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Amir Lerman - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of surgical unroofing of Myocardial Bridging in symptomatic patients
The Annals of Thoracic Surgery, 2020Co-Authors: Pouya Hemmati, Hartzell V Schaff, Joseph A Dearani, Richard C Daly, Brian D Lahr, Amir LermanAbstract:Background There is a paucity of data regarding results of surgical management of Myocardial Bridging. Our objective was to evaluate the clinical outcomes of unroofing procedures in patients with Myocardial Bridging of the left anterior descending (LAD) coronary artery who had chest pain refractory to medical therapy. Methods Among 274 adult patients diagnosed with Myocardial Bridging at our institution (1996-2017), 71 underwent surgical intervention. To understand the potential benefit of unroofing, we excluded patients with concomitant operations for other diagnoses or known obstructive coronary disease. The study included 35 patients with preoperative chest pain and isolated LAD coronary artery Bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality. Results Mean age was 48.2 ± 11.2 years (18 men [51%]). All patients underwent preoperative coronary angiography. Endothelial dysfunction in the LAD coronary artery bridged segment was confirmed in 20 of 24 patients (83%). Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 minutes and 33.7 ± 22.2 minutes, respectively. Median lengths of hospital and intensive care unit stay were 5 days and 1 day, respectively. During follow-up (median, 31 months; 95% confidence interval, 18-49) there were no cardiac-related deaths, and 22 patients (63%) reported no chest pain. Among 13 symptomatic patients, 10 underwent postoperative noninvasive testing, which was negative for ischemia in all cases. Conclusions Myocardial unroofing can be performed safely in patients with chest pain and isolated LAD coronary artery Myocardial Bridging. However, patients should be aware of the potential for recurrent nonischemic chest pain and continued medical therapy despite relief of coronary compression.
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Myocardial Bridging.
European heart journal, 2005Co-Authors: Jorge R Alegria, Joerg Herrmann, David R Holmes, Amir Lerman, Charanjit S RihalAbstract:Myocardial Bridging, a congenital coronary anomaly, is a clinical condition with several possible manifestations, and its clinical relevance is debated. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of Myocardial Bridging. Myocardial Bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. Myocardial Bridging has been associated with angina, arrhythmia, depressed left ventricular function, Myocardial stunning, early death after cardiac transplantation, and sudden death. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to development of atherosclerotic lesions because of haemodynamic disturbances. New techniques (e.g. intravascular ultrasonography and intracoronary Doppler studies) have revealed new characteristics and pathophysiologic processes such as diastolic flow abnormalities. Medical treatment generally includes beta-blockers. Nitrates should be avoided because symptoms may worsen. Intracoronary stents and surgery have been attempted in selected patients. Additional research is needed to define patients in whom Myocardial Bridging is potentially pathologic, and randomized multicentre long-term follow-up studies are needed to assess the natural history, patient selection, and therapeutic approaches.
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Myocardial Bridging is associated with alteration in coronary vasoreactivity
European Heart Journal, 2004Co-Authors: Joerg Herrmann, Charanjit S Rihal, Stuart T Higano, Ryan J Lenon, Amir LermanAbstract:Background Shear stress alteration has been recognized as a predisposing factor for the impairment of endothelial function. Myocardial Bridging is a congenital condition associated with alteration in shear stress, however, its impact upon vasoreactivity remains undetermined. Methods and results This was a case-control designed study with 29 patients with Myocardial Bridging and 58 patients without Myocardial Bridging. Endotheliumdependent and endothelium-independent changes in coronary artery diameters, blood flow and wall shear stress were determined after intracoronary infusion of acetylcholine (ACH, 10 6 ‐10 4 mol/L) and nitroglycerine (NTG, 200 lg). Coronary flow velocity reserve (CFVR) was determined after intracoronary injection of adenosine (18‐36 lg). In response to ACH, there was more epicardial vasoconstriction at the Myocardial Bridging site compared with the proximal and distal segments (29.6 ± 21.7 vs. 9.6 ± 22.5 and 17.4 ± 21.5%, p < 0.05) and compared with the control group (29.6 ± 21.7 vs. 5.9 ± 36.5%, p < 0.001). The response to NTG and CFVR was the same in the case and the control group. Wall shear rate (WSR) was higher in the MB site at baseline and in response to ACH. Conclusions MB is characterised by enhanced WSR and impairment in endotheliumdependent vasorelaxation. These functional alterations may add to the severity of structural lumen compression and thus to the clinical presentation of this congenital abnormality.
