Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study

Journal of Forensic Sciences

Negoi

Rusu

et al. 2017

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.

Section: Resultsmentioning

confidence: 99%

Myocardial Bridging: A Meta‐Analysis of Prevalence

Journal of Forensic Sciences

Negoi

Rusu

et al. 2017

“…Aksan et al . demonstrated that subjects with MB have a significantly increased QTd during peak exercise compared with its baseline value (42.6 ms versus 36.4 ms), while in non-MB subjects the increase during peak exercise was not statistically significant (29.1 ms, versus a baseline value of 27.1 ms) 72 .…”

Section: Discussionmentioning

confidence: 87%

Cardiovascular consequences of myocardial bridging: A meta-analysis and meta-regression

Rusu

et al. 2017

Sci Rep

Myocardial bridging, a congenital abnormality in which a coronary artery tunnels through the myocardial fibres was usually considered a benign condition. Many studies suggested a potential hemodynamic significance of myocardial bridging and some, usually case reports, implied a possible correlation between it and various cardiovascular pathologies like acute myocardial infarction, ventricular rupture, life-threatening arrhythmias, hypertrophic cardiomyopathy, apical ballooning syndrome or sudden death. The main objective of this article is to evaluate whether myocardial bridging may be associated with significant cardiac effects or if it is strictly a benign anatomical variation. To this purpose, we performed a meta-analysis (performed using the inverse variance heterogeneity model) and meta-regression, on scientific articles selected from three main databases (Scopus, Web of Science, Pubmed). The study included 21 articles. MB was associated with major adverse cardiac events - OR = 1.52 (1.01–2.30), and myocardial ischemia OR = 3.00 (1.02–8.82) but not with acute myocardial infarction, cardiovascular death, ischemia identified using imaging techniques, or positive exercise stress testing. Overall, myocardial bridging may have significant cardiovascular consequences (MACE, myocardial ischemia). More studies are needed to reveal/refute a clear association with MI, sudden death or other cardiovascular pathologies.

SAGE Open Medical Case Reports

“…Although generally benign, MB has been associated with coronary spasm, myocardial infarction, unstable angina, supraventricular and ventricular arrhythmia, syncope, myocardial stunning, 7 ventricular septal rupture, 8 transient ventricular dysfunction, or sudden cardiac arrest or death. 9…”

Section: Discussionmentioning

confidence: 99%

Extensive unroofing of myocardial bridge: A case report and literature review

Mok

Majdalany

Pettersson

2019

Background:Myocardial bridge is defined as a segment of a coronary artery that takes an intramyocardial course. The presence of myocardial bridge has been observed in as many as 40%–80% of cases on autopsy, angiographically from 0.5% to 16.0%, and often asymptomatic. However, it has been associated with angina, coronary spasm, myocardial infarction, arrhythmias, syncope, sudden cardiac arrest, and death. Conflicting opinions exist on the timing of surgical intervention for myocardial bridge.Methods:We present an unusual case of a young female, with prior aortic surgery, who had refractory chest pain despite optimal medical therapy. Stress testing revealed anterior ischemia. Cardiac catherization showed myocardial bridge of the left anterior descending artery with significant compromise of blood flow (fractional flow reserve = 0.75 with adenosine). We proceeded with surgery. Intraoperatively, we found an unusually long (10-cm) intramyocardial segment of the left anterior descending artery which was managed by surgically unroofing. Our patient felt better post procedure. Repeat cardiac catheterization showed no further narrowing of the left anterior descending artery with a fractional flow reserve of 0.87 in its distal segment.Results/discussion:Myocardial bridge is present mostly in female patients (74.5%), with median age at 56.2 years and mostly involving the left anterior descending artery (77.2%). The average length of myocardial bridge is 21.85 ± 16.10 mm (range: 5–70 mm). Our case is unique as the involved myocardial bridge was 10 cm in length, the longest ever reported. Multiple imaging modality revealed significant coronary insufficiency, with a subsequent clinical and angiographic improvement upon unroofing of the culprit coronary vessel.Conclusion:Management decision on myocardial bridge remains controversial. This is a case of the longest symptomatic myocardial bridge, with a subsequent improvement post unroofing.