Anatomical risks and complications associated with myocardial bridging

Objective: Myocardial bridging (MB) is an asymptomatic, benign, and congenital coronary anomaly with several possible manifestations. MB is formed by a segment of a coronary artery taking an intra-myocardial course.  As of date, huge knowledge gap exists in the literature in terms of MB and its associated complications. Methods: This single-centre, observational, non-randomised study was conducted over a period of 20 months to identify the rare anomalies such as MB using coronary angiograms. Results: Eight of 400 cases screened have been found to have MB bridging in mid left anterior descending artery (LAD) segment. The male to female ratio was 7:1 all within an age range of 24 years to 45 years. Most of the patients were asymptomatic with no history of drug usage (6/8) and family history (3/8) of coronary disorders. In symptomatic cases, the most common presenting symptoms were observed to be typical chest pain, dyspnea, nausea, light-headedness, or headaches, diaphoresis, and tachycardia. In most of the patients, MB showed systolic shortening with resultant flow limitation on coronary angiography. The segments were reported to be 1 mm to 10 mm in size and traversed 1 cm to 3 cm length. All the patients were treated symptomatically and were kept on follow-up. No mortality was observed in any case with MB. Conclusion:  Even though MB is a benign condition, but its vast array of related complications was reported to be life threatening and require prompt diagnosis and treatment. This study focus on such MB related risks by highlighting the importance of differential diagnosis and the treatment followed by to avoid all possible complications in all those patients presenting with possible signs and symptoms.