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Myocardial bridge of coronary artery — Clinical Guidelines

Overview

Myocardial bridge (MB) is a congenital anomaly characterized by myocardial tissue partially or completely covering a segment of a coronary artery, potentially causing dynamic compression during systole. While often considered benign, symptomatic cases may require intervention 1 3.

Diagnosis

Clinical Presentation: Syncope, chest pain, elevated cardiac enzymes, ST-T changes on ECG 1.

Imaging Techniques: Coronary angiography identifies systolic narrowing of the coronary artery 9.

Non-invasive Imaging: Coronary computed tomography angiography (CCTA) with transluminal attenuation gradient (TAG) can predict significant dynamic compression 6.

Prevalence Studies: High variability in prevalence rates; reported up to 96% in some populations 2 5.

Management

Medical Therapy: Beta-blockers may resolve wall motion abnormalities and perfusion defects 10.

Surgical Intervention: Unroofing via minimally invasive techniques (minithoracotomy or sternotomy) for symptomatic, hemodynamically significant cases 3.

Adjunctive Treatments: Intracoronary stenting may be considered in refractory cases, though associated with risks like restenosis 11.

Special Populations

Pediatrics: Symptomatic MB in children may present with syncope and require surgical intervention 1.

Elderly: No specific considerations noted in the provided abstracts.

Comorbidities: No specific guidance provided for comorbidities; management tailored to symptom severity 9.

Key Recommendations

Symptomatic Patients: Consider surgical unroofing for symptomatic, hemodynamically significant myocardial bridges (Evidence: Moderate 3).

Initial Management: Initiate medical therapy with beta-blockers for symptomatic patients with MB-related abnormalities (Evidence: Weak 10).

Diagnostic Imaging: Utilize coronary angiography for definitive diagnosis and CCTA with TAG for predicting significant dynamic compression (Evidence: Moderate 6).

Prevalence Awareness: Recognize high variability in MB prevalence across populations, influencing clinical suspicion (Evidence: Expert opinion 2 5).

References

1 Wang F, Zhang W, Zhang J, Wei X, Li Q, Fan T et al.. Surgical unroofing of long and deep myocardial bridges in children: A 2-case report. Medicine 2026. link 2 Rojas-Granados A, Pérez-Campos E, Sanchez-Sanchez M, Chávez MAM, Pérez-Campos-Mayoral L, Ángeles-Castellanos M. Prevalence of myocardial bridges in the Mexican population: A morphometric and histological analysis. Morphologie : bulletin de l'Association des anatomistes 2024. link 3 Wang H, Pargaonkar VS, Hironaka CE, Bajaj SS, Abbot CJ, O'Donnell CT et al.. Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing. The Annals of thoracic surgery 2021. link 4 Enhos A, Cosansu K, Huyut MA, Turna F, Karacop E, Bakshaliyev N et al.. Assessment of the Relationship between Monocyte to High-Density Lipoprotein Ratio and Myocardial Bridge. Arquivos brasileiros de cardiologia 2019. link 5 Teofilovski-Parapid G, Jankovic R, Kanjuh V, Virmani R, Danchin N, Prates N et al.. Myocardial bridges, neither rare nor isolated-Autopsy study. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft 2017. link 6 Li Y, Yu M, Zhang J, Li M, Lu Z, Wei M. Non-invasive imaging of myocardial bridge by coronary computed tomography angiography: the value of transluminal attenuation gradient to predict significant dynamic compression. European radiology 2017. link 7 Ercakmak B, Bulut E, Hayran M, Kaymaz F, Bilgin S, Hazirolan T et al.. Comparison of radiological and morphologic assessments of myocardial bridges. Anatomical science international 2015. link 8 Cai W, Dong Y, Zhou X, Chen SB, Zhao JH, Jiang TM et al.. Left ventricular systolic dyssynchrony in patients with isolated symptomatic myocardial bridge. Scandinavian cardiovascular journal. Supplement 2013. link 9 Ciçek D, Kalay N, Müderrisoğlu H. Incidence, clinical characteristics, and 4-year follow-up of patients with isolated myocardial bridge: a retrospective, single-center, epidemiologic, coronary arteriographic follow-up study in southern Turkey. Cardiovascular revascularization medicine : including molecular interventions 2011. link 10 Hurst RT, Askew JW, Lee R. Resolution of myocardial bridge-related wall motion abnormality and associated myocardial perfusion defect with beta-blocker therapy. The Journal of invasive cardiology 2005. link 11 Gomberg-Maitland M, Kim MC, Fuster V. A stratified approach to the treatment of a symptomatic myocardial bridge. Clinical cardiology 2002. link 12 Carvalho VB, Macruz R, Décourt LV, Arie S, Manrique R, Mello SC et al.. Hemodynamic determinants of coronary constriction in human myocardial bridges. American heart journal 1984. link90547-7)

Myocardial bridge of coronary artery