Intramural left anterior descending coronary artery: Significance of the depth of the muscular tunnel

Morales, Azorides R.; Romanelli, R; Tate, Larry G.; Boucek, Robert J.; Marchena, Eduardo de

doi:10.1016/0046-8177(93)90004-z

Cited by 86 publications

(51 citation statements)

References 45 publications

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“…The authors conclude that it cannot be excluded that myocardial bridging had been responsible for sudden death in some cases. At autopsy, Morales et al found myocardial lesions that were indicative of ischaemia in 22 of 39 hearts with myocardial bridging; all of these had a deep intramural LAD and 13 of these persons had died suddenly [40]. Eckart et al reviewed 126 cases of non-traumatic sudden deaths in military recruits and found in 2 cases myocardial bridging but no other cardiac abnormalities [41].…”

Section: Prognosismentioning

confidence: 99%

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made. Keywords Myocardial bridging . Computed tomography angiography . Coronary arteriographyAccording to the original definitions the term 'myocardial bridging' is used for an anatomic variation in which a band of cardiac muscle overlies a segment of an epicardial coronary artery while the artery involved is referred to as being 'tunnelled'. Initially the diagnosis could only be made at autopsy but soon after coronary arteriography (CAG) had become an established clinical diagnostic tool systolic compression of a coronary artery, usually the left anterior descending artery (LAD), was occasionally observed and correctly interpreted as evidence of myocardial bridging [1,2]. Since then the clinical significance of myocardial bridging has been a subject of discussion and controversy. In the last decade it was shown that myocardial bridging can be very well depicted by computed tomography coronary angiography (CTCA) [3,4] which has rekindled the interest in this anomaly. We expect that in the near future increasing numbers of patients with myocardial bridging will be detected by CTCA which may significantly enhance our understanding of the pathology and clinical consequences. At the same time, to ensure that these patients receive optimal treatment it is imperative that we stay aware of what previous studies have taught us. It is the purpose of this paper to critically review the outcomes of previous studies and to define remaining questions of clinical relevance that hopefully can be resolved with newer diagnostic modalities. DiagnosisAlthough myocardial bridging has been held responsible for a variety of symptoms in individual cases, ranging from atypical chest pain to sudden death, thus far clinical studies have been unable to identify specific diagnostic features that allow a diagnosis of myocardial bridging without visualisation of the coronary arteries [5][6][7][8][9][10][11]. The diagnosis is usually established by chance in patients who are examined by CAG or CTCA for various reasons but not because they are suspected of having myocardial bridging. It should be noted that there are essential differences between the diagnostic information provided by each of the two visualisati...

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Section: Prognosismentioning

confidence: 99%

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

et al. 2012

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“…[17][18][19] Until the pathophysiological mechanisms of ischemia and sudden death are clarified, in patients who die inexplicably, the presence of an anatomically variant coronary pattern should be considered a possible but unproved cause of death. Examples of uncertain assignment of cause-effect relationships in these instances include most reported cases of muscular bridges, 20 single coronary artery (not coursing between the aorta and pulmonary artery), 21,22 and hypoplastic coronary artery. 23,24 Indeed, sudden unexpected death is frequently unexplained even at necropsy.…”

Section: Definitions and Incidencementioning

confidence: 99%

Coronary Anomalies

2002

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“…29, 57 In hypertrophic hearts, a long MB also leads to significant LAD compression, 14 and a deeply situated intramyocardial LAD with a thick MB is associated with sudden cardiac death. 44 Furthermore, the location of the MB in patients with MI 37,59,60 and symptomatic coronary insufficiency 58 tends to be proximal toward the coronary ostium. These reports indicate the close relationship between the anatomical properties of the MB and the occurrence of CHD.…”

Section: Direct Compression Of the Lad By The Mbmentioning

confidence: 99%

Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease

Ishikawa

Kawawa

Kohda

et al. 2011

Circ J

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he myocardial bridge (MB) is an anatomical variant that often covers part of the left anterior descending coronary artery (LAD). 1 It occurs almost exclusively in the mid-portion of the LAD (Figure 1). 2,3 Muscular contraction of the MB itself alters blood flow within the LAD, as demonstrated by coronary angiography, and influences the distribution of hemodynamic stress. [3][4][5] It is widely accepted that an MB sometimes causes coronary heart disease (CHD), 2,5,6 either from direct compression of the MB at cardiac systole or by enhancement of the natural progression of coronary atherosclerosis in the LAD segment proximal to the MB. 2,5,7 Both mechanisms are closely associated with changes in hemodynamic stress driven by the force of the MB contraction through a combination of anatomical properties, such as the location, length, and thickness of the MB. 3,7,8 This review focuses on the relationship between the presence of an MB in the LAD and the occurrence of CHD, specifically addressing the importance of the anatomical properties of the MB as the common root for the 2 distinct mechanisms. In addition, therapeutic approaches to CHD caused by an MB are summarized, along with their outcomes. A myocardial bridge (MB), partially covering the coronary artery, is a congenital anatomical variant usually present in the left anterior descending coronary artery (LAD). MB causes coronary heart disease (CHD) by 2 distinct mechanisms influenced by the anatomical properties of the MB, such as its length, thickness, and location. One is direct MB compression of the LAD at cardiac systole, resulting in delayed arterial relaxation at diastole, reduced blood flow reserve, and decreased blood perfusion. The other is enhancement of coronary atherosclerosis causing stenosis of the LAD proximal to the MB, occurring because of endothelial injury arising from the abnormal hemodynamics provoked by retrograde blood flow up toward the left coronary ostium at cardiac systole. The magnitude of the effect of the 2 distinct mechanisms of the MB on LAD blood flow is prescribed by a common root of the MB-muscle mass volume generated by those properties. Furthermore, the anatomical properties of the MB are closely associated with the choice of treatment and therapeutic outcome in CHD patients having an MB. Thus, the anatomical properties of an MB should be considered in the diagnosis and management of CHD patients with this anomaly. (Circ J 2011; 75: 1559 - 1566

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Intramural left anterior descending coronary artery: Significance of the depth of the muscular tunnel

Cited by 86 publications

References 45 publications

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights?

Coronary Anomalies

Significance of the Anatomical Properties of a Myocardial Bridge in Coronary Heart Disease

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