title: Results of coronary artery bypass grafting in myocardial bridging of left anterior descending artery.
abstract: BACKGROUND
  We aimed to evaluate the graft patency rate following coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD) with proximal myocardial bridging (MB). While MB is generally a benign coronary abnormality, ischemia, stunning, and sudden death have been reported. In symptomatic patients with proximal LAD systolic compression of >50%, positive for ischemic noninvasive testing and noneffective optimal medical therapy, coronary intervention could be indicated. Few studies of CABG in myocardial bridging have been reported. The influence of high flow in coronaries with MB on graft patency is cause for concern.
  
  
  METHODS
  We retrospectively studied 39 patients operated on for isolated MB of proximal LAD with >50% systolic compression. All patients were severely symptomatic despite optimal medical therapy and positive noninvasive tests for myocardial ischemia. CABG was performed through the midsternotomy with cardiopulmonary bypass and cardioplegia. Patients were divided into two groups: in 20 patients, LAD was bypassed with left internal mammary artery (LIMA) (Group 1) and in 19 patients with saphenous vein graft (SVG) (Group 2). All patients underwent follow-up coronary angiography.
  
  
  RESULTS
  Demographics and degree of systolic compression of the LAD were similar in both groups. There was no mortality or major morbidity. Freedom from angina was 68% in Group 1 and 94% in Group 2 at 18 months postoperatively (p = 0.58). Twelve LIMA grafts and three SVGs were found occluded (p = 0.002).
  
  
  CONCLUSIONS
  LIMA patency in myocardial bridging of the LAD can be low. SVGs should be considered in cases of CABG for myocardial bridging.
authors.affiliation: Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Leo A
authors.initials: LA
authors.lastname: Bockeria
authors.forename: Sergey G
authors.initials: SG
authors.lastname: Sukhanov
authors.forename: Ekaterina N
authors.initials: EN
authors.lastname: Orekhova
authors.forename: Mesrop P
authors.initials: MP
authors.lastname: Shatakhyan
authors.forename: Dmitry A
authors.initials: DA
authors.lastname: Korotayev
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000000981:diagnostic imaging / Q000601:surgery*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012008:Recurrence; D012189:Retrospective Studies; D014680:Veins / Q000637:transplantation