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1.
Clin Anat ; 24(6): 675-83, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21751254

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.


Subject(s)
Myocardial Bridging/diagnosis , Myocardium/pathology , Animals , Atherosclerosis/etiology , Death, Sudden, Cardiac/etiology , Humans , Myocardial Bridging/classification , Myocardial Ischemia/etiology , Myocardial Ischemia/therapy
2.
Cardiology ; 112(1): 13-21, 2009.
Article in English | MEDLINE | ID: mdl-18577881

ABSTRACT

BACKGROUND: There is no widely accepted classification to guide therapy in patients with symptomatic myocardial bridging (MB). METHODS: A retrospective analysis of 157 patients with chest pain, angiographic MB of the left anterior descending artery without obstructive coronary artery disease (CAD) was performed. Patients were evaluated for clinical symptoms, objective signs of ischemia by stress test, intracoronary Doppler flow measurement and coronary flow reserve. 100 patients without CAD or MB served as controls. RESULTS: There was no difference in clinical symptoms and objective signs of ischemia between controls and patients with MB. The length of MB was 22.6 +/- 7.8 mm, maximal systolic luminal diameter reduction 71 +/- 16%, and maximal mid-diastolic luminal reduction 34.7 +/- 13% as demonstrated by quantitative coronary angiography (QCA). Intracoronary Doppler showed significantly increased average peak flow velocity (APV), average systolic peak velocity (ASPV), average diastolic peak flow velocity (ADPV), and maximal peak velocity (MPV) in MB versus proximal and distal segments at rest and after maximal vasodilatation (p < 0.001 for all parameters). Coronary flow reserve was significantly higher proximally (2.9 +/- 0.9) compared with segments distal to the MB (2.0 +/- 0.6, p < 0.01). We propose a new MB classification for symptomatic patients with MB:Type A:incidental finding on angiography, no objective signs of ischemia; Type B: objective signs of ischemia, and Type C: with or without objective signs of ischemia and altered intracoronary hemodynamics (by QCA/CFR/intracoronary Doppler). 5-Year follow-up data based on this classification showed that types B and C responded well to beta-blockers or calcium channel antagonists. Patients with type C refractory to medical therapy were treated with stenting of the MB. CONCLUSION: Patients with MB without CAD did not have a higher prevalence of chest pain or abnormal non-invasive stress tests compared to patients without CAD or MB. Intracoronary hemodynamic measurement is a novel approach that may be valuable in defining the functional significance of MB. We propose a classification of symptomatic patients with MB without CAD using non-invasive and invasive parameters to guide therapeutic choices.


Subject(s)
Coronary Angiography , Myocardial Bridging/classification , Myocardial Bridging/diagnostic imaging , Adult , Angina Pectoris/classification , Angina Pectoris/diagnostic imaging , Coronary Artery Disease , Echocardiography, Doppler , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Ischemia/classification , Myocardial Ischemia/diagnostic imaging , Retrospective Studies , Ultrasonography, Interventional
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