Circulation, Vol 89, 1725-1732, Copyright © 1994 by American Heart Association
J Ge, R Erbel, HJ Rupprecht, L Koch, P Kearney, G Gorge, M Haude and J Meyer
BACKGROUND: In autopsy, myocardial bridging is a common finding. With
coronary angiography, a systolic compression, mainly of the left anterior
descending coronary artery, is observed in 1% to 3% of the patients.
Controversy exists concerning the functional importance of this finding. To
obtain a functional insight into the myocardial bridging, intravascular
ultrasound and intracoronary Doppler were performed. METHODS AND RESULTS:
Intracoronary ultrasound and Doppler were performed in 14 patients with
angiographic evidence of systolic vessel compression ("milking effect") in
the left anterior descending coronary artery. The 4.8F, 20-MHz ultrasound
catheter could not be advanced through the entire myocardial bridge segment
in 6 of the 14 patients studied because the lumen was < 1.6 mm. In these
patients, only the proximal parts of the bridge segment were scanned. The
changes in cross-sectional shape during the cardiac cycle were determined
for both the normal proximal segment and the bridge segment by use of a
semiautomatic computer program. Intracoronary Doppler (20 MHz) was
performed in 7 patients with a 3F catheter. A highly characteristic
systolic eccentric or concentric compression with delayed relaxation in
diastole of the myocardial bridging segment was clearly visualized in all
patients. The cross-sectional lumen area variation was 40 +/- 25% in the
bridging segments and 9 +/- 7% in the normal segments (P < .01). No
atherosclerotic lesions were detected in the bridge or the distal segment
in the 8 patients in whom the IVUS catheter was successfully advanced
through the entire myocardial bridge. However, atherosclerotic plaques were
found in the segments proximal to the bridge in 12 of 14 patients (86%).
The resting mean flow velocity was 6.4 +/- 1.2 cm/s; the maximal mean flow
velocity after intracoronary administration of 10 mg papaverine was 14.1
+/- 3.4 cm/s. The coronary flow velocity reserve was 2.2 +/- 0.7. A highly
characteristic pattern showing a prominent peak in coronary velocity in
early diastole was observed in 86% of patients, and this pattern was
enhanced after injection of intracoronary papaverine. CONCLUSION:
Intravascular ultrasound demonstrated a characteristic systolic compression
of the bridge segments. The delayed compression release may explain the
characteristic sharp early diastolic peak in coronary flow velocity found
with intracoronary Doppler in vessels with myocardial bridging. Reduced
coronary flow reserve may be related to this phenomenon, possibly
explaining signs of ischemia detected in some of the patients, but may
alternatively be a result of the presence of atherosclerosis in the segment
proximal to the bridge in these patients.
ARTICLES
Comparison of intravascular ultrasound and angiography in the assessment of myocardial bridging
Department of Cardiology, University of Essen, Germany.
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