The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries

Konen, Eli; Goitein, Orly; Sternik, Leonid; Eshet, Yael; Shemesh, Joseph; Segni, Elio Di

doi:10.1016/j.jacc.2006.09.039

Cited by 166 publications

(122 citation statements)

References 31 publications

(54 reference statements)

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“…CTCA depicts the beginning and end of the tunnelled segment and the length and depth of the bridging [5,[13][14][15][16] which is often best demonstrated by curved multiplanar reconstruction ( Fig. 1).…”

Section: Diagnosismentioning

confidence: 99%

“…Several studies using CAG, CTCA and IVUS have demonstrated that myocardial bridging of the LAD is often associated with atherosclerotic lesions proximal to the bridge whereas the tunnelled segment and the distal portion are conspicuously free from atherosclerosis [9,15,31,33,34] (Fig. 3).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Hazenberg et al described the results of multiple invasive tests in a series of 12 patients with myocardial bridging and demonstrated that extensive testing is feasible and provides more insight into the mechanisms underlying myocardial bridging [36] but the clinical consequences in individual patients have yet to be determined. When analysing the CTCA results particular attention should be given to the length and depth of the bridge, the overlying tissue, and the proximity to right and left ventricular myocardium [15] (Figs. 1 and 4).…”

Section: Patients With Isolated Myocardial Bridgingmentioning

confidence: 99%

“…The coronary flow velocity is minimal during systole LAD this may cause a pressure drop in the distal LAD and thus aggravate the systolic lumen reduction caused by the bridge. In these cases it may only be possible to estimate the influence of the bridging on the basis of the length, depth, and proximity to left ventricular myocardium of the tunnelling as can be assessed by CTCA [15].…”

Section: Patients With Concomitant Coronary Artery Disease (Cad) or Omentioning

confidence: 99%

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Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made. Keywords Myocardial bridging . Computed tomography angiography . Coronary arteriographyAccording to the original definitions the term 'myocardial bridging' is used for an anatomic variation in which a band of cardiac muscle overlies a segment of an epicardial coronary artery while the artery involved is referred to as being 'tunnelled'. Initially the diagnosis could only be made at autopsy but soon after coronary arteriography (CAG) had become an established clinical diagnostic tool systolic compression of a coronary artery, usually the left anterior descending artery (LAD), was occasionally observed and correctly interpreted as evidence of myocardial bridging [1,2]. Since then the clinical significance of myocardial bridging has been a subject of discussion and controversy. In the last decade it was shown that myocardial bridging can be very well depicted by computed tomography coronary angiography (CTCA) [3,4] which has rekindled the interest in this anomaly. We expect that in the near future increasing numbers of patients with myocardial bridging will be detected by CTCA which may significantly enhance our understanding of the pathology and clinical consequences. At the same time, to ensure that these patients receive optimal treatment it is imperative that we stay aware of what previous studies have taught us. It is the purpose of this paper to critically review the outcomes of previous studies and to define remaining questions of clinical relevance that hopefully can be resolved with newer diagnostic modalities. DiagnosisAlthough myocardial bridging has been held responsible for a variety of symptoms in individual cases, ranging from atypical chest pain to sudden death, thus far clinical studies have been unable to identify specific diagnostic features that allow a diagnosis of myocardial bridging without visualisation of the coronary arteries [5][6][7][8][9][10][11]. The diagnosis is usually established by chance in patients who are examined by CAG or CTCA for various reasons but not because they are suspected of having myocardial bridging. It should be noted that there are essential differences between the diagnostic information provided by each of the two visualisati...

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Section: Diagnosismentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

Section: Patients With Isolated Myocardial Bridgingmentioning

confidence: 99%

Section: Patients With Concomitant Coronary Artery Disease (Cad) or Omentioning

confidence: 99%

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Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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“…The length, the depth and the location of the MB have been associated with the mechanisms above [21,30]. Therefore, MB is classified as superficial or deep, depending on the thickness of the covering muscular layer (≤ 1 mm or > 1 mm) [26]. Also, superficial MB can be classified as complete or incomplete by the extent of the vessel encasement by the myocardium [23].…”

Section: Discussionmentioning

confidence: 99%