Surgical Considerations for Extended Myocardial Bridging
Lucian Lozonschi, Paul C. Tang, Takushi Kohmoto.
University of Wisconsin School of Medicine, Madison, WI, USA.
OBJECTIVE: Myocardial bridging can present with symptoms of myocardial ischemia, syncope or even sudden death. In a review on this topic by Corban et al (J Am Coll Cardiol. 2014 Jun 10;63(22):2346-55) it is suggested that CABG with saphenous vein is preferable to LIMA based on one single published retrospective study from Russia.
METHODS: The patient described below was referred for surgical revascularization with saphenous vein graft.
RESULTS: A 43 year old female with primary hyperparathyroidism and Raynauds’ syndrome presented with few months history of severe exertional angina and one syncopal episode. She was diagnosed with a long (>2.5cm) and deep (>5mm) of myocardial bridge in the LAD with an FFR of 0.7. She underwent robotic assisted LIMA takedown and off pump CABGx1 with LIMA-LAD through an inframammary left minithoracotomy. The flow in the lima graft had a mean of 13 ml/min a PI of 2.9 and DF of 77%. Patient had complete resolution of her symptoms postop and was discharged home in three days.
CONCLUSIONS: While rare, clinically symptomatic myocardial bridge can present a treatment dilemma. Published data come from series with very small number of patients. An international database with prospective enrolment and follow up is needed.
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