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Symptomatic myocardial bridging: a frequently occurring coronary variation can cause severe myocardial ischaemia in affected children with underlying cardiac conditions

Published online by Cambridge University Press:  16 May 2018

Alexandra Kiess ,
Marcel Vollroth ,
Farhad Bakhtiary ,
Hiroshi Seki ,
Martin Kostelka ,
Milan Djukic ,
Ingo Daehnert  and
Robert Wagner
Alexandra Kiess
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Heart Center, University of Leipzig, Leipzig, Germany
Marcel Vollroth
Affiliation:
Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Farhad Bakhtiary
Affiliation:
Department of Cardiac Surgery, HELIOS Clinic Siegburg, Siegburg, Germany
Hiroshi Seki
Affiliation:
Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, Japan
Martin Kostelka
Affiliation:
Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Milan Djukic
Affiliation:
Department of Pediatric Cardiology, University Children’s Hospital, Tiršova, Belgrade, Serbia
Ingo Daehnert
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Heart Center, University of Leipzig, Leipzig, Germany
Robert Wagner*
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Heart Center, University of Leipzig, Leipzig, Germany
*
Author for correspondence: R. Wagner, MD, PhD, Senior Physician for Pediatric Cardiology and Pediatric Intensive care, Department of Pediatric Cardiology and Congenital Heart Disease, Heart Center, University of Leipzig, Struempellstraße 39, D-04289 Leipzig, Germany. Tel: +49 341 86525 3009; Fax: +49 341 865 1143; E-mail: robert.wagner@medizin.uni-leipzig.de
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Abstract

Myocardial bridging is a congenital coronary artery anomaly in which the coronary artery has a partly “tunnelled” intramyocardial course. This tunnelling leads to compression of the affected vessel segment during ventricular systole. It is considered to be a benign variation of the norm in about 25% of the population caused by an aberrancy of embryologic coronary development. The bridging is also thought to cause severe cardiac conditions in a few of those affected. The series of six young patients presented here is the largest series so far to report on symptomatic myocardial bridging in children with different underlying heart diseases. All patients recently presented to our centre with signs of myocardial ischaemia. They subsequently underwent coronary angiography, which revealed myocardial bridging of the ramus interventricularis anterior. In all patients, therapy with β blockers was started to reduce heart rate and myocardial contractility. β Blocker treatment was also given in order to prolong diastole and improve coronary artery blood flow. Two patients underwent surgical exposure of the involved coronary segment: a 2-year-old boy because of recurrent, severe myocardial ischaemia in combination with a reduction of general health, changes in ST-segments, and the presence of a dilative cardiomyopathy; and a 13-year-old girl because of evidence of myocardial ischaemia during exercise testing after surviving sudden cardiac death. Surgery was successful and recovery was complete and uneventful. The presented series shows that myocardial bridging can be symptomatic and may require urgent treatment and even surgical intervention in early childhood in rare cases.

Keywords

Myocardial bridgingtunnelled coronary arterymyocardial ischaemiapaediatric cardiac surgery
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 6 , June 2018 , pp. 826 - 831
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Copyright
© Cambridge University Press 2018 

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