Abstract
Although myocardial bridging (MB) is a common coronary anomaly, its cardiovascular
consequences are still disputed. A positive link between sudden cardiac death (SCD)
and myocardial bridging has not yet been definitively proved, even though many case
reports and small scale studies support this association. For myocardial bridging
to be associated with sudden cardiac death it must exhibit certain specific characteristics
involving coronary or myocardial changes sufficient to explain a terminal cardiac
event. In this study we aimed to analyze the morphological changes (both myocardial
and coronary) associated with hemodynamically significant myocardial bridging and
the morphological differences between hemodynamically significant MB and MB considered
to be non-hemodynamically significant. Material and Method: We analyzed 53 cases of sudden cardiac death, of which 21 cases had hemodynamically
significant myocardial bridging, 14 had non-hemodynamically significant myocardial
bridging and 20 cases suffered sudden cardiac death without myocardial bridging, using
a morphological score with seven histological parameters. Results: Myocardial fibrosis and interstitial edema were found to be highly correlated with
hemodynamically significant myocardial bridging (HSMB), as were interstitial edema
and interstitial fibrosis. Conclusions: Hemodynamically significant myocardial bridging can be discovered during heart dissection
by analyzing a series of morphological markers (width, distribution of atherosclerosis,
distal hypoplasia). Our study showed that MB was associated with increased myocardial
fibrosis and edema, both of which have an increased risk of electrical instability.
Compared to non-hemodynamically significant myocardial bridging, HSMB shows a distinct
histological pattern, with increased myocardial fibrosis and edema. The main cause
of SCD in association with HSMB seems to be electrical due to increased electrical
myocardial heterogeneity, but large scale studies are needed to test this.
Key words
myocardial bridging - atherosclerosis - cardiac anatomy/pathological anatomy - congenital
heart disease - CHD - interstitial fibrosis - interstitial edema
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Sorin Hostiuc
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