Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device

Zóka, András; Andréka, Péter; Becker, Dávid; Fontos, Géza; Merkely, Béla; Szabó, György; Szatmári, András; Bárczi, György

doi:10.3325/cmj.2012.53.627

Cited by 14 publications

(15 citation statements)

References 8 publications

(13 reference statements)

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“…Isolated myocardial bridging is generally considered as a benign condition. Beside appealing, unique clinical cases [ 6 , 7 , 8 , 9 ], studies with long-term follow-up suggest that bridging might be associated with negative clinical outcomes, such as myocardial infarctions and arrhythmias [ 29 ]. In particular, long bridges were associated with these complications.…”

Section: Discussionmentioning

confidence: 99%

“…While myocardial bridging is generally considered as a benign phenomenon and related serious events are uncommon, many cases have been reported where MB was considered responsible for a wide variety of cardiovascular symptoms and complications, including angina, acute coronary syndrome, left ventricular dysfunction, arrhythmias and even sudden cardiac death [ 5 , 6 , 7 , 8 , 9 , 10 ]. By using novel invasive methods (fractional flow reserve, intracoronary Doppler and intravascular ultrasound), our understanding about the pathophysiology has been expanded [ 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge

Bárczi

Becker

Sydó

et al. 2022

JCDD

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Although myocardial bridging (MB) has been intensively investigated using different methods, the effect of bridge morphology on long-term outcome is still doubtful. We aimed at describing the anatomical differences in coronary angiography between symptomatic and non-symptomatic LAD myocardial bridges and to investigate the influence of clinical and morphological factors on long-term mortality. In our retrospective, long-term, single center study we found relevant MB on the left anterior descendent (LAD) coronary artery in 146 cases during a two-year period, when 11,385 patients underwent coronary angiography due to angina pectoris. Patients were divided into two groups: those with myocardial bridge only (LAD-MBneg, n = 78) and those with associated obstructive coronary artery disease (LAD-MBpos, n = 68). Clinical factors, morphology of bridge by quantitative coronary analysis and ten-year long mortality data were collected. The LAD-MBneg group was associated with younger age and decreased incidence of diabetes mellitus, as well as with increased minimal diameter to reference diameter ratio (LAD-MBneg 54.5 (13.1)% vs. LAD-MBpos 46.5 (16.4)%, p = 0.016), while there was a tendency towards longer lesions and higher vessel diameter values compared to the LAD-MBpos group. The LAD-MBpos group was associated with increased mortality compared to the LAD-MBneg group. The analysis of our data showed that morphological parameters of LAD bridge did not influence long-term mortality, either in the overall population or in the LAD-MBneg patients. Morphological parameters of LAD bridge did not influence long-term mortality outcomes; therefore, it suggests that anatomical differences might not predict long-term outcomes and should not influence therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge

Bárczi

Becker

Sydó

et al. 2022

JCDD

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“…A myocardialis izomhíd kóroki, prognosztikai szerepéről ismereteink továbbra is szűkösek annak ellenére, hogy számtalan esetet közöltek, amikor az izomhíd -ischaemia révén -tüneteket okozott. Az ischaemia következtében angina pectoris, szívinfarktus, különböző ritmuszavarok vagy akár hirtelen szívhalál jelentkezhet [10][11][12][13][14].…”

Section: Klinikai Megjelenésunclassified

“…Ez magyarázható a jelenség alapvetően jóindulatúnak vélt természetével, illetve az experimentális modellek hiányával. Alapvető lenne annak tisztázása, mely típusú myocardialis izomhidak veszélyesek, olykor akár életet veszélyeztető ischaemiát okozva [11][12][13].…”

