Author: Attaran Saina Moscarelli Marco Athanasiou Thanos Anderson Jon
Publisher: Oxford University Press
ISSN: 1569-9293
Source: Interactive CardioVascular and Thoracic Surgery, Vol.16, Iss.3, 2013-03, pp. : 347-349
Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was Is CABG an effective alternative for the treatment of myocardial bridging? Altogether, only six papers were identified using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated; these studies reported the outcome of myotomy and coronary artery bypass grafting (CABG) for myocardial bridging. All of these studies were retrospective reports of the results of surgical intervention in patients with myocardial bridging. They showed that the incidence of myocardial bridging was less than 11.5 in patients with angina requiring angiography, and 79 of these patients had refractory angina despite medical treatment and required surgery. The evidence on the treatment of this congenital condition that mainly affects the middle segment of left anterior descending artery is limited, and there are no treatment guidelines currently available. Stenting of the tunnelled segment has shown high failure rates in approximately half of the cases. Current evidence in the literature suggests that surgery is the mainstay treatment for myocardial bridging. Surgery is performed either as supra-arterial myotomy and de-roofing of the muscle bands on- or off-pump, or as coronary artery bypass grafting of the affected coronary artery beyond the tunnelled segment. Although no mortality was reported with either of these operations, surgical myotomy on deep and extensive myocardial bridges carries the risk of entering the right ventricle, bleeding and aneurysm formation. In addition, in a small percentage of the patients undergoing myotomy, angina recurred. Despite the possibility of competitive flow in the native coronary artery after CABG for myocardial bridging, we did not identify any evidence demonstrating graft occlusion after CABG for myocardial bridging. In conclusion, in extensive and deep myocardial bridgings, CABG may be the treatment of choice that carries low risk, limited complications and excellent symptomatic relief.
Related content
By Larstorp Anne Cecilie K. Lund Søraas Camilla Tønnessen Theis Müller Carl Kjeldsen Sverre E. Mangschau Arild
Scandinavian Cardiovascular Journal, Vol. 40, Iss. 6, 2006-12 ,pp. :