Joseph A Dearani - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of surgical unroofing of Myocardial Bridging in symptomatic patients
The Annals of Thoracic Surgery, 2020Co-Authors: Pouya Hemmati, Hartzell V Schaff, Joseph A Dearani, Richard C Daly, Brian D Lahr, Amir LermanAbstract:Background There is a paucity of data regarding results of surgical management of Myocardial Bridging. Our objective was to evaluate the clinical outcomes of unroofing procedures in patients with Myocardial Bridging of the left anterior descending (LAD) coronary artery who had chest pain refractory to medical therapy. Methods Among 274 adult patients diagnosed with Myocardial Bridging at our institution (1996-2017), 71 underwent surgical intervention. To understand the potential benefit of unroofing, we excluded patients with concomitant operations for other diagnoses or known obstructive coronary disease. The study included 35 patients with preoperative chest pain and isolated LAD coronary artery Bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality. Results Mean age was 48.2 ± 11.2 years (18 men [51%]). All patients underwent preoperative coronary angiography. Endothelial dysfunction in the LAD coronary artery bridged segment was confirmed in 20 of 24 patients (83%). Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 minutes and 33.7 ± 22.2 minutes, respectively. Median lengths of hospital and intensive care unit stay were 5 days and 1 day, respectively. During follow-up (median, 31 months; 95% confidence interval, 18-49) there were no cardiac-related deaths, and 22 patients (63%) reported no chest pain. Among 13 symptomatic patients, 10 underwent postoperative noninvasive testing, which was negative for ischemia in all cases. Conclusions Myocardial unroofing can be performed safely in patients with chest pain and isolated LAD coronary artery Myocardial Bridging. However, patients should be aware of the potential for recurrent nonischemic chest pain and continued medical therapy despite relief of coronary compression.
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outcome of repair of Myocardial Bridging at the time of septal myectomy
The Annals of Thoracic Surgery, 2014Co-Authors: Meghana R Kunkala, Paul Sorajja, Steve R. Ommen, Hartzell V Schaff, Gurpreet S Sandhu, Harold M Burkhart, Daniel B Spoon, Joseph A DearaniAbstract:Background Myocardial Bridging describes systolic compression of the muscular investment of a portion of an epicardial coronary artery. We evaluated the outcome of muscular bridge unroofing of the left anterior descending artery at the time of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We conducted a case-controlled study of 36 patients (23 men; median age, 42 years) with hypertrophic cardiomyopathy and Myocardial Bridging. Group 1 patients had septal myectomy and concomitant unroofing (n = 13), group 2 patients underwent myectomy alone (n = 10), and group 3 patients were treated medically (n = 13). Results Angina was more prevalent preoperatively in group 1, 46% compared with 20% in group 2. Preoperative left ventricular outflow tract gradients of 67.8 ± 58.2 mm Hg and 74.1 ± 19.7 mm Hg were reduced to 1.9 ± 2.9 mm Hg in group 1 ( p p p = 0.297), 100.0% in group 2, and 67.9% in group 3; there were no late sudden deaths. At follow-up, 77% in group 1 were asymptomatic compared with 70% of patients in group 2 ( p = 0.19). There was no recurrent angina in group 1. Conclusions Myocardial unroofing can be performed safely at the time of septal myectomy for left ventricular outflow tract obstruction. Angina was improved, but we found no difference in late survival compared with patients who had Myocardial Bridging and myectomy alone. Unroofing should be considered in patients with angina who have significant left anterior descending artery Bridging and require myectomy.
Raimund Erbel - One of the best experts on this subject based on the ideXlab platform.
