The current state of the problem of myocardial bridges

Abstract

Myocardial bridge (MB) a congenital developmental anomaly of the coronary arteries (CA), in which the epicardial segment of the vessel passes under the myocardium. With this anomaly, any CA can be affected, but most often it is located in the left anterior descending artery. Most MB is associated with an asymptomatic course, however, in the available scientific literature about the problem of MB, there are a lot of publications describing and proving the relationship between MB and symptoms of myocardial ischemia, including cases of acute coronary syndrome and sudden cardiac death. In this review the authors summarize and present modern data of the frequency, pathophysiological mechanisms, anatomical, functional and clinical evaluation, as well as treatment of MB. Medical treatment is usually an effective therapy in patients with symptomatic MB. If it is ineffective, a comprehensive anatomical and functional assessment of the MM should be carried out to select the safest and most effective revascularization technique. Percutaneous coronary intervention with new generation stent, coronary artery bypass grafting and myotomy are currently being considered as a treatment strategy for MB. The lack of generally accepted recommendations obviously makes it necessary to conduct further research in the field of the problem under consideration in order to develop and validate unified algorithms for the diagnosis and treatment of patients with MB.