TY - JOUR
T1 - Myocardial bridging
AU - Alegria, Jorge R.
AU - Herrmann, Joerg
AU - Holmes, David R.
AU - Lerman, Amir
AU - Rihal, Charanjit S.
N1 - Funding Information:
Dr. Hung is supported by the Ruth L. Kirschstein National Research Service Awards training grant ( 5T32HL007745 ). Dr. Mekonnen is supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health ( P01HL101398 ). Dr. Timmins is supported by an American Heart Association Postdoctoral Fellowship ( 11POST7210012 ). Dr. Guyton is a consultant for Medtronic, Inc. Dr. Samady receives research funding from Volcano Corp., St. Jude Medical, Toshiba, and Forest Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Corban and Hung contributed equally to this work.
PY - 2005/6
Y1 - 2005/6
N2 - Myocardial bridging, a congenital coronary anomaly, is a clinical condition with several possible manifestations, and its clinical relevance is debated. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of myocardial bridging. Myocardial bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. Myocardial bridging has been associated with angina, arrhythmia, depressed left ventricular function, myocardial stunning, early death after cardiac transplantation, and sudden death. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to development of atherosclerotic lesions because of haemodynamic disturbances. New techniques (e.g. intravascular ultrasonography and intracoronary Doppler studies) have revealed new characteristics and pathophysiologic processes such as diastolic flow abnormalities. Medical treatment generally includes β-blockers. Nitrates should be avoided because symptoms may worsen. Intracoronary stents and surgery have been attempted in selected patients. Additional research is needed to define patients in whom myocardial bridging is potentially pathologic, and randomized multicentre long-term follow-up studies are needed to assess the natural history, patient selection, and therapeutic approaches.
AB - Myocardial bridging, a congenital coronary anomaly, is a clinical condition with several possible manifestations, and its clinical relevance is debated. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of myocardial bridging. Myocardial bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. Myocardial bridging has been associated with angina, arrhythmia, depressed left ventricular function, myocardial stunning, early death after cardiac transplantation, and sudden death. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to development of atherosclerotic lesions because of haemodynamic disturbances. New techniques (e.g. intravascular ultrasonography and intracoronary Doppler studies) have revealed new characteristics and pathophysiologic processes such as diastolic flow abnormalities. Medical treatment generally includes β-blockers. Nitrates should be avoided because symptoms may worsen. Intracoronary stents and surgery have been attempted in selected patients. Additional research is needed to define patients in whom myocardial bridging is potentially pathologic, and randomized multicentre long-term follow-up studies are needed to assess the natural history, patient selection, and therapeutic approaches.
KW - Anatomy
KW - Blood flow
KW - Myocardial bridging
KW - Tunnelled artery
KW - Ultrasound
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U2 - 10.1093/eurheartj/ehi203
DO - 10.1093/eurheartj/ehi203
M3 - Review article
C2 - 15764618
AN - SCOPUS:20844451543
SN - 0195-668X
VL - 26
SP - 1159
EP - 1168
JO - European heart journal
JF - European heart journal
IS - 12
ER -