Coronary artery bypass grafting for myocardial bridges of the left anterior descending artery.
ABSTRACT There is still controversy with regard to adequate therapy for symptomatic patients who are refractory to medical management with myocardial bridges of the left anterior descending artery. This study sought to evaluate the treatment of symptomatic coronary myocardial bridges with coronary artery bypass graft surgery.
Thirteen patients who underwent surgery between October 2005 and May 2008 were included in this study. The mean patient age was 51.3 ± 10.2 years (range, 39-75 years). There were ten men and three women. All 13 patients had angina pectoris preoperatively, and they had myocardial bridges only. Coronary angiography prior to surgery demonstrated myocardial bridging of the left anterior descending artery with systolic compression ≥75% in all patients. They underwent off-pump coronary artery bypass grafting using the internal mammary artery.
The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death, or other major in-hospital complications. Postoperative coronary CT angiography studies in seven patients after one year demonstrated no graft stenosis. During follow-up, no patient had symptoms of angina.
Coronary artery bypass graft surgery using a LIMA graft is a safe and effective treatment for symptomatic coronary myocardial bridges.
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ABSTRACT: A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Is CABG an effective alternative for the treatment of myocardial bridging?' Altogether, only six papers were identified using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated; these studies reported the outcome of myotomy and coronary artery bypass grafting (CABG) for myocardial bridging. All of these studies were retrospective reports of the results of surgical intervention in patients with myocardial bridging. They showed that the incidence of myocardial bridging was less than 1-1.5% in patients with angina requiring angiography, and 7-9% of these patients had refractory angina despite medical treatment and required surgery. The evidence on the treatment of this congenital condition that mainly affects the middle segment of left anterior descending artery is limited, and there are no treatment guidelines currently available. Stenting of the tunnelled segment has shown high failure rates in approximately half of the cases. Current evidence in the literature suggests that surgery is the mainstay treatment for myocardial bridging. Surgery is performed either as supra-arterial myotomy and de-roofing of the muscle bands on- or off-pump, or as coronary artery bypass grafting of the affected coronary artery beyond the tunnelled segment. Although no mortality was reported with either of these operations, surgical myotomy on deep and extensive myocardial bridges carries the risk of entering the right ventricle, bleeding and aneurysm formation. In addition, in a small percentage of the patients undergoing myotomy, angina recurred. Despite the possibility of competitive flow in the native coronary artery after CABG for myocardial bridging, we did not identify any evidence demonstrating graft occlusion after CABG for myocardial bridging. In conclusion, in extensive and deep myocardial bridgings, CABG may be the treatment of choice that carries low risk, limited complications and excellent symptomatic relief.Interactive Cardiovascular and Thoracic Surgery 11/2012; · 1.11 Impact Factor
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ABSTRACT: 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.Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 11/2012; · 2.26 Impact Factor