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Myocardial Bridging a congenital variant as an anatomic risk factor for Myocardial infarction
Circulation, 2009Co-Authors: Raimund Erbel, Stefan MöhlenkampAbstract:According to postmortem studies, coronary atherosclerosis can be substantial and reach a high prevalence of advanced lesions, including atheroma and fibroatheroma in young adults.1,2 Risk factors associated with coronary atherosclerosis such as dyslipidemia, smoking, diabetes mellitus, and hypertension have been identified. The development of atherosclerosis seems to be related to the magnitude and duration of exposure.3 Although research concentrates on identifying genetic markers in genome-wide association studies, there is still a lack of knowledge about the individual risk of developing coronary atherosclerosis.4 When atherosclerosis presents as acute coronary syndromes, mortality may be high.5 Plaque rupture and erosion have been identified as major underlying pathological-anatomic characteristics,6 but some suspect other mechanisms.7 In this issue of Circulation , Ishikawa et al8 present evidence that Myocardial Bridging may play a role as a congenital anatomic risk factor for coronary atherosclerosis and Myocardial infarction. Article see p 376 Myocardial Bridging results when Myocardial tissue covers part of the left anterior descending coronary artery, resulting in a tunneled arterial segment, which can be regarded as a congenital variant.9–11 The prevalence is reported to be >50% at autopsy.12 Clinically, the diagnosis of Myocardial Bridging is established by coronary angiography demonstrating a systolic compression, described as a “milking effect,”13 but it was present in only <5% of cases recently in a large number of Chinese patients.14 When nitroglycerin was used as …
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Update on Myocardial Bridging
Circulation, 2002Co-Authors: Stefan Möhlenkamp, Waldemar Hort, Raimund ErbelAbstract:Muscle overlying the intraMyocardial segment of an epicardial coronary artery, first mentioned by Reyman1 in 1737, is termed a Myocardial bridge, and the artery coursing within the myocardium is called a tunneled artery (Figure 1). It is characterized by systolic compression of the tunneled segment, which remains clinically silent in the vast majority of cases. An in-depth analysis of autopsy samples was first presented by Geiringer et al2 in 1951, but clinical interest and systematic research was triggered by an observed association of Myocardial Bridging with Myocardial ischemia.2–5 Figure 1. Typical systolic compression (arrows) of the mid LAD at two sites in series. Diastolic lumen dimensions are normal. The coronary tree shows no angiographic signs of coronary atherosclerosis. New imaging techniques have led to improved identification and functional quantitation of Myocardial Bridging in vivo, which is crucial for establishing a link between systolic compression and the clinical presentation, and hence for commencing appropriate therapy. In the present article, we summarize clinically relevant aspects of Myocardial Bridging with an emphasis on morphological and hemodynamic alterations and their representation in imaging techniques. The prevalence varies substantially among studies with a much higher rate at autopsy versus angiography (Table).2,4–28 Variation at autopsy may in part be attributable to the care taken at preparation and the selection of hearts. Polacek, who included Myocardial loops, reports the highest rate with bridges or loops in 86% of cases.29 On average, Myocardial bridges are present in about one third of adults. View this table: Prevalence of Myocardial Bridging at Autopsy and Angiography The rate of angiographic Bridging is
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update on Myocardial Bridging
Circulation, 2002Co-Authors: Stefan Möhlenkamp, Waldemar Hort, Raimund ErbelAbstract:Muscle overlying the intraMyocardial segment of an epicardial coronary artery, first mentioned by Reyman1 in 1737, is termed a Myocardial bridge, and the artery coursing within the myocardium is called a tunneled artery (Figure 1). It is characterized by systolic compression of the tunneled segment, which remains clinically silent in the vast majority of cases. An in-depth analysis of autopsy samples was first presented by Geiringer et al2 in 1951, but clinical interest and systematic research was triggered by an observed association of Myocardial Bridging with Myocardial ischemia.2–5 Figure 1. Typical systolic compression (arrows) of the mid LAD at two sites in series. Diastolic lumen dimensions are normal. The coronary tree shows no angiographic signs of coronary atherosclerosis. New imaging techniques have led to improved identification and functional quantitation of Myocardial Bridging in vivo, which is crucial for establishing a link between systolic compression and the clinical presentation, and hence for commencing appropriate therapy. In the present article, we summarize clinically relevant aspects of Myocardial Bridging with an emphasis on morphological and hemodynamic alterations and their representation in imaging techniques. The prevalence varies substantially among studies with a much higher rate at autopsy versus angiography (Table).2,4–28 Variation at autopsy may in part be attributable to the care taken at preparation and the selection of hearts. Polacek, who included Myocardial loops, reports the highest rate with bridges or loops in 86% of cases.29 On average, Myocardial bridges are present in about one third of adults. View this table: Prevalence of Myocardial Bridging at Autopsy and Angiography The rate of angiographic Bridging is <5%, attributable to thin bridges causing little compression. In subjects with angiographically normal coronary arteries, the use of provocation tests may enhance systolic Myocardial compression and thereby reveal Myocardial bridges in ≤40% of cases.26,30 A …
