Symptomatic Myocardial Bridging Treated by Coronary Stenting
Abstract
Background : Myocardial bridging is a congenital coronary anomaly withmostly benign course throughout life. However, several pathological clinical
manifestations may accompany myocardial bridging, such as arrhythmia,
angina, depressed left ventricular function, myocardial stunning, myocardial
infarction, and sudden death. Symptomatic management with anti anginal
agents should be adequate in most cases. Stenting, surgical resection of
the bridge (myotomy), and coronary bypass surgery are only reserved for
the rare patient with severe symptoms.
Case Report : A 44 year old man was admitted to the hospital because of
the recurrent episodes of palpitations, syncope and chest pain. ECG showed
sinus rhythm with bigeminy ventricular extra systoles. Echocardiography
showed no regional wall motion abnormalities with normal ejection fraction.
Coronary angiography showed myocardial bridging in mid LAD with
no associated atherosclerotic coronary disease.
Recurrent episodes of angina and non-sustained VT were detected during
observation in ICCU, despite anti-arrhytmic drug treatment and Kalium
correction. Decision was made to perform PCI to cover bridging segment
using drug eluting stent (DES). Post stent angiography showed no subsequent
milking effect of systole with improvement in the occurrence of
arrhythmia. Holter monitoring which was done 1 week after PCI showed
no ventricular extrasystole found. Clinical evaluation and treadmill test at
3 months after the procedure demonstrated good clinical condition and
the patient remained free of symptoms.
Conclusion : A successful coronary stenting to mid LAD due to myocardial
bridging with persistent symptoms despite medial therapy. A thorough follow
up should be done to identify the possibility of luminal narrowing caused
by intimal proliferation or stent fracture due to external compression.
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References
Chen JS and Lin CL. Myocardial bridging. Tzu Chi Med J 2003;
15(6): 357-361.
Dermengiu D, Vovolis I, Sorin H, Curca GC, Rusu MC, and
Luca L. Morphological features in myocardial bridging. Rom J
Leg Med 2010; 18: 163-170.
Alegria JR, Herrmann J, Holmes DR, Lerman A, Rihal CS.
Myocardial bridging. European Heart Journal 2005; 26: 1159-
68.
Karfis I, Dresios C, Kotsalou I, Voyatzis M, Antoniadis D,
Dimakopoulos N. Myocardial bridge: An unusual cause of
asymptomatic ST-elevation during treadmill stress test causing
functional ischaemia. Hell J Nucl Med 2012; 15(2): 147-9.
Wan L and Wu Q. Myocardial bridge, surgery or stenting? Interactive
CardioVascular and Thoracic Surgery 2004; 4: 517-20.
Kelle S, Thouet T, Tangcharoen T, Fleck E, and Nagel E. Anatomical
and functional evaluation of myocardial bridging on
the left anterior descending artery by cardiovascular magnetic
resonance imaging. Journal of Cardiovascular Magnetic Resonance
2006; 8: 755-7.
Hayashi T and Ishikawa K. Myocardial bridge: Harmless or
harmful. Internal Medicine 2004; 43: 1097-8.
Rahman A, Burma O, Uyar IS, Karaca I, Ilkay E, and Cekirdekci
A. Surgical approach in symptomatic myocardial bridge. Asian
Cardiovasc Thorac Ann 2000; 8: 158-60.
Kurt IH. A case of muscular bridge resulting in myocardial
infarction following heavy effort: a case report. Cases Journal
2009; 2: 135.
Abhilash SP, Krishnakumar B, Velappan P, PrabhaninGupta,
Viswanathan S, Koshy AG. Myocardial bridging: Clinical and
angiographic profile in last 5 years; a study of 129 cases. Kerala
Heart Journal Nov. 2010-Jan. 2011 : 9-13.
Cotlar MJ. Myocardial bridging. Journal of Insurance Medicine
2004; 36: 335-8.
Vuyst DD. Vanhoenacker FM, Catry F, Mespreuve M, Praeter
GD. Myocardial bridging of the left anterior descending coronary artery. JBR-BTR 2009; 92: 148-9.
Singh H, Singh C, Kumar A, Aggarwai N, and Banerji A. Acute
myocardial infarction secondary to myocardial bridge treated
with drug-eluting stent. Indian Heart J 2005; 57: 734-7.
Zwaan D and Wellens HS. Left ventricular aneurysm subsequent
to cleavage of myocardial bridging of coronary artery. J Am Coll
Cardiol 1984; 3: 1345-8.
Kursaklioglu H, Barcin C, Iyisoy A, Kose S, Amasyali B, and Isik
E. Angiographic restenosis after myocardial bridge stenting: A
comparative study with direct stenting of de-novo atherosclerotic
lesions. Jpn Heart J 2004; 45: 581-9.
Haager PK, Schwarz ER, Vom Dahl S, Klues HG, Reffelmann
T, and Hanrath P. Longterm angiographic and clinical follow up
in patients with stent implantation for symptomatic myocardial
bridging. Heart 2008; 84: 403-8.
Kurtoglu N, Mutlu B, Soydinc S, Tanalp C, Izqi A, Dagdelen S,
Bakkai RB, and Dindar I. Normalization of coronary fractional
flow reserve with successful intracoronary stent placement to a
myocardial bridge. J Interven Cardiol 2004; 17: 33-6.
