Die intramurale Koronarie im Angiogramm

Porstmann, W; Iwig, Jeffrey S.

doi:10.1055/s-0029-1226492

Cited by 155 publications

(67 citation statements)

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“…4 Portsmann and Iwig were the first to report a radiological description of transient occlusion in a segment of LAD during systole. 8 The importance of differentiating myocardial bridging, with its transient nature of coronary arterial narrowing, from fixed atherosclerotic stenosis was emphasized by Amplatz and Anderson in 1968. 9 The origin of this arterial anomaly is probably congenital in light of the intramural location of the left anterior descending coronary artery during embryonic life.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Bridges: Their Clinical Implications and Prognostic Signs

et al. 1996

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Among 980 consecutive selective coronary angiograms performed, nine patients had myocardial bridges of the left anterior descending (LAD) coronary artery. The overall prevalence of myocardial bridges was 0.92%. Among these patients, three patients had coronary artery disease, while six cases were isolated myocardial muscle bridges. With respect to functional abnormality, three had grade III milking effect, three had grade II and three had grade I milking effect. The indications for coronary angiograms were typical chest pain in seven cases and atypical pain in two cases. Myocardial bridges are sections of a coronary artery, almost all the left anterior descending and/or one of its diagonal branches, which run under a strip of left ventricular muscle and dip below the epicardial surface under small areas of the myocardium: During systole, the segment of the artery surrounded by myocardium is narrowed and appears as localized stenosis. This systolic compression is defined as the "milking" effect. The key to recognizing these myocardial bridges is that the apparent localized stenosis returns to normal during diastole.1 In 1976, Noble et al. stated that myocardial bridges with a milking effect on the proximal third of the left anterior descending artery could represent a new type of ischemic heart disease.2 In 1977, Grondin et al. classified the milking effect as grade I when less than 50% of arterial narrowing occurs, grade II when it is between 50% and 75%, and grade III when it is greater than 75%.3 As early as 1951, Geiringer reported the etiology of this anatomical variant to be congenital, explaining that most of the coronary arteries have an intramyocardial course during fetal life. 4As suggested by Binet et al. in 1975, muscle bridges might explain some cases of sudden death occurring during strenuous exercises among athletes in whom no coronary arterial lesions are demonstrated at postmortem examination. 5 In 1993, on an experimental basis, Campbell et al. studied similarities between dynamic elastance responsible for the left ventricular chamber and the papillary muscle of a rabbit heart. They concluded that the dynamic elements responsible for myofiber stiffness were also responsible for left ventricle chamber elastance. Furthermore, it was possible to describe and interpret dynamic chamber elastance and muscle stiffness with a common model based on the muscle-bridge theory. This model did a reasonable job of reproducing all the important features of experimentally observed left ventricular chamber elastance and muscle stiffness. Thus, dynamic homologies between chamber and muscle were established in experimental data and, in fact, this single interpretive model served equally well for both chamber elastance and muscle stiffness. 5,6 The aim of this study is to assess the prevalence of myocardial bridging of the left anterior descending coronary artery in a population of patients referred for diagnostic coronary angiography and to throw some light on the pathophysiology, clinical implications and prognosi...

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Section: Discussionmentioning

confidence: 99%

Myocardial Bridges: Their Clinical Implications and Prognostic Signs

et al. 1996

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“…It was first described in an autopsy conducted by Reyman in 1737, [1] and was identified on selective coronary angiography in 1960. [2] Systolic compression of the epicardial artery is visible on angiographic imaging. There is no specific classification for myocardial bridging.…”

Section: Bulgularmentioning

confidence: 99%

Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study

Aksakal

Urumdaş

Yaman

et al. 2016

Arch Turk Soc Cardiol

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Objective: Myocardial bridge (MB), also known as muscular bridge, is a rare congenital disease with relatively good prognosis. However, it has been associated with unstable angina, myocardial infarction, and sudden cardiac death. Incidence and prognosis of patients diagnosed with isolated MB after having undergone coronary angiography are evaluated in the present retrospective study. Methods: Coronary angiograms of 18,250 patients, obtained between 2008 and 2011, were reexamined for presence of MB at the cardiology clinic. Of these patients, 241 (0.95%) had MB, and 181 (0.99%) had it as an isolated finding. Patients with isolated MB were divided into 2 groups according to severity of the lesion in the cardiac systole. Group 1 was comprised of patients with non-critical (<70%) stenosis; group 2 was comprised of patients with critical (≥70%) stenosis. Demographic characteristics, symptoms at initial diagnosis, and coronary angiographic findings regarding localization and severity of stenosis were noted. Follow-up was performed by phone, with outpatient clinic visits, and by reviewing hospital records.Results: Twenty-five patients (13%) had critical stenosis (group 2), and 146 (87%) had non-critical stenosis (group 1). Mean follow-up duration was 38±7 months. Recurrent angina and repeated coronary angiography were reported in 15 group 1 patients (10.2%) and in 2 group 2 patients (8.0%) (p=non-significant). No instance of myocardial infarction was reported. Conclusion:Isolated MB seems to be a relatively benign disease, a conclusion made in accordance with those of previous studies. Symptoms and prognosis are not determined by degree of stenosis generated by the muscular bridge.

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“…1,8) The reported frequency of MB in the LAD determined by coronary angiography is 0.4%-5.4%. [9][10][11][12] However, that the frequency of MB detection by angiography increases from 1.7% to 9.7% when the same images are reviewed specifi cally to detect MBs is noteworthy.…”

Section: Coronary Artery Imaging In Clinical Practicementioning

confidence: 99%

“…1) At cardiac systole, myocardial tissue comprising MB contracts and directly presses the coronary artery beneath it. Hemodynamic force driven by MB contraction infl uences blood fl ow within the coronary artery, in which blood can be retrograde towards the coronary ostium and accelerated towards the cardiac apex.…”

Section: Introductionmentioning

confidence: 99%

Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

Ishii

Ishikawa

Akasaka

2014

Annals of Vascular Diseases

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Myocardial bridge (MB) is a chance anatomical structure, comprised of the myocardial tissue, with which the coronary artery running in epicardial adipose tissue is partly covered. It is predominantly present in the left anterior descending artery (LAD) and recognizable through imaging techniques as changes in blood fl ow within the LAD that arises from MB contraction at cardiac systole. Such changes in blood fl ow infl uence the pathophysiology of coronary circulation and atherosclerosis development, thus generating controversy as to whether MB predisposes individual to myocardial infarction (MI). However, recent histomorphometric studies have shown that the individual anatomic properties of MB, such as location, length and thickness, consistently play a critical role in the occurrence of MI. This review article comprehensively addresses the pathophysiological mechanisms of MI occurrence together with the benign suppressive effect of coronary atherosclerosis by MB.

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Die intramurale Koronarie im Angiogramm

Cited by 155 publications

References 0 publications

Myocardial Bridges: Their Clinical Implications and Prognostic Signs

Myocardial Bridges: Their Clinical Implications and Prognostic Signs

Prevalence and three-year follow-up of patients with isolated myocardial bridge in the mid-Black Sea region: a retrospective single-center study

Myocardial Bridge as a Structure of “Double-Edged Sword” for the Coronary Artery

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