Myocardial bridge. Surgical outcome and midterm follow up

OBJECTIVE: To investigate the results of surgery and long-term follow up in 26 patients who were symptomatic due to myocardial bridge.

METHODS: From 1999-2004 more than 18800 coronary angiography were performed in the Shahid Madani Heart Hospital, Tabriz, Iran. Of these, 290 (1.5%) cases had angiographic diagnosis of myocardial bridge. Out of the 290 cases, 26 (9%) patients underwent surgical myotomy for treatment of myocardial bridge causing significant systolic arterial compression. Patients were examined with radio nucleotide study preceding angiography that was positive for ischemia and we found 20 cases (76%). Coronary angiography and left heart catheterization in all patients revealed impaired blood flow due to myocardial bridge in left anterior descending artery and there was an additional atherosclerotic stenosis of coronary arteries in 6 and mitral valve disease in one patient. Supra arterial myotomy was performed in all patients.

RESULTS: We observed no mortality or major intraoperative complication. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery except in one patient who had recurrent anginal chest pain after operation and coronary angiography showed residual narrowing in the left anterior descending despite myotomy and underwent coronary artery bypass graft of left internal mammary artery (LIMA) to distal left anterior descending. During 7-81 months of follow-up (mean 34.2 +/= 21), only 2 patients had symptoms of angina that was not shown significant residual compression and symptoms were controlled by medical treatment.

CONCLUSION: The surgical relief of myocardial ischemia due to myocardial bridge can be accomplished with low operative risk and excellent mid term result.