Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Successful supra-arterial myotomy with symptomatic myocardial bridge

Authors: Kurbanova B.G., Yarbekov R.R., Muradov M.M.

Company:
Republican Specialized Scientific and Practical Medical Center of Cardiology, Tashkent, 100052, Uzbekistan

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-2-158-164

UDC: 616.127-089.168

Link: Clinical Physiology of Blood Circulaiton. 2021; 2 (18): 158-164

Quote as: Kurbanova B.G., Yarbekov R.R., Muradov M.M. Successful supra-arterial myotomy with symptomatic myocardial bridge. Clinical Physiology of Circulation. 2021; 18 (2): 158–64 (in Russ.). DOI: 10.24022/1814-6910-2021-18-2-158-164

Received / Accepted:  15.04.2021 / 23.04.2021

Full text:  

Abstract

The myocardial bridge (MВ) is a congenital anatomical anomaly in which myocardial fibers partially cover the epicardial coronary vessels, in particular the left anterior interventricular coronary branch of the left coronary artery. Despite the fact that this variant is considered clinically benign, it can lead to significant clinical problems such as: arrhythmia, myocardial ischemia, conduction disturbances, myocardial infarction and sudden death. Various treatment strategies, including surgical intervention for refractory angina pectoris, are more dependent on the anatomical factors of MВ, the severity of coronary lesions, the patient's condition and the experience of the operating surgeon. Despite the large number of publications devoted to various aspects of coronary circulation as a result of MВ, there are very few data on the results of surgical treatment, or they are represented by isolated observations. In this report, presented a clinical case of successful surgical treatment of coronary artery disease with isolated MВ by the method of supraarterial myotomy.

References

  1. Möhlenkamp S., Hort W., Ge J., Erbel R. Update on myocardial bridging. Circulation. 2002; 106 (20): 2616–22. DOI: 10.1161/01.CIR.0000038420.14867.7A
  2. Kim P.J., Hur G., Kim S.Y., Namgung J., Hong S.W., Kim Y.H., Lee W.R. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009; 119 (10): 1408–16. DOI: 10.1161/CIRCULATIONAHA.108.788901
  3. Said S.M., Dearani J.A., Burkhart H.M., Schaff H.V. Surgical management of congenital coronary arterial anomalies in adults. Cardiol. Young. 2010; 20 (Suppl. 3): 68–85.
  4. Reyman H.C. Disertatio de vasis cordis propriis. Bibl. Anat. 1737; 2: 359–79.
  5. Porstmann W., Iwig J. Die intramurale koronarie im angiogramm. RöFo. 1960; 92 (2): 129–33. DOI: 10.1055/s-0029-1226492
  6. Lin S., Tremmel J.A., Yamada R., Rogers I.S., Yong C.M., Turcott R. et al. A novel stress echocardiography pattern for myocardial bridge with invasive structural and hemodynamic correlation. J. Am. Heart Assoc. 2013; 2 (2): e000097. DOI: 10.1161/JAHA.113.000097
  7. Sara J.D.S., Corban M.T., Prasad M., Prasad A., Gulati R., Lerman L.O. et al. Prevalence of myocardial bridging associated with coronary endothelial dysfunction in patients with chest pain and non-obstructive coronary artery disease. EuroIntervention. 2020; 15: 1262–8. DOI: 10.4244/EIJ-D-18-00920
  8. Angelini P., Uribe C., Lozano P. Differential local spasticity in myocardial bridges. Tex. Heart Inst. J. 2012; 39: 384–8. 9. Yuan S.-M. Myocardial bridging. Braz. J. Cardiovasc. Surg. 2016; 31: 60—2. DOI: 10.5935/1678-9741.20150082
  9. Alegria J.R., Herrmann J., Holmes D.R., Jr, Lerman A., Rihal C.S. Myocardial bridging. Eur. Heart J. 2005; 26: 1159–68. DOI: 10.1093/eurheartj/ehi203
  10. Ernst A., Bulum J., Separovi C., Hanzevacki J., Lovric Bencic M., Strozzi M. Five-year angiographic and clinical follow-up of patients with drug-eluting stent implantation for symptomatic myocardial bridging in absence of coronary atherosclerotic disease. J. Invasive Cardiol. 2013; 25: 586–92.
  11. Ekeke C.N., Noble S., Mazzaferri E., Crestanello J.A. Myocardial bridging over the left anterior descending: myotomy, bypass, or both? J. Thorac. Cardiovasc. Surg. 2015; 149: e57–8. DOI: 10.1016/j.jtcvs.2014.12.054
  12. Ji Q., Shen J.Q., Xia L.M., Ding W., Wang C.S. Surgical treatment of symptomatic left anterior descending myocardial bridges: myotomy vs. bypass surgery. Surgery Today. 2020; 50: 685–92. DOI: 10.1007/s00595-019-01935-1
  13. Bruschke A.V., Veltman C.E., de Graaf M.A., Vliegen H.W. Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights? Neth. Heart J. 2013; 21: 6–13. DOI: 10.1007/s12471-012-0355-x
  14. Cerratoа E., Barbero U., D’Ascenzo F., Taha S., Biondi-Zoccai G., Omedé P. et al. What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis. J. Cardiovasc. Med. 2017; 18: 758–70.
  15. Hemmati P., Schaff H.V., Dearani J.A., Daly R.C., Lahr B.D., Lerman A. Clinical outcomes of surgical unroofing of myocardial bridging in symptomatic patients. Ann. Thorac. Surg. 2020; 109 (2): 452–7. DOI: 10.1016/j.athoracsur.2019.07.005
  16. Wu Q.Y., Xu Z.H. Surgical treatment of myocardial bridging: report of 31 cases. Chin. Med. J. 2007; 120 (19): 1689–93.
  17. Huang X.H., Wang S.Y., Xu J.P., Song Y.H., Sun H.S., Tang Y. et al. Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging. Chin. Med. J. 2007; 120 (18): 1563–6.
  18. Bockeria L.A., Sukhanov S.G., Orekhova E.N., Shatakhyan M.P., Korotayev D.A., Sternik L. Results of coronary artery bypass grafting in myocardial bridging of left anterior descending artery. J. Card. Surg. 2013; 28: 218–21. DOI: 10.1111/jocs.12101
  19. Boyd J.H., Pargaonkar V.S., Scoville D.H., Rogers I.S., Kimura T., Tanaka S. et al. Surgical unroofing of hemodynamically significant left anterior descending myocardial bridges. Ann. Thorac. Surg. 2017; 103: 1443–50. DOI: 10.1016/j.athoracsur.2016.08.035
  20. Tarantini G., Migliore F., Cademartiri F., Fraccaro C., Iliceto C. Left anterior descending artery myocardial bridging: a clinical approach. J. Am. Coll. Cardiol. 2016; 68 (25): 2887–99. DOI: 10.1016/j.jacc.2016.09.973

About Authors

  • Bernara G. Kurbanova, Head of Department of Radiation Diagnostics; ORCID
  • Rustam R. Yarbekov, Dr. Med. Sc., Head of Department of Cardiac Surgery; ORCID
  • Maksud M. Muradov, Cand. Med. Sc., Сardiac Surgeon; ORCID

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