[Myocardial bridging. The role of microcirculation, coronary reserve and systolic endothelial injury].
BACKGROUND
The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. However, a recent new evidence suggests that this relation is not by chance.


OBJECTIVE
The purpose of our study was to review in a critical manner, the evidence for the relationship between MB and myocardial ischemia and its possible consequences.


METHODS
We present 2 cases of our series and review the medical literature from January 1966 to January 1998 published and included in Medline and Current Contents.


CONCLUSIONS
The principal findings after this review were: 1) MB is not a normal variant; 2) The clinical impact of MB depends on its anatomical extension and degree of compressive effect; 3) The MB muscle is not similar to myocytes from other cardiac areas; 4) The environment surrounding coronary artery may be a crucial factor in determining whether the MB influences the induction of heart disorders or not; 5) The overshoot due to compressive effect on coronary artery might determine endothelial injury in the microcirculation post-MB; 6) In some cases, the systolic endothelial injury may contribute to release factors that are able to reduce the coronary reserve, resulting in myocardial ischemia; 7) The possible role of PTCA in this disorder still has to be proven. Surgical treatment should be considered when important myocardial ischemia had been demonstrated, even in those asymptomatic cases.
Rosas Peralta
M
M
Departamento de Cardiología Clínica/Hemodinámica, Instituto Nacional de Cardiología Ignacio Chávez.
Kuri Alfaro
J
J
Gómez
A
A
Trevethan Cravioto
S
S
Chávez Negrete
A
A
Cossio Aranda
J
J
Martínez Reding
J
J
González Romero
S
S
Martínez Rios
M A
MA
D000328:Adult; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008833:Microcirculation; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery
Puentes miocárdicos. Papel de la microcirculación, reserva coronaria y daño endotelial sistólico.