Section: Megbeszélésunclassified

Myocardialis izomhíd: a tüneteket befolyásoló morfológiai faktorok vizsgálata

Bárczi

Merkely

Oláh

et al. 2023

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Bevezetés: A myocardialis izomhíd a koszorúereken gyakran kimutatott, jóindulatúnak tartott, veleszületett eltérés. Egyedülálló abban a tekintetben, hogy dinamikus kompressziót okoz az adott érszakaszon. Célkitűzés: A közleményben arra kerestük a választ, hogy melyek és hogyan vizsgálhatók azok a morfológiai és funkcionális jellemzők, amelyek meghatározzák a myocardialis izomhíd tünetképző voltát. Módszer: A rendelkezésre álló invazív és nem invazív vizsgálómódszerekkel a morfológiai és a funkcionalitási összefüggések ismertetésével bemutatjuk saját retrospektív kutatásunkat, amikor angina pectoris miatt végzett koronarográfia során a bal elülső leszálló coronarián kimutatott myocardialis izomhíd morfológiai jellemzőit vizsgáltuk. Összehasonlítottuk a betegek életkilátásait azoknál a betegeknél, akiknél csak myocardialis izomhíd fordult elő, azokkal, akiknél szignifikáns arteriosclerosis is jelen volt. Eredmények: Az intravascularis ultrahangvizsgálat alkalmas az eltérés vizualizálására, a kompresszió mértékének megítélésére. Már funkcionális megítélést is lehetővé tesz az intracoronariás Doppler- és a frakcionális ’flow’ rezerv vizsgálat. A nem invazív funkcionális vizsgálatok közül a leggyakrabban a terheléses echokardiográfia használatos. Saját eredményeink szerint, ahol koronarográfiával izolált myocardialis izomhidat találtunk, ott a csoport morfológiai jegyei súlyosabb jellemzőket mutattak, a myocardialis izomhíd rövidülése nagyobb volt. A hosszú távú, 10 éves utánkövetés során a mortalitás kicsi volt, és eredményeink azt mutatták, hogy a mért morfológiai paraméterek egyike sem befolyásolja a mortalitást. Következtetés: Alapvető ellentmondás az állapot gyakori előfordulása a jó prognózisa, illetve a nagyszámú esetleírás között, ahol súlyos szövődményeket mutatnak be. Ma már rendelkezésre állnak azok a nem invazív és invazív vizsgálómódszerek, amelyek segítségével egy jól tervezett prospektív tanulmány választ adhat a myocardialis izomhíd morfológiai jellemzőinek funkcionális jelentőségére. Orv Hetil. 2023; 164(15): 563–570.

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“…5 Thus, acute MI and its mechanical complications should be considered even in patients without coronary artery thrombosis.…”

mentioning

confidence: 99%

Ventricular septal rupture in a patient with non‑ST‑segment elevation myocardial infarction caused by myocardial bridge

Zawiślak¹,

Dziewierz²,

Kmita³

et al. 2015

Polish Archives of Internal Medicine

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POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2015; 125 (5) 386 the LV apex. An intraaortic balloon pump was immediately inserted. 2,3 A cardiac surgeon decided to postpone the closure of the ventricular septal rupture (VSR) because of a high risk of recurrent septal defect. Percutaneous closure with an Amplatzer septal occluder was also postponed for the same reason. On the fourth day of hospitalization, a sudden hemodynamic deterioration occurred, with a decrease in blood pressure to 70/50 mmHg, dyspnea, dizziness, and oliguria, considered to be signs of cardiogenic shock. Echocardiography 1 showed enlargement of apical septal dropout to 13 mm and a decrease of transseptal pressure gradient to 47 mmHg with deterioration of tricuspid regurgitation (gap in leaflet coaptation, 10 mm; decrease of the maximum RV-RA gradient to 26 mmHg). Emergency surgical closure of VSR and cut of the myocardial bridge were performed. The patient's condition continued to deteriorate despite surgery and intensive pharmacological treatment including high doses of inotropes and prolonged mechanical ventilation. On day 7 after the surgery, the patient died of refractory multiorgan failure.In our patient, NSTEMI was probably caused by a narrowing of the left anterior descending coronary artery due to the myocardial bridge. Cases of VSRs with "normal" coronary arteries have been reported, where a normal coronary angiogram was attributed to clot lysis, or a coronary artery spasm was suspected.4 So far, only 1 case report of VSR associated with a myocardial bridge has been published. 5 Thus, acute MI and its mechanical complications should be considered even in patients without coronary artery thrombosis.A 68-year-old woman with a non-ST-segment elevation myocardial infarction (NSTEMI) was admitted to our department for emergency coronary angiography. She had a history of 2 NSTEMIs without coronary artery stenosis on coronary angiography. On admission, she was hypotensive but hemodynamically stable. Auscultation did not reveal any pathological heart murmurs. An electrocardiogram showed negative T waves in leads II, III, aVF, and V 5 -V 6 . On coronary angiography, the only abnormality was a myocardial bridge (systolic stenosis, 60%-70%) of the left anterior descending coronary artery ( Figure 1AB). Further conservative treatment was scheduled.Since the recorded values of creatine kinase (CK) / CK-MB (245/51 IU/l) and troponin I (1.79 μg/l; cut-off value, 0.01) were the highest on admission, we estimated that the MI occurred 2 days earlier.On the next day, a new holosystolic murmur appeared. Echocardiography 1 showed a 10-mm dropout in the apical part of the septum, with turbulent left-to-right transseptal flow with a peak gradient of 53 mmHg (Figure 1C-H). The size of the left ventricle (LV) was normal, with regional septoapical akinesis, but with an ejection fraction of 80% due to hyperkinesia of all segments. The right ventricle (RV) was significantly enlarged (5.8 cm in an apical 4-chamber view) with a 7-mm gap in tricuspid valve leaflet coapta...

show abstract

Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device

Cited by 14 publications

References 8 publications

Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge

Impact of Clinical and Morphological Factors on Long-Term Mortality in Patients with Myocardial Bridge

Myocardialis izomhíd: a tüneteket befolyásoló morfológiai faktorok vizsgálata

Ventricular septal rupture in a patient with non‑ST‑segment elevation myocardial infarction caused by myocardial bridge

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