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comparison of intravascular ultrasound and angiography in the assessment of Myocardial Bridging
Circulation, 1994Co-Authors: Raimund Erbel, M Haude, H J Rupprecht, L Koch, P Kearney, Gunter Gorge, J MeyerAbstract:BACKGROUNDIn autopsy, Myocardial Bridging is a common finding. With coronary angiography, a systolic compression, mainly of the left anterior descending coronary artery, is observed in 1% to 3% of the patients. Controversy exists concerning the functional importance of this finding. To obtain a functional insight into the Myocardial Bridging, intravascular ultrasound and intracoronary Doppler were performed.METHODS AND RESULTSIntracoronary ultrasound and Doppler were performed in 14 patients with angiographic evidence of systolic vessel compression ("milking effect") in the left anterior descending coronary artery. The 4.8F, 20-MHz ultrasound catheter could not be advanced through the entire Myocardial bridge segment in 6 of the 14 patients studied because the lumen was < 1.6 mm. In these patients, only the proximal parts of the bridge segment were scanned. The changes in cross-sectional shape during the cardiac cycle were determined for both the normal proximal segment and the bridge segment by use of a ...
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surgical treatment of Myocardial Bridging causing coronary artery obstruction
Scandinavian Cardiovascular Journal, 1992Co-Authors: S Iversen, Raimund Erbel, U Hake, Eckhard Mayer, C Diefenbach, Hellmut OelertAbstract:Nine patients with obstruction of coronary artery blood flow caused by Myocardial Bridging underwent surgery after failure of medical treatment. The diagnoses were made angiographically at rest or during beta-stimulation. Impaired blood flow was found only in the left anterior descending artery in seven patients and additionally in the diagonal branch in two. The operations, performed with cardiopulmonary bypass consisted of complete dissection of the overlying myocardium. All patients survived the operation. Major intraoperative complications were accidental opening of the right ventricle in two patients. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and Myocardial perfusion without residual Myocardial bridges under beta-stimulation. Surgical relief of Myocardial ischemia due to systolic compression of intraMyocardial coronary arteries can be accomplished with low operative risk and with excellent functional results.
David R Holmes - One of the best experts on this subject based on the ideXlab platform.
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clinical relevance of Myocardial Bridging severity single center experience
European Journal of Clinical Investigation, 2009Co-Authors: Farouk Mookadam, David R Holmes, J Green, Sherif Moustafa, C RihalAbstract:Background Myocardial Bridging refers to intraMyocardial systolic compression of a segment of an epicardial coronary artery. We aimed to identify the clinical significance of Myocardial Bridging by assessing the clinical presentation in non-obstructive coronary artery disease among a cohort of consecutive patients presenting for coronary angiography. Materials and methods A retrospective review of our institution's database between September 2002 and March 2005 was conducted to review coronary angiography reports of 14 416 patients. The study group included 226 patients (prevalence = 1·57%) with isolated Myocardial Bridging and < 50% stenosis in the non-bridged arteries. Cases with Myocardial Bridging were classified according to the percentage of systolic compression of the left anterior descending artery into group I (< 50% compression), group II (50–70% compression) and group III (compression ≥ 70%). Results Mean age was 57·6 ± 15·5 years; 59% were men. The mean duration of follow-up was 12 ± 2 months. The left anterior descending was the most common site of Bridging (210, 93%). There was a significant difference between groups I and III with respect to the percentage of patients who presented with non-fatal Myocardial infarction (P = 0·02). Unstable angina had the highest association with Myocardial Bridging, but there was no significance among the level of Myocardial Bridging severity and the clinical presentation of angina. Conclusions Myocardial Bridging is not a benign variation of coronary anatomy. It is associated with angina and Myocardial infarction in patients with ≥ 70% systolic compression. The bridged segment may be a cause of enhanced atherosclerotic plaque formation.
