Myocardial Bridge: Evaluation on MDCT

Zeina, Abdel-Rauf; Odeh, Majed; Blinder, Jorge; Rosenschein, Uri; Barmeir, Elisha

doi:10.2214/ajr.06.0714

Cited by 98 publications

(92 citation statements)

References 31 publications

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“…The reason for generally higher prevalence of bridging detected by CT angiography compared with conventional catheter angiography lies in the nature and capabilities of the CT technique, as CT angiography examination can easily identify bridging, regardless of the shortness of the segment it involves, its superficiality, and presence of luminal narrowing. However, data from this series still shows higher prevalence of bridging among double LAD cases than the prevalence for general population obtained from previous CT angiography series (11,12).…”

Section: Discussioncontrasting

confidence: 68%

“…Data emerging from our series show definitely higher prevalence of these two anatomic variations among dual LAD cases compared with the previously described frequency for normal population (15%-30% for ramus intermedius and 3.5%-26% for bridging) (9)(10)(11)(12). The reason for generally higher prevalence of bridging detected by CT angiography compared with conventional catheter angiography lies in the nature and capabilities of the CT technique, as CT angiography examination can easily identify bridging, regardless of the shortness of the segment it involves, its superficiality, and presence of luminal narrowing.…”

Section: Discussionsupporting

confidence: 46%

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Prevalence of dual left anterior descending artery variations in CT angiography

Bozlar

Mş²,

Sarı³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEWe aimed to evaluate the frequency and features of dual left anterior descending artery (LAD) variants using computed tomography (CT) angiography. METHODSA total of 1337 consecutive coronary CT angiography examinations performed between April 2010 and December 2013 were retrospectively evaluated for the presence of dual LAD. CT examinations were performed with either 64-or 320-row multidetector CT scanners. All CT angiography images were evaluated for the presence and morphologic features of dual LAD subtypes. RESULTSFifty-six dual LAD variations (4%) were identified in this study population. Type 1 was the most common type of dual LAD (n=48), while Type 3 (n=3) and Type 4 (n=2) were infrequent and Type 2 was not detected. Additionally, we detected previously unclassified dual LAD variations in three cases. CONCLUSIONDual LAD may be a relatively more common variant than described in the medical literature, which is mostly based on catheter angiography studies. Coronary CT angiography seems markedly efficacious for detecting and documenting the anatomical details of dual LAD subtypes, as well as showing other associated cardiocoronary anomalies. Dual left anterior descending (LAD) coronary artery is a rare congenital anomaly (1), basically defined as the existence of two distinct segments of the vessel occupying the anterior interventricular sulcus (AIS) of the heart.First study classifying dual LAD anomalies based on coronary catheter angiography was published in 1983 by Spindola-Franco et al. (2), which has served as a primary classification system. However, individual reports further described previously unclassified LAD variants (3, 4). Most of the recent publications about dual LAD anomalies involve case reports and there is a paucity of large series using coronary computed tomography (CT) angiography (3-8).At present, quite a large number of coronary CT angiography examinations are being performed and recognition of dual LAD variations by CT angiography requires familiarity. Being aware of dual LAD anomalies could be critical for coronary bypass surgery and interventions. Surely, sound knowledge on dual LAD anomalies is a prerequisite for proper management of patients with coronary artery disease.In this study, we aimed to identify the frequency of dual LAD variations, and define the morphoanatomical features based on Spindola-Franco classification, using CT angiography. Appendageal subtypes of this variation were also documented and discussed. Methods PatientsThe study was approved by our institutional review board. A total of 1337 consecutive coronary CT angiography examinations performed in our department from April 2010 to December 2013 were retrospectively evaluated for dual LAD anomalies. These examinations had been performed for various reasons including, but not limited to, the assessment of coronary and cardiac morphology, electrocardiography (ECG) abnormalities, coronary bypass graft evaluation, coronary stent evaluation, coronary atherosclerosis evaluation and screening fo...

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionsupporting

confidence: 46%

Prevalence of dual left anterior descending artery variations in CT angiography

Bozlar

Mş²,

Sarı³

et al. 2015

Diagn Interv Radiol

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“…However, it is neither reasonable nor practical to use such an invasive imaging modality merely to quantify MB compression in patients without coronary artery disease. Coronary CTA has been proven to be more sensitive than ICA for detection of MB due to its ability to visualize the intra-mural course of coronary arteries [12][13][14][15][16]. However, determination of compression extent requires artifact-free images of end-systolic phases, which are sometimes not available with low-dose prospective acquisition [12].…”

Section: Discussionmentioning

confidence: 99%

“…MB lesions were divided into three subgroups according to the extent of systolic compression as determined by end-systolic phases of CTA imThe MB detection rate varies significantly between the different imaging modalities of coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA). Coronary CTA usually reveals a much higher incidence of MB than ICA [12][13][14][15][16] due to the capability of coronary CTA to detect MB without the presence of systolic compression. The clinical significance of myocardial bridging lies in related regional hemodynamic changes caused by dynamic compression.…”

Section: Cta Image Reconstruction and Analysismentioning

confidence: 99%

Attenuation Drop of Intra-Mural Coronary Segment Observed at Diastolic Phase of Coronary CT Angiography Predicts Significant Systolic Compression of Myocardial Bridge

et al. 2018

Cardiovasc Imaging Asia

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“…5) Atherosclerosis suppression in the LAD beneath MB Clinical coronary angiography, IVUS and MDCT have shown the absence of atherosclerotic changes in the LAD intima beneath MB, whereas atherosclerotic changes are always found in the LAD segment proximal to an MB entrance in the various extent. 14,15,17,18,31) them, 172 (79.6%) had coronary heart diseases including angina, myocardial ischemia, myocardial infarction (MI), and sudden cardiac death ( Table 1). We assigned all of these patients to one group without considerable coronary atherosclerosis that develops around middle age and another with coronary atherosclerosis that is probably exacerbated by MB mainly in older persons.…”

Section: Effects Of Mbs On the Coronary Arterymentioning

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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Myocardial Bridge: Evaluation on MDCT

Abstract: Myocardial bridge predisposes to the development of atherosclerosis in the coronary artery segment proximal to the bridge. This may indicate that myocardial bridge should be considered an anatomic risk factor in the evaluation of CAD.

Cited by 98 publications

References 31 publications

Prevalence of dual left anterior descending artery variations in CT angiography

Prevalence of dual left anterior descending artery variations in CT angiography

Attenuation Drop of Intra-Mural Coronary Segment Observed at Diastolic Phase of Coronary CT Angiography Predicts Significant Systolic Compression of Myocardial Bridge

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

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