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      Challenges in Evaluation and Management of Children with Myocardial Bridging



      S. Karger AG

      Angiography, Children, Congenital heart disease, Coronary arteries

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          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 references 77

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          Update on myocardial bridging.

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            Myocardial bridging.

            Myocardial bridging, a congenital coronary anomaly, is a clinical condition with several possible manifestations, and its clinical relevance is debated. This article reviews current knowledge about the anatomy, pathophysiology, clinical relevance, and treatment of myocardial bridging. Myocardial bridging is present when a segment of a major epicardial coronary artery, the 'tunnelled artery', runs intramurally through the myocardium. With each systole, the coronary artery is compressed. Myocardial bridging has been associated with angina, arrhythmia, depressed left ventricular function, myocardial stunning, early death after cardiac transplantation, and sudden death. Evidence indicates that the intima beneath the bridge is protected from atherosclerosis, and the proximal segment is more susceptible to development of atherosclerotic lesions because of haemodynamic disturbances. New techniques (e.g. intravascular ultrasonography and intracoronary Doppler studies) have revealed new characteristics and pathophysiologic processes such as diastolic flow abnormalities. Medical treatment generally includes beta-blockers. Nitrates should be avoided because symptoms may worsen. Intracoronary stents and surgery have been attempted in selected patients. Additional research is needed to define patients in whom myocardial bridging is potentially pathologic, and randomized multicentre long-term follow-up studies are needed to assess the natural history, patient selection, and therapeutic approaches.
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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.

                Author and article information

                S. Karger AG
                May 2021
                25 February 2021
                : 146
                : 3
                : 273-280
                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
                513900 Cardiology 2021;146:273–280
                © 2021 S. Karger AG, Basel

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                Page count
                Pages: 8
                CAD and AMI: Review Article


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