represents the most frequent congenital coronary anomaly and has an estimated prevalence of ≤13% on angiographic series. With the emergence of cardiac computed tomography and its ability to simultaneously image the coronary arteries and also the myocardium, there has been an apparent increase in the detection rates of myocardial bridges (prevalence as high as 44%). It has now become important to evaluate their clinical significance. Myocardial bridging is generally considered a benign entity with survival rates of 97% at 5 years; however, there is now emerging evidence that certain myocardial bridge characteristics may be associated with cardiovascular morbidity. The length and depth of myocardial bridges have been associated with increased atherosclerosis, whereas the degree of systolic compression has been associated with ischemia on myocardial perfusion single-photon emission tomography. On the basis of current evidence, it appears that limiting further testing for ischemia to symptomatic patients with long and/or deep myocardial brides would be appropriate.
Topics: Causality; Comorbidity; Coronary Angiography; Humans; Myocardial Bridging; Myocardial Infarction; Prevalence; Risk Assessment; Risk Factors; Survival Analysis; Survival Rate; Tomography, X-Ray Computed
PubMed: 22264630
DOI: 10.1016/j.jcct.2011.10.015 -
International Journal of Cardiology Feb 2017
Topics: Death, Sudden, Cardiac; Hallucinogens; Humans; Myocardial Bridging; N-Methyl-3,4-methylenedioxyamphetamine; Vasoconstriction
PubMed: 27923515
DOI: 10.1016/j.ijcard.2016.11.308 -
European Heart Journal. Cardiovascular... Jun 2013
Topics: Adult; Coronary Angiography; Female; Humans; Imaging, Three-Dimensional; Infant, Newborn; Male; Monitoring, Physiologic; Myocardial Bridging; Prognosis; Risk Assessment; Survival Rate; Tomography, X-Ray Computed
PubMed: 23413082
DOI: 10.1093/ehjci/jet021