ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Myocardial Bridging Over Left Anterior Descending Coronary Artery Surgical Therapy and Results
Atıf AKÇEVİN, Halil TÜRKOĞLU, Vedat BAYER, Cihangir ERSOY, Aydın AYTAÇ, *Tufan PAKER, *Murat MERT
Vehbi Koç Vakfı Amerikan Hastanesi Kalp ve Damar Cerrahisi Departmanı,
*İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kalp ve Damar Cerrahisi Anabilim Dalı
Myocardial ischemia in the absence of obstructive coronary atherosclerosis can be caused by compression of a major coronary artery by contraction of an overbridging left ventricular muscle. Although the mechanism of pathology is obscure it was postulated that systolic over-narrowing of the LAD can produce a "time-lag" between mechanical diastole and diastolic blood flow during tachycardia. This increased time-lag could result in myocardial ischemia and functional deterrioration.

Between 1986 and 1991, 9 patients with symptomatic myocardial bridging have been operated. Myocardial ischemia established preoperatively by positive excersise ECG and thalium scanning. Angiographically systolic narrowing of the LAD was 75-90% in 8 patients and 60% in the other. During surgery muscular bridges were released by supraarterial myotomy with the aid of cardiopulmonary bypass in all. Their postoperative course was uneventful and they were asymptomatic for 20-35 month (mean 25.2 month) follow-up.

We suggest that if the patients in symptomatic despite adequate medical treatment and if the systolic narrowing of the LAD is more than 75% surgery is indicated. In addition to our experiences, we also reviewed the literature and discussed the origin, mechanisms and surgical indications of the pathology.

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