Myocardial Bridging: An Up-to-Date Review

摘要: Myocardial bridging is a congenital anomaly in which segment of coronary artery takes "tunneled" intramuscular course under "bridge" overlying myocardium. This causes vessel compression systole, resulting hemodynamic changes that may be associated with angina, myocardial ischemia, acute syndrome, left ventricular dysfunction, arrhythmias, and even sudden cardiac death. While described on autopsy for centuries, technological advances such as computed tomography angiography intravascular ultrasound have contributed greatly to our understanding the anatomic, hemodynamic, pathophysiological consequences systolic compression. Atherosclerosis preferentially develops immediately proximal bridged segment, likely due alterations shear stress, while compressed itself often spared. First-line therapy symptomatic remains medical treatment beta-blockers non-dihydropyridine calcium-channel blockers, nitrates are contraindicated. Surgical myotomy, intracoronary stenting, bypass graft surgery been used refractory symptoms, but long-term outcomes remain uncertain. Further research required better define patient population would derive greatest benefit from surgical percutaneous intervention.