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Clinically significant myocardial bridging
  1. Barbara A Danek,
  2. Kathleen Kearney,
  3. Zachary L Steinberg
  1. Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Zachary L Steinberg, Medicine, University of Washington, Seattle, WA 98195, USA; zsteinberg{at}cardiology.washington.edu

Abstract

Myocardial bridging is a common anatomical variant in which a major epicardial coronary artery takes an intramyocardial course, leading to dynamic systolic compression. Because coronary perfusion occurs primarily during diastole, most patients with this anatomical variant have no associated perfusion abnormalities or symptoms. Despite this, there is a subset of patients with myocardial bridging who experience ischaemic symptoms. Determining which anatomical variants are benign and which are clinically relevant remains a challenge. Further complicating the picture, functional factors such as diastolic dysfunction and coronary vasospasm may exacerbate myocardial bridging-related ischaemia. In patients with ischaemic symptoms in the absence of alternative explanations, a detailed assessment of myocardial bridging with invasive physiology should be performed to define the significance of the lesion and guide tailored medical therapy. Patients with refractory symptoms despite maximally tolerated medical therapy should be considered for surgical coronary unroofing.

  • Cardiac Imaging Techniques
  • Chest Pain
  • Coronary Vessels

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Footnotes

  • Contributors BAD—conception of the review; drafting and revision; final approval, agreement to be accountable for all aspects of the work. KK—conception of the review; critical revision; final approval, agreement to be accountable for all aspects of the work. ZLS—conception of the review; critical revision; final approval, agreement to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ZLS—consultant for Medtronic, Abbott and Gore Medical. KK—consultant for Abbott, Abiomed, Boston Scientific, CSI, Medtronic, Philips Vascular and Teleflex.

  • Provenance and peer review Commissioned; externally peer reviewed.