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Clinical relevance of Myocardial Bridging severity: single center experience
European journal of clinical investigation, 2009Co-Authors: Farouk Mookadam, David R Holmes, J Green, Sherif Moustafa, C RihalAbstract:Background Myocardial Bridging refers to intraMyocardial systolic compression of a segment of an epicardial coronary artery. We aimed to identify the clinical significance of Myocardial Bridging by assessing the clinical presentation in non-obstructive coronary artery disease among a cohort of consecutive patients presenting for coronary angiography. Materials and methods A retrospective review of our institution's database between September 2002 and March 2005 was conducted to review coronary angiography reports of 14 416 patients. The study group included 226 patients (prevalence = 1·57%) with isolated Myocardial Bridging and
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Myocardial Bridging.
European heart journal, 2005Co-Authors: Jorge R Alegria, Joerg Herrmann, David R Holmes, Amir Lerman, Charanjit S RihalAbstract:Myocardial Bridging, a congenital coronary anomaly, is a clinical condition with several possible manifestations, and its clinical relevance is debated. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of Myocardial Bridging. Myocardial Bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. Myocardial Bridging has been associated with angina, arrhythmia, depressed left ventricular function, Myocardial stunning, early death after cardiac transplantation, and sudden death. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to development of atherosclerotic lesions because of haemodynamic disturbances. New techniques (e.g. intravascular ultrasonography and intracoronary Doppler studies) have revealed new characteristics and pathophysiologic processes such as diastolic flow abnormalities. Medical treatment generally includes beta-blockers. Nitrates should be avoided because symptoms may worsen. Intracoronary stents and surgery have been attempted in selected patients. Additional research is needed to define patients in whom Myocardial Bridging is potentially pathologic, and randomized multicentre long-term follow-up studies are needed to assess the natural history, patient selection, and therapeutic approaches.
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Myocardial Bridging in adult patients with hypertrophic cardiomyopathy
Journal of the American College of Cardiology, 2003Co-Authors: Paul Sorajja, Steve R. Ommen, Rick A. Nishimura, Bernard J. Gersh, A. Jamil Tajik, David R HolmesAbstract:This investigation examined the risk of sudden cardiac death and other mortality in adult patients with hypertrophic cardiomyopathy (HCM) who have Myocardial Bridging diagnosed at coronary angiography. Several reports have associated Myocardial Bridging with an adverse prognosis in pediatric HCM patients, but the prognosis of Myocardial Bridging in adult patients with HCM is unknown. The coronary angiograms of 425 patients with HCM (mean age 60 +/- 15 years [range 18 to 89 years]) at the Mayo Clinic were examined for the presence of Myocardial Bridging. Clinical follow-up was conducted to assess mortality. Survival of patients with Bridging was compared with HCM patients who also underwent angiography but who did not have evidence of Bridging. A total of 64 patients (15%) had Myocardial Bridging. The mean follow-up for the entire study was 6.8 +/- 5.4 years. There was no difference in survival free of all-cause mortality (5-year estimate, Bridging vs. no Bridging, 91% vs. 85%; p = 0.42), all cardiac death (93% vs. 89%; p = 0.60), and sudden cardiac death (95% vs. 97%; p = 0.72). Univariate and multivariate proportional hazards models also did not identify the presence of Bridging or specific characteristics of the degree or extent of Bridging with a poor outcome. This study observed no increased risk of death, including sudden cardiac death, among adult patients with HCM who had Myocardial Bridging diagnosed at coronary angiography.
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Myocardial Bridging in adult patients with hypertrophic cardiomyopathy
Journal of the American College of Cardiology, 2003Co-Authors: Paul Sorajja, Steve R. Ommen, Rick A. Nishimura, Bernard J. Gersh, Jamil A Tajik, David R HolmesAbstract:Abstract Objectives This investigation examined the risk of sudden cardiac death and other mortality in adult patients with hypertrophic cardiomyopathy (HCM) who have Myocardial Bridging diagnosed at coronary angiography. Background Several reports have associated Myocardial Bridging with an adverse prognosis in pediatric HCM patients, but the prognosis of Myocardial Bridging in adult patients with HCM is unknown. Methods The coronary angiograms of 425 patients with HCM (mean age 60 ± 15 years [range 18 to 89 years]) at the Mayo Clinic were examined for the presence of Myocardial Bridging. Clinical follow-up was conducted to assess mortality. Survival of patients with Bridging was compared with HCM patients who also underwent angiography but who did not have evidence of Bridging. Results A total of 64 patients (15%) had Myocardial Bridging. The mean follow-up for the entire study was 6.8 ± 5.4 years. There was no difference in survival free of all-cause mortality (5-year estimate, Bridging vs. no Bridging, 91% vs. 85%; p = 0.42), all cardiac death (93% vs. 89%; p = 0.60), and sudden cardiac death (95% vs. 97%; p = 0.72). Univariate and multivariate proportional hazards models also did not identify the presence of Bridging or specific characteristics of the degree or extent of Bridging with a poor outcome. Conclusions This study observed no increased risk of death, including sudden cardiac death, among adult patients with HCM who had Myocardial Bridging diagnosed at coronary angiography.
