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Myocardial Bridge: Diagnosis, Treatment, and Challenges

      A MYOCARDIAL bridge (MB) occurs when a segment of a coronary artery tunnels through the myocardium instead of its correct epicardial anatomic position. This results in the compression of the artery during systole that extends into diastole, limiting coronary blood flow and filling.
      • Giuseppe T
      • Federico M
      • Filippo C
      • et al.
      Left anterior descending artery myocardial bridging.
      Coronary compression can cause symptoms that are indistinguishable from that of acute coronary syndromes or refractory/chronic angina. The treatment of chest pain caused by an MB that is refractory to medical therapy typically is surgically treated. Numerous studies of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and myotomy have demonstrated excellent results after correction of an MB.
      • Iversen S
      • Hake U
      • Mayer E
      • et al.
      Surgical treatment of myocardial bridging causing coronary artery obstruction.
      • Rezayat P
      • Hassan D
      • Amirreza S
      • et al.
      Myocardial bridge. Surgical outcome and midterm follow up.
      • Wan L
      • Wu Q.
      Myocardial bridge, surgery or stenting?.
      • Wu QY
      • Xu ZH.
      Surgical treatment of myocardial bridging: Report of 31 cases.
      • Huang X
      • Wang S
      • Xu J-P
      • et al.
      Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging.
      • Sun X
      • Chen H
      • Xia L
      • et al.
      Coronary artery bypass grafting for myocardial bridges of the left anterior descending artery.
      • Bockeria LA
      • Sukhanov SG
      • Orekhova EN
      • et al.
      Results of coronary artery bypass grafting in myocardial bridging of left anterior descending artery.
      • Boyd JH
      • Pargaonkar VS
      • Scoville DH
      • et al.
      Surgical unroofing of hemodynamically significant left anterior descending myocardial bridges.
      In contrast, the authors present a case of a patient with severe persistent postoperative chest pain despite multimodal analgesia, including intrathecal morphine, after a robotic totally endoscopic off-pump MB myotomy.

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