Myocardial Bridge: Diagnosis, Treatment, and Challenges

A MYOCARDIAL bridge (MB) occurs when a segment of a coronary artery tunnels through the myocardium instead of its correct epicardial anatomic position. This results in the compression of the artery during systole that extends into diastole, limiting coronary blood flow and filling. 1 Giuseppe T Federico M Filippo C et al. Left anterior descending artery myocardial bridging. J Am Coll Cardiol. 2016; 68: 2887-2899 Crossref PubMed Scopus (89) Google Scholar Coronary compression can cause symptoms that are indistinguishable from that of acute coronary syndromes or refractory/chronic angina. The treatment of chest pain caused by an MB that is refractory to medical therapy typically is surgically treated. Numerous studies of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and myotomy have demonstrated excellent results after correction of an MB. 2 Iversen S Hake U Mayer E et al. Surgical treatment of myocardial bridging causing coronary artery obstruction. Scand J Thorac Cardiovasc Surg. 1992; 26: 107-111 Crossref PubMed Scopus (77) Google Scholar , 3 Rezayat P Hassan D Amirreza S et al. Myocardial bridge. Surgical outcome and midterm follow up. Saudi Med J. 2006; 27: 1530-1533 PubMed Google Scholar , 4 Wan L Wu Q. Myocardial bridge, surgery or stenting?. Interact Cardiovasc Thorac Surg. 2005; 4: 517-520 Crossref PubMed Scopus (22) Google Scholar , 5 Wu QY Xu ZH. Surgical treatment of myocardial bridging: Report of 31 cases. Chin Med J. 2007; 120: 1689-1693 Crossref PubMed Scopus (27) Google Scholar , 6 Huang X Wang S Xu J-P et al. Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging. Chin Med J. 2007; 120: 1563-1566 Crossref PubMed Scopus (31) Google Scholar , 7 Sun X Chen H Xia L et al. Coronary artery bypass grafting for myocardial bridges of the left anterior descending artery. J Card Surg. 2012; 27: 405-407 Crossref PubMed Scopus (15) Google Scholar , 8 Bockeria LA Sukhanov SG Orekhova EN et al. Results of coronary artery bypass grafting in myocardial bridging of left anterior descending artery. J Card Surg. 2013; 28: 218-221 Crossref PubMed Scopus (26) Google Scholar , 9 Boyd JH Pargaonkar VS Scoville DH et al. Surgical unroofing of hemodynamically significant left anterior descending myocardial bridges. Ann Thorac Surg. 2017; 103: 1443-1450 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar In contrast, the authors present a case of a patient with severe persistent postoperative chest pain despite multimodal analgesia, including intrathecal morphine, after a robotic totally endoscopic off-pump MB myotomy.