Hartzell V Schaff - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of surgical unroofing of Myocardial Bridging in symptomatic patients
The Annals of Thoracic Surgery, 2020Co-Authors: Pouya Hemmati, Hartzell V Schaff, Joseph A Dearani, Richard C Daly, Brian D Lahr, Amir LermanAbstract:Background There is a paucity of data regarding results of surgical management of Myocardial Bridging. Our objective was to evaluate the clinical outcomes of unroofing procedures in patients with Myocardial Bridging of the left anterior descending (LAD) coronary artery who had chest pain refractory to medical therapy. Methods Among 274 adult patients diagnosed with Myocardial Bridging at our institution (1996-2017), 71 underwent surgical intervention. To understand the potential benefit of unroofing, we excluded patients with concomitant operations for other diagnoses or known obstructive coronary disease. The study included 35 patients with preoperative chest pain and isolated LAD coronary artery Bridging who underwent surgical unroofing. We analyzed recurrent symptoms, postoperative medication use, and mortality. Results Mean age was 48.2 ± 11.2 years (18 men [51%]). All patients underwent preoperative coronary angiography. Endothelial dysfunction in the LAD coronary artery bridged segment was confirmed in 20 of 24 patients (83%). Mean cardiopulmonary bypass and cross-clamp times were 47.6 ± 29.8 minutes and 33.7 ± 22.2 minutes, respectively. Median lengths of hospital and intensive care unit stay were 5 days and 1 day, respectively. During follow-up (median, 31 months; 95% confidence interval, 18-49) there were no cardiac-related deaths, and 22 patients (63%) reported no chest pain. Among 13 symptomatic patients, 10 underwent postoperative noninvasive testing, which was negative for ischemia in all cases. Conclusions Myocardial unroofing can be performed safely in patients with chest pain and isolated LAD coronary artery Myocardial Bridging. However, patients should be aware of the potential for recurrent nonischemic chest pain and continued medical therapy despite relief of coronary compression.
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outcome of repair of Myocardial Bridging at the time of septal myectomy
The Annals of Thoracic Surgery, 2014Co-Authors: Meghana R Kunkala, Paul Sorajja, Steve R. Ommen, Hartzell V Schaff, Gurpreet S Sandhu, Harold M Burkhart, Daniel B Spoon, Joseph A DearaniAbstract:Background Myocardial Bridging describes systolic compression of the muscular investment of a portion of an epicardial coronary artery. We evaluated the outcome of muscular bridge unroofing of the left anterior descending artery at the time of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We conducted a case-controlled study of 36 patients (23 men; median age, 42 years) with hypertrophic cardiomyopathy and Myocardial Bridging. Group 1 patients had septal myectomy and concomitant unroofing (n = 13), group 2 patients underwent myectomy alone (n = 10), and group 3 patients were treated medically (n = 13). Results Angina was more prevalent preoperatively in group 1, 46% compared with 20% in group 2. Preoperative left ventricular outflow tract gradients of 67.8 ± 58.2 mm Hg and 74.1 ± 19.7 mm Hg were reduced to 1.9 ± 2.9 mm Hg in group 1 ( p p p = 0.297), 100.0% in group 2, and 67.9% in group 3; there were no late sudden deaths. At follow-up, 77% in group 1 were asymptomatic compared with 70% of patients in group 2 ( p = 0.19). There was no recurrent angina in group 1. Conclusions Myocardial unroofing can be performed safely at the time of septal myectomy for left ventricular outflow tract obstruction. Angina was improved, but we found no difference in late survival compared with patients who had Myocardial Bridging and myectomy alone. Unroofing should be considered in patients with angina who have significant left anterior descending artery Bridging and require myectomy.
