“Surgery has already been established as superior to stenting, which carries a higher risk of perforation, stent fracture and thrombosis,” says Dr. Surgical management superior to stentsįor symptomatic patients or those with hypertrophy or aortic stenosis, surgical intervention is sometimes recommended. The patient underwent septal myectomy and unroofing of the mid LAD. Rubidium-82 stress myocardial perfusion scan showing apical ischemia in a patient with hypertrophic cardiomyopathy. “If I see a partial encasement or superficial bridge, I usually err on the side of not commenting to discourage inappropriate downstream testing.”
![lad guideliner lad guideliner](https://live.staticflickr.com/3885/14628170576_1a3f602596_b.jpg)
“Myocardial bridges are quite common on coronary CTA,” says Paul Cremer, MD, a cardiologist in the Section of Cardiovascular Imaging. Many of those incidental findings arise from coronary CT angiography (CTA) testing, which allows for a more sophisticated view of the cardiac anatomy. For those who do present with symptoms, we should perform both anatomic and functional testing to determine whether they are a fit for surgery.” Symptoms can include angina, ischemia, arrhythmia, acute coronary syndrome, myocardial infarction and sudden cardiac death. “A good number of people are born with this condition,” notes Hani Najm, MD, Chair of Pediatric and Congenital Heart Surgery, “and yet many of them never present with symptoms, and we only find out incidentally or after death. The reported prevalence of myocardial bridging ranges from 1.5% to 26%, with higher numbers reported in autopsy findings versus invasive coronary angiography studies.
#LAD GUIDELINER HOW TO#
“Our understanding of this condition has certainly evolved from the days of assuming most cases to be benign, but now that we have more accurate tests and treatments, we need larger-scale data to guide clinicians on when and how to treat.” Anatomic and functional testing
![lad guideliner lad guideliner](https://www.safemaster.net.au/wp-content/uploads/2021/01/Safemaster-3M%E2%84%A2-DBI-SALA%C2%AE-Lad-Saf-Systems-Climb-Extension-2-User-Galvanised-Steel-6116636-768x768.jpg)
“We hope our findings will get us closer to an established algorithm and guidelines for myocardial bridging,” says Joanna Ghobrial, MD, MSc, Interventional Director of Cleveland Clinic’s Adult Congenital Heart Disease Center.
![lad guideliner lad guideliner](https://files.eurointervention.com/issues/86th_issue/60/epub/OEBPS/images/10_Chan_fmt.jpeg)
We do not endorse non-Cleveland Clinic products or services Policy Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center.