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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