Klues HG, Schwarz ER, Vom Dahl J, Reffelmann T, Reul H,
Potthast K, Schmitz C, Minartz J, Krebs W, and Hanrath P.
Disturbed intracoronary hemodynamics in myocardial bridging.
Circulation 1997; 96: 2905-13.
Stables RH, Knight CJ, McNeill JG, and Sigwart V. Coronary
Stenting in the management of myocardial ischemia caused by
muscle bridging. Br Heart J 1995; 74(1): s90-2.
Li W, Li Y, Sheng L, Gong Y. Myocardial bridge: Is the risk of
perforation increased? Can J Cardiol 2008; 24: e80-1.
15(6): 357-361.
Dermengiu D, Vovolis I, Sorin H, Curca GC, Rusu MC, and
Luca L. Morphological features in myocardial bridging. Rom J
Leg Med 2010; 18: 163-170.
Alegria JR, Herrmann J, Holmes DR, Lerman A, Rihal CS.
Myocardial bridging. European Heart Journal 2005; 26: 1159-
68.
Karfis I, Dresios C, Kotsalou I, Voyatzis M, Antoniadis D,
Dimakopoulos N. Myocardial bridge: An unusual cause of
asymptomatic ST-elevation during treadmill stress test causing
functional ischaemia. Hell J Nucl Med 2012; 15(2): 147-9.
Wan L and Wu Q. Myocardial bridge, surgery or stenting? Interactive
CardioVascular and Thoracic Surgery 2004; 4: 517-20.
Kelle S, Thouet T, Tangcharoen T, Fleck E, and Nagel E. Anatomical
and functional evaluation of myocardial bridging on
the left anterior descending artery by cardiovascular magnetic
resonance imaging. Journal of Cardiovascular Magnetic Resonance
2006; 8: 755-7.
Hayashi T and Ishikawa K. Myocardial bridge: Harmless or
harmful. Internal Medicine 2004; 43: 1097-8.
Rahman A, Burma O, Uyar IS, Karaca I, Ilkay E, and Cekirdekci
A. Surgical approach in symptomatic myocardial bridge. Asian
Cardiovasc Thorac Ann 2000; 8: 158-60.
Kurt IH. A case of muscular bridge resulting in myocardial
infarction following heavy effort: a case report. Cases Journal
2009; 2: 135.
Abhilash SP, Krishnakumar B, Velappan P, PrabhaninGupta,
Viswanathan S, Koshy AG. Myocardial bridging: Clinical and
angiographic profile in last 5 years; a study of 129 cases. Kerala
Heart Journal Nov. 2010-Jan. 2011 : 9-13.
Cotlar MJ. Myocardial bridging. Journal of Insurance Medicine
2004; 36: 335-8.
Vuyst DD. Vanhoenacker FM, Catry F, Mespreuve M, Praeter
GD. Myocardial bridging of the left anterior descending coronary artery. JBR-BTR 2009; 92: 148-9.
Singh H, Singh C, Kumar A, Aggarwai N, and Banerji A. Acute
myocardial infarction secondary to myocardial bridge treated
with drug-eluting stent. Indian Heart J 2005; 57: 734-7.
Zwaan D and Wellens HS. Left ventricular aneurysm subsequent
to cleavage of myocardial bridging of coronary artery. J Am Coll
Cardiol 1984; 3: 1345-8.
Kursaklioglu H, Barcin C, Iyisoy A, Kose S, Amasyali B, and Isik
E. Angiographic restenosis after myocardial bridge stenting: A
comparative study with direct stenting of de-novo atherosclerotic
lesions. Jpn Heart J 2004; 45: 581-9.
Haager PK, Schwarz ER, Vom Dahl S, Klues HG, Reffelmann
T, and Hanrath P. Longterm angiographic and clinical follow up
in patients with stent implantation for symptomatic myocardial
bridging. Heart 2008; 84: 403-8.
Kurtoglu N, Mutlu B, Soydinc S, Tanalp C, Izqi A, Dagdelen S,
Bakkai RB, and Dindar I. Normalization of coronary fractional
flow reserve with successful intracoronary stent placement to a
myocardial bridge. J Interven Cardiol 2004; 17: 33-6.
Klues HG, Schwarz ER, Vom Dahl J, Reffelmann T, Reul H,
Potthast K, Schmitz C, Minartz J, Krebs W, and Hanrath P.
Disturbed intracoronary hemodynamics in myocardial bridging.
Circulation 1997; 96: 2905-13.
Stables RH, Knight CJ, McNeill JG, and Sigwart V. Coronary
Stenting in the management of myocardial ischemia caused by
muscle bridging. Br Heart J 1995; 74(1): s90-2.
Li W, Li Y, Sheng L, Gong Y. Myocardial bridge: Is the risk of
perforation increased? Can J Cardiol 2008; 24: e80-1.
Published
2014-03-25
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How to Cite
Winata, J., Reppi, E., Budiono, B., & Lefrandt, R. (2014). Symptomatic Myocardial Bridging Treated by Coronary Stenting. Indonesian Journal of Cardiology, 34(3), 172-8. https://doi.org/10.30701/ijc.v34i3.345
Section
Case Reports
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