A CADAVERIC STUDY OF THE MYOCARDIAL BRIDGES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 2
Abstract
BACKGROUND Myocardial bridging is a congenital anomaly, where a segment of an epicardial coronary artery is undercover of myocardial fibres for a variable distance and the underlying arterial segment is described as a mural coronary artery or a tunnelled artery. The history of myocardial bridges dates back to 1737 when it was first recognized by Reyman and then by Black in 1805. The first detailed post mortem examination of myocardial bridges was done by Geiringer in 1951 and the first radiological description was given by Portmann and Iwig in 1960. The bridged segment of the coronary artery is susceptible to various pathophysiological mechanisms leading to myocardial ischemia, especially when associated with other cardiovascular diseases. The myocardial bridges were initially thought to be innocent bystanders in the development of acute coronary syndromes. But in the last two decades, the outlook has changed with the increasing incidence of sudden cardiac deaths in young athletes, where myocardial bridges were the only finding at autopsy. The mechanism by which the myocardial bridges induce clinical symptoms is uncertain, but among the proposed are vasospasm, thrombus formation, endothelial dysfunction and impaired coronary flow reserve. Most important of these is the dynamic systolic compression of the tunnelled artery with sustained early diastolic diameter reduction. The aim of this study is to provide more information on the incidence of myocardial bridges, arterial preponderance for myocardial bridging, the length of the bridged segment and multiple bridging. MATERIALS AND METHODS A descriptive study of fifty formalin fixed hearts from the department of anatomy were dissected by conventional dissection methods as guided by Cunningham. RESULTS Myocardial bridges were found in 18 (36%) hearts with a total of about 28 bridges. Most common artery involved was the anterior inter ventricular artery (66.6%), which even had multiple bridges over it. The mean length of the bridges was 26.54 mm. CONCLUSION From the present study, we infer that the presence of myocardial bridges in an unsuspected population is relatively higher. The definitive role of these bridges in acute coronary syndromes is yet uncertain. But owing to its higher rate of detection in those with myocardial ischemia, it is better to screen for the bridges along with other aetiological factors and treat the patients prophylactically. Of the imaging modalities, CT Coronary Angiography is found to be the investigation of choice. In the near future, holistic studies involving cadaveric, radiologic and clinical data are mandatory in researching the myocardial bridges.
Authors and Affiliations
Suganya Saminathan, Vishnuvarthan Selvaraj
Keywords
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- EP ID EP553076
- DOI 10.14260/jemds/2019/29
- Views 97
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