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      Challenges in Evaluation and Management of Children with Myocardial Bridging

      review-article
      *
      Cardiology
      S. Karger AG
      Angiography, Children, Congenital heart disease, Coronary arteries

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          Abstract

          Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered “benign,” it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.

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          Most cited references77

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          Update on myocardial bridging.

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            Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress.

            Atherosclerotic lesions are predominantly observed in curved arteries and near side branches, where low or oscillatory shear stress patterns occur, suggesting a causal connection. However, the effect of shear stress on plaque vulnerability is unknown because the lack of an appropriate in vivo model precludes cause-effect studies. We developed a perivascular shear stress modifier that induces regions of lowered, increased, and lowered/oscillatory (ie, with vortices) shear stresses in mouse carotid arteries and studied plaque formation and composition. Atherosclerotic lesions developed invariably in the regions with lowered shear stress or vortices, whereas the regions of increased shear stress were protected. Lowered shear stress lesions were larger (intima/media, 1.38+/-0.68 versus 0.22+/-0.04); contained fewer smooth muscle cells (1.9+/-1.6% versus 26.3+/-9.7%), less collagen (15.3+/-1.0% versus 22.2+/-1.0%), and more lipids (15.8+/-0.9% versus 10.2+/-0.5%); and showed more outward vascular remodeling (214+/-19% versus 117+/-9%) than did oscillatory shear stress lesions. Expression of proatherogenic inflammatory mediators and matrix metalloproteinase activity was higher in the lowered shear stress regions. Spontaneous and angiotensin II-induced intraplaque hemorrhages occurred in the lowered shear stress regions only. Lowered shear stress and oscillatory shear stress are both essential conditions in plaque formation. Lowered shear stress induces larger lesions with a vulnerable plaque phenotype, whereas vortices with oscillatory shear stress induce stable lesions.
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              Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies.

              Patients with myocardial bridging are often asymptomatic, but this anomaly may be associated with exertional angina, acute coronary syndromes, cardiac arrhythmias, syncope, or even sudden cardiac death. This review presents our understanding of the pathophysiology of myocardial bridging and describes prevailing diagnostic modalities and therapeutic options for this challenging clinical entity.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2021
                May 2021
                25 February 2021
                : 146
                : 3
                : 273-280
                Affiliations
                Pediatric Clinics, Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital, Health Sciences University, Uskudar/Istanbul, Turkey
                Author notes
                *Nurdan Erol, Pediatric Clinics, Zeynep Kamil Gynecology and Pediatrics Training and Research Hospital, Health Sciences University, Dr. Burhanettin Ustunel Sokagi No. 10, Uskudar/Istanbul 34668 (Turkey), nurdaneroltr61@gmail.com
                Author information
                https://orcid.org/0000-0002-9650-2077
                Article
                513900 Cardiology 2021;146:273–280
                10.1159/000513900
                33631747
                9d1f7e1b-71c2-4712-82b2-841d00f9b38a
                © 2021 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 30 May 2020
                : 10 December 2020
                Page count
                Pages: 8
                Categories
                CAD and AMI: Review Article

                General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
                Coronary arteries,Congenital heart disease,Children